非创伤性脊髓硬膜外血肿的MRI诊断及鉴别诊断

The Diagnosis and Differential Diagnosis of Nontraumatic Spinal Epidural Hematoma on MRI

目的分析非创伤性硬膜外血肿的MR影像学表现及其鉴别诊断。方法 10例非创伤性硬膜外血肿患者行常规MR平扫,其中7例行MR增强扫描,9例经手术病理证实,1例经MR复查证实。结果血肿发生于颈段4例,颈胸段3例,胸段3例;血肿位于脊髓背侧8例,腹侧1例,腹侧背侧均有血肿1例,血肿形状7例呈梭形,2例呈环状、条形,1例为长圆形;术后证实血管出血2例,血管瘤2例,血管畸形1例,急性期血肿T1WI稍高信号,T2WI稍低信号,亚急性期血肿T1WI呈等或高信号,T2WI呈低或高信号,慢性期血肿呈等信号。强化方式因出血原因、时间而有所不同。结论 MR是诊断非创伤性硬膜外血肿最有价值的手段,可准确显示病变范围,正确判读血肿时期,并对分析出血原因可提供一定的帮助。

Objective To analyze the MR manifestations and differential diagnosis of nontraumatic spinal epidural hematoma. Methods 10 patients with nontraumatic spinal epidural hematoma were performed MR plan scan, 7 of which enhanced. 9 cases were proved by surgery and pathology and 1 case were proved by follow up. Results Hematoma occurred in cervical level in 4 cases, cervical-thoracic level in 3 cases and thoracic level in 3 cases. Hematoma were located in the dorsal of spinal cord in 7cases, located in the ventral of the spinal cord in 1 case and both in 1 case. The hematomas in 7 cases were spindle-shaped, 2 were strip-shaped and 1 was oval. Vessel bleeding were found in 2 case, angioma in 2 case and AVM in 1 case by surgery. Hematoma were demonstrated slight hyper intensity on T1WI and slight hypo intensity on T2WI in acute phase. In subacute phase, hematoma showed iso- or hyper signal intensity on T1WI, hypo-or hyper intensity on T2WI, and isointensity on both sequences in chronic phase. The enhanced pattern was different towards period and different reason. Conclusions MR is valuable in diagnosing the nontraumatic spinal epidural hematoma with presenting the extend of lesions precisely, judging the phase of hematoma correctly and help in analyzing the reason some degree.