脊髓亚急性联合变性的临床和MRI影像学分析

Clinical and MRI features of subacute combined degeneration of the spinal cord

目的探讨脊髓亚急性联合变性(SCD)的临床和MRI影像学特点。方法回顾性分析12例SCD患者的MRI影像图像及临床诊治资料。结果 12例患者均因神经系统损害体征起病,血清维生素B12降低6例,升高2例,正常4例。1例MRI检查未见明显异常。11例患者MRI检查能直观地显示病灶,其中1例表现为脊髓萎缩,其余10例表现为颈胸段脊髓后、侧索的对称性T1WI等或稍低信号和T2WI高信号,其中1例合并颅内异常信号。患者经维生素B12治疗后,11例症状有明显改善,1例无明显改善。结论 MRI检查能准确显示病变部位,且病灶形态具有一定影像学特异性,对SCD的诊断有辅助作用。

Objective To investigate the clinical and MRI features of patients with subacute combined de-generation of the spinal cord （SCD）. Methods The MRI images and other clinical data of 12 patients with SCD were collected and retrospectively analyzed. All the patients had underwent MRI scan before clinical diagnosis and four of them accepted enhanced MRI scan and three of them undertook the follow-up MRI scan after Vitamin B12 treatment. Results The initial clinical features of 12 patients were damage in nervous system among whom there were 6 pa-tients with low serum vitamin B12 level, 4 patients with normal serum vitamin B12 level and 2 patients with high serum vitamin B12 level. In these 12 cases, there was 1 case with no MRI abnormality and 11 cases with obvious lesions, among which there was 1 case of amyelotrophy and the other ten cases were of lesions in dorsal columns or lateral col-umns of cervical or thoracic spinal cord showing symmetric hyperintensity on T2WI and isointensity or mild hypoin-tensity on T1WI. In these 10 cases, there was 1 case complicated with intracranial abnormal signals. After Vitamin Bl2 supplementation,significant improvement was observed in 11 patients and 1 case with no improvement in symptoms. Conclusion SCD has specific MRI characteristics and the extent of lesion could be clearly showed on MRI. MRI study is helpful for the diagnosis of SCD.