硬脊膜动静脉瘘的多序列MRI特征与临床

Multiple sequence MRI imaging features and clinical manifestations of spinal dural arteriovenous fistula

目的探讨多序列MRI在硬脊膜动静脉瘘(SDAVF)诊断中的价值。方法选取22例SDAVF患者进行多序列MRI检查,其中14例接受外科手术治疗,8例实施选择性脊髓动脉造影及血管内栓塞治疗;以病变定性诊断及供血动脉、瘘口、引流静脉的显示情况作为评价指标,将多序列MRI与数字减影血管造影(DSA)及手术结果进行对比分析。结果22例SDAVF患者均存在长节段脊髓病变,在矢状位可见T2WI呈“铅笔样”;18例MRI平扫在髓周可见“串珠状”、“虫蚀样”的多发流空血管影;8例MRI增强后髓周可见迂曲扩张的冠状静脉丛,脊髓内病变斑片状强化。22例经多序列MRI检查均明确显示脊髓异常血管及病变范围,3例三维动态增强磁共振血管成像(3D-DCE-MRA)很好的显示供血动脉和引流静脉,对定位瘘口有一定的帮助。结论多序列MRI是诊断SDAVF的主要影像学方法,对早期诊断有着重要的临床意义。

Objective To evaluate the value of multiple sequence MRI in diagnosis of spinal dural arteriovenous fistula(SDAVF).Methods Multi-sequence MRI examinations were performed in 22 patients with SDAVF.Surgical treatment was conducted in 14 patients,while selective spinal cord angiography and endovascular embolization were performed in 8 patients.The qualitative diagnosis of the lesion,as well as the visualization of the feeding arteries,fistula orifices,and draining veins,were used as evaluation indicators.The multi-sequence MRI was compared with DSA and surgical outcomes.Results All 22 patients with SDAVF had long-segment spinal cord lesions,which appeared as"pencil-like"on sagittal T2-weighted imaging(T2WI).MR imaging revealed"bead-like"and"moth-eaten"multiple venous flow voids around the spinal cord in 18 patients on routine scanning.After contrast enhancement,eight patients demonstrated tortuous and dilated coronary venous complexes,and patchy enhancement of the spinal cord lesions.Multi-sequence MRI examinations clearly demonstrated the abnormal vessels and lesion extent in all 22 patients.Three-dimensional dynamic contrast-enhanced magnetic resonance angiography(3D-DCE-MRA)well displayed the feeding arteries and draining veins,providing certain assistance in localizing the fistula orifice.Conclusion Multi-sequence MRI is the primary diagnostic method for SDAVF and has significant clinical importance for early diagnosis.