易被误诊的骶神经发育不良

Dysplastic sacral nerve：easily misdiagnosed disease

目的探讨骶神经发育不良的影像特征。方法总结分析2004年5月至2017年3月86例有神经源性膀胱症状、腰骶椎磁共振检查报告为＂未见异常＂的患者影像学特点，患者年龄为2～38岁，平均5.7岁，其中14岁以下患儿81例。全部患者无脊柱脊髓和泌尿系伤病史，无糖皮质激素用药史。重新阅读全部患者的腰骶椎磁共振片子。结果全部患者的骶椎X线片或CT均显示有骶椎裂。90%（77/86）磁共振影像显示有典型的骶管脂肪堆积，硬脊膜囊盲端高于第一骶椎；其余病例表现为非典型性骶管脂肪增多。给5例神经源性膀胱患者做了骶管内探查手术，发现骶神经根（至少包括S3）混有脂肪，呈结节样增粗，但终丝正常并不紧张。结论骶管脂肪堆积是一种易被忽视的影像学特征。具有＂尿控功能障碍＋X线骶椎裂＋MRI骶管脂肪堆积但无圆锥低位＂者，尤其是对于儿童患者，应考虑可能患有骶神经发育不良。

ObjectiveTo explore the imaging features of patients with dysplastic sacral nerve.MethodsThe lumbosacral magnetic resonance imaging （MRI） findings were retrospectively examined for 86 patients with neurogenic bladder symptoms.The average age was 5.7 （2-38） years.Among them, 81 cases were aged under 14 years.ResultsAll radiological or computed tomography （CT） studies showed bifid sacrum.And 90% （77/86） cases of lumbosacral MRIs hinted at typical sacral epidural lipomatosis and the level of dural sac termination was above sacral vertebra I and the remainder non-typical excessive fat in sacral canal.Sacral canal exploration was performed for 5 cases with neurogenic bladder symptoms and tiny lipomatosus nodes were detected in sacral nerve roots （at least including S3 roots） without tight filum terminale.ConclusionsSacral epidural lipomatosis is an easily ignored imaging characterization.Urination continence dysfunction, bifid sacrum on radiological film and sacral canal fatty deposits without low-lying conus on MRI are a classic triad of potentially dysplastic sacral nerve, especially in children.