脊髓血管畸形的MRI与DSA对照研究

Spinal Cord Vascular Malformation:Study of MRI Compared with DSA

目的 对照分析脊髓血管畸形的MRI和DSA表现 ,评价其分类价值。方法 65例有不同程度的脊髓神经功能障碍患者 ,均行MRI及DSA检查 ,其中 13例行手术治疗。结果 MRI显示髓内病变 18例、累及髓内外病变 19例、髓外病变 2 8例 ;DSA检出髓内球型AVM 5例、幼稚型AVM 12例 ;髓外硬膜内AVF 2 4例 ,其中Ⅰ型 5例、Ⅱ型 12例、Ⅲ型 7例 ;硬膜AVF 8例 ;颅内硬脑膜AVF向颈段椎管内静脉引流 2例 ;14例无阳性发现 ,其中 13例手术后病理结果显示毛细血管扩张症 3例、微小动静脉畸形 6例、海绵状血管瘤 2例、混合型 2例。结论 MRI对隐匿型AVM的诊断优于DSA ,可明确病变的部位 ,有无合并出血 ;可初步鉴别诊断髓内、髓外AVM ;DSA是确定AVM的供血动脉、数目、瘘口部位、引流静脉的最佳方法 ,是AVM分型的黄金标准。MRI和DSA结合 。

Purpose To compare the finding of MRI with DSA in spinal AVMs and evaluate the differential value of them. Methods Sixty five patients with different neurological symptoms of spinal cord underwent MR imaging and DSA,13 of them underwent surgical treatment. Results MRI demonstrated 18 cases with intramedullary nidus,19 with intra and extramedullary nidus, 28 with extramedullary nidus. DSA indicated 5 patients with intramedullary glomus AVMs and 12 juvenile AVMs,24 intradural AVF (5 AVFⅠ,12 AVFⅡand 7 AVF Ⅲ),8 dural AVF and 2 intracranial dural AVF which were drained into cervical vertebrae canal venous. Fourteen patients were negative in DSA in which 13 patients were operated on and the pathology indicated 3 capillary telangiectasia,6 mini AVMs,2 cavernous angioma and 2 multiple AVMs. Conclusion MRI has more efficiency to diagnose the intramedullary nidus,especially to dedicate the occult AVM with or without hemorrhage,to determine the site of the nidus. DSA is more accurate to demonstrate the feeding arteries,nidu of AVF,draining veins,the extent and the types of spinal cord AVMs. MRI combined with DSA may determine the type of spinal AVMs and supply the imaging evidence for further treatment.