特发性急性横贯性脊髓炎的磁共振成像分析

MRI performance analysis of idiopathic acute transverse myelitis

目的探讨特发性急性横贯性脊髓炎(idiopathic acute transverse myelitis,IATM)的磁共振成像(magnetic resonance imaging,MRI)的影像学表现,提高对IATM的诊断准确性。方法回顾性分析2010年1月-2014年12月经临床治疗或病理证实的31例IATM患者影像资料,分析病变的分布区域、累及的脊髓节段长度、灰白质受累程度、病变脊髓肿胀以及病变的增强特征。结果脊髓MRI表现异常者29例,占93.5%,脊髓形态及信号未见明显异常2例,占6.5%;6例患者为多区域病变,单区域病变以胸段脊髓最多;所有病例均可见灰质受累,6例患者可见灰白质同时受累;25例累及长脊髓节段,占86.2%;病变的平均脊髓节段(5.7±0.9)个;14例存在脊髓肿胀,占48.3%;增强扫描17例脊髓无强化,占58.6%,12例病变区呈条状或结节状强化,占41.4%。结论 IATM的MRI征象有一定的特征性,但当MRI表现不典型时,结合临床及实验室检查并严格执行诊断标准尤其重要。

OBJECTIVE To discuss the magnetic resonance imaging （MRI） features of idiopathic acute transverse myelitis （IATM） so as to to improve the diagnostic accuracy .METHODS MR images were retrospectively analyzed in 31 patients with pathologically or clinically confirmed IATM from Jan .2010 to Dec .2014 .MR image and con‐trast‐enhanced MR image features were evaluated ,including anatomic regions ,vertebral segmental length ,gray or white matter involvement ,cord swelling and gadolinium enhancement characteristics .RESULTS Spinal MRIs were abnormal in 29 cases ,accounting for 93 .5% ,and two cases （6 .5% ） showed normal in spinal shape and signal . The lesion involving more than one anatomic region was defined as multiregional in 6 cases ;thoracic spine was the most common area of single‐regional lesion ,accounting for 41 .4% .Central cord hyper intensity involving gray matter was seen in all cases ,both gray or white matter involvement was seen in 6 cases .Totally 25 cases demon‐strated long segment lesions with a mean segment length of （5 .7 ± 0 .9） ,accounting for 86 .2% .Cord swelling was seen in 14 cases ,accounting for 48 .3% .Contrast‐enhanced MR scanning demonstrated that no enhancement was seen in 17 cases ,accounting for 58 .6% ,and peripheral or nodular （small focus） enhancement was revealed in 12 cases ,accounting for 41 .4% .CONCLUSION IATM has certain MR characteristics .Careful consideration of clinical symptoms and strictly observing the diagnostic criteria are very important to make a correct diagnosis when M RI findings are complex and atypical .