特发性急性横贯性脊髓炎的MRI征象及临床价值

MRI Manifestations of Idiopathic Acute Transverse Myelitis and Its Clinical Value

目的探讨特发性急性横贯性脊髓炎(IATM)的磁共振征象及其临床诊断标准。方法回顾性分析26例IATM患者的临床表现、实验室检查及磁共振表现。结果 22例病变脊髓轻度均匀增粗,4例脊髓形态未见异常。病灶在矢状面T1WI上表现为等信号10例,条状、斑片状低信号16例,T2WI稍高或高信号26例;横断面T2WI脊髓2/3以上面积呈均匀高信号21例,5例信号不均匀增高,且面积小于脊髓的2/3;增强扫描脊髓12例无强化,10例病变区条状、斑片状强化,4例病灶区见偏心性结节状轻中度均匀/不均匀强化。结论 IATM的MRI征象有一定的特征性,但在面对其MRI征象复杂且不典型时,结合临床并严格执行诊断标准尤其重要。

Objective To explore MRI features of idiopathic acute transverse myelitis and to discuss its clinical diagnostic criteria. Methods A total of 26 patients with idiopathic acute transverse myelitis were enrolled in this study. The clinical manifestations, laboratory findings and MRI features were retrospectively analyzed. Results In 22 cases the invalved spinal cord were slightly and homogeneously thickened, and in the remaining 4 cases the spinal cord showed normal appearance. The lesions were manifested as iso-intesity signal on T1WI in 10 patients, as strip or patchy hypo-intense signal on T1WI in 16 cases, and as hyper-intensity or slight hyper-intensity signal on sagittal TEWI in all 26 cases. On transverse T2WI the lesions showed homogeneous hyper-intensity signal in 21 cases, which involved more than two-thirds transverse area of the spinal cord, or the lesions showed heterogeneous signal in 5 cases, which involved less than two-thirds transverse area of the spinal cord. Contrast-enhanced MR scanning demonstrated that no enhancement was seen in 12 cases, strip or patchy enhancement was revealed in 10 cases, and eccentric nodular mild-moderate enhancement was displayed in 4 cases. Conclusion Idiopathic acute transverse myelitis has certain MRI features. Careful consideration of clinical symptoms and strictly observing the diagnostic criteria are very important to make a correct diagnosis when MRI findings are complex and atypical.