颈髓脱髓鞘病变与髓内胶质瘤的鉴别诊断

Differential diagnosis of cervical spinal cord demyelinating diseases and cervical intramedullary gliomas

目的对颈髓炎性脱髓鞘病变和髓内胶质瘤的影像学特征进行分析,以提高对二者的鉴别诊断能力。方法与结果对22例颈髓炎性脱髓鞘病变、16例颈髓髓内胶质瘤患者的临床资料和MRI表现进行回顾分析。结果显示,两组患者临床均表现为感觉异常[77.27%(17/22)和12/16]、肢体无力[72.73%(16/22)和10/16]和自主神经功能紊乱[45.45%(10/22)和4/16]。颈髓MRI检查病灶≥3个椎体节段者分别占63.64%(14/22)和15/16,病灶平均长度为(3.41±1.74)和(3.59±1.28)个椎体节段;呈长T1[68.18%(15/22)和7/16]、等T1[31.82%(7/22)和6/16]或长T2信号[100.00%(22/22)和8/15],胶质瘤组尚可见混杂T1和混杂T2信号(3/16和6/15);脱髓鞘病变组患者病灶边界模糊常见[90.91%(20/22)],并以条片状和点状强化为主(13/16),而胶质瘤组则以局限性脊髓增粗(15/16)、脊膜增厚(14/16)更常见,呈块状或环形强化(12/16),且可见中央管周围脊髓组织受累(14/15),易发生颈髓囊性变或中央管扩张、出血坏死和"帽征"(7/16、5/16和4/16)。结论虽然任何单一临床和MRI特征均不足以鉴别颈髓炎性脱髓鞘病变和髓内胶质瘤,但不同特征综合分析有助于提高鉴别诊断水平。

Objective To analyze the imaging characteristics of cervical spinal cord demyelinating diseases and cervical intramedullary gliomas, so as to improve the differential diagnosis between them. Methods A retrospective analysis was conducted using clinical and MRI data from 22 cases of cervical spinal cord demyelinating diseases and 16 cases of cervical intramedullary gliomas. Results Clinical features in both groups included paresthesia [77.27% （17/22）, 12/16], weakness of limbs [72.73% （16/22）, 10/16], and dysfunction of autonomic nerve [45.45% （10/22）, 4/16]. In cervical MRI, the lesions involving more than 3 vertebras were 63.64% （14/22） in demyelinating group and 15/16 in glioma group, and the average lengths of lesions were （3.41 ± 1.74） and （3.59 ± 1.28） vertebras in 2 groups. The lesions showed long T1 signal [68.18% （15/22）, 7/16], equisignal T1 [31.82% （7/22）, 6/16] and long T2 signal [100% （22/22）, 8/15] in 2 groups. Mixed T1 and T2 signals （3/16, 6/15） could be seen in glioma group. Demyelinating lesions had unclear boundary [90.91% （20/22）] with patchy and ribbon-like enhancement （13/16）. Limited enlargement of spinal cord （15/16） and thickening spinal meninges （14/16） were more common in glioma group, usually with block and circular enhancement （12/16）. Spinal cord involvement around central canal could be seen （14/15）, and the cysts or central canal enlargement, hemorrhage and ＂cap sign＂ were showed frequently （7/16, 5/16 and 4/16）. Conclusions Although none of one single clinical or MRI feature was sufficient enough to identify cervical spinal demyelinating diseases from cervical glioma, the comprehensive analysis of multiple features could help to make differential diagnosis of these diseases.