MRI、320-CTA及DSA在脊髓血管病诊断中的应用

Value of MRI,320-CTA and DSA to diagnosis of spinal vascular disease

目的通过对比分析脊髓血管病在MRI、320-CTA及DSA中的特点，探讨三者在脊髓血管病诊断中的作用。方法回顾性分析34例脊髓血管病患者影像学资料，34例均行DSA检查，33例行MRI检查，14例行320-CTA检查；同时行MRI及DSA检查31例，同时行320-CTA及DSA检查13例，同时行MRI、320-CTA及DSA检查13例。结果DSA检查确诊为硬脊膜动静脉瘘20例，髓内动静脉畸形7例，髓周动静脉瘘3例，双侧甲状颈干发育异常l例，3例阴性。30例MRI检查考虑脊髓血管病，28例经DSA检查得到证实，2例DSA检查为阴性；1例MRI诊断为颈6-7椎体水平脊髓血管畸形，DSA检查诊断双侧甲状颈干发育异常；MRI诊断符合率为90．3％（28／31）。10例320-CTA检查诊断为脊髓血管病，其中8例诊断为硬脊膜动静脉瘘，2例为髓内动静脉畸形；7例硬脊膜动静脉瘘及1例髓内动静脉畸形的320-CTA诊断与DSA诊断结果-致；3例320-CTA阴性结果与DSA-致；1例320-CTA考虑后颅窝延髓前及颈1-6水平硬脊膜动静脉瘘，但DSA检查为阴性；1例320-CTA考虑髓内动静脉畸形，DSA诊断为动静脉瘘；320-CTA诊断符合率为84．6％（11／13）。结论MRI适用于脊髓血管畸形的初步筛查；320-CTA可以无创、快速、全面地显示脊髓血管病，为DSA检查进-步提供目标，缩短DSA诊疗时间，降低漏诊率，同时可以明确病灶在椎管内的具体位置，指导手术；DSA是诊断脊髓血管病的金标准，是进-步治疗的基础。

Objective To investigate the value of MRI, 320-CTA and DSA techniques to the diagnosis of the spinal vascular disease. Methods The imaging data of 34 patients with spinal vascular disease were analyzed retrospectively. Before the operation, 34 patients received DSA examination, 33 MRI and 14 the 320-CTA. Both the MRI and DSA examinations were performed in 31 patients, both the 320-CTA and DSA examinations in 13, and the three examinations including MRI, 320-CTA and DSA in 13. Results DSA found the spinal dural arteriovenous fistulas in 20 patients, intramedullary arteriovenous malformations in 7, perimedullary arteriovenous fistulas in 3, bilateral thyrocervieal trunk dysplasia in 1, and nothing （i.e. DSA examination was negative） in 3. MRI showed that there was spinal vascular disease in 30 patients, of whom, 28 had spinal vascular disease and 2 not （there were no positive findings） according to DSA examination. The spinal vascular malformation was suspected by MRI in 1 patient suffering from the bilateral thyrocervical trunk dysplasia verified by DSA. The accuracy rate of the spinal vascular disease diagnosed by MRI examination was 90.3% （28131）. There was spinal vascular diseases on the 320-CTA images in 10 patients, of whom, 8 suffered from the spinal dura arteriovenous fistulas and 2 from the intramedullary spinal arteriovenous malformations according to DSA examination. The diagnoses made by the 320-CTA was consistent with those made by DSA in 7 patients with the spinal dura arteriovenous fistulas and 1 patient with the intramedullary spinal arteriovenous malformation. There were not all the positive findings in other three patients on the 320-CTA and DSA images. The accuracy rate of spinal vascular disease diagnosed by the 320-CTA examination was 84.6% （11/13）. Conclusions MRI technique is applicable to screening the spinal vascular disease. The 320-CTA can quickly show noninvasively the spinal vascular disease from multiple perspectives, and provide the base for the further examination, for example DSA. DSA technique is the golden standard of the diagnosis of spinal vascular disease. Both the DSA and 320-CTA are helpful to the treatment of the spinal vascular disease.