椎管内硬膜外海绵状血管瘤的MRI表现及鉴别诊断

MRI Findings and Differential Diagnosis of Spinal Epidural Cavernous Hemangioma

目的探讨椎管内硬膜外海绵状血管瘤的MRI表现及鉴别诊断价值。方法对6例椎管内硬膜外海绵状血管瘤患者均行MRI检查。行快速自旋回波序列矢状位T1加权像(T1WI)TE/TR 12/630,T2加权像(T2WI)TE/TR 100/3 000,横轴位(T2WI)TE/TR 100/2 800,5例行冠状位(T2WI)TE/TR 100/2 800。6例均行增强扫描,使用钆喷替酸葡甲胺0.1 mmol.kg-1经肘静脉注射,注完药后即行横轴位、冠状位和矢状位T1WI(参数同T1WI平扫)。并与硬膜外其他病变进行鉴别。结果 6例患者中,肿瘤位于胸段椎管硬膜外5例,颈胸段1例,均沿脊髓长轴生长。其中脊髓背侧2例,可见环绕脊髓生长,呈钳状;左后侧1例,右后侧3例,沿相邻椎间孔向外生长;梭形4例,长椭圆形2例,两端尖锐,呈鼠尾状或毛笔尖状。6例肿瘤信号强度在T1WI呈等高或稍高信号。T2WI呈均匀高信号5例,T2WI呈不均匀稍高信号1例。结论椎管内硬膜外海绵状血管瘤是较少见的良性病变,并有其特征性表现。MRI是目前最为可靠的术前检查手段,但最终确诊仍须结合临床及病理检查。

Objective To explore the MRI findings of spinal epidural cavernous hemangioma and the differential diagnosis value.Methods Six patients with spinal epidural cavernous hemangioma underwent MRI,including fast spin-echo sequence sagittal T1-weighted imaging（T1WI;TE/TR,12/630）,T2-weighted imaging（T2WI;TE/TR 100/3 000）,and horizontal axis T2WI（TE/TR,100/2 800）.Five patients underwent routine coronal T2WI MRI（TE/TR,100/2 800）.All MRI investigations were enhanced by cubital vein injection of gadolinium diethylenetriaminepentaacetic acid（0.1 mmol·kg-1）,and then axial,coronal and sagittal T1WI were obtained with the same parameters used in T1WI plain scan.Moreover,spinal epidural cavernous hemangioma was differentiated from other epidural lesions.Results Among the 6 patients,5 had thoracic spinal epidural cavernous hemangioma and 1 had cervicothoracic spinal epidural cavernous hemangioma.The location of lesions was distributed along the long axis of spinal cord.Clamp-like hemangioma in dorsal spinal cord（growth around the spinal cord） was found in 2 patients.One case of hemangioma was presented at left rear and 3 cases at right rear（growth along the adjacent intervertebral foramen）.Spindle hemangioma was found in 4 patients and 2 cases of hemangioma was oblong oval with rat-tailed or writing brush tip-like tips at both ends.Tumors showed fairly high or slightly higher signal intensity on T1WI in 6 cases,uniform high signal intensity on T2WI in 5 cases,and unevenly slightly higher signal intensity on T2WI in 1 case.Conclusion Spinal epidural cavernous hemangioma is a rare benign lesion without characteristic manifestations.MRI is the most reliable preoperative examination technique.However,the final diagnosis of spinal epidural cavernous hemangioma still need be combined with clinical and pathological examinations.