Correlation of Pathological Findings with MRI Imaging in Traumatic Spinal Cord Injury in Hyperacute Time Period in Non Human Primate Model

Traumatic Spinal Cord Injury (TSCI) remains a significant cause of human suffering. The World Health Organization estimates that there are between 250,000 to 500,000 new cases every year. Magnetic Resonance Imaging (MRI) has been an important advancement in the diagnosis and management of TSCI. Nevertheless, there is a lack of literature correlating the radiological abnormalities and histopathological findings in the first hour (i.e., hyperacute period) after injury. The aim of this preliminary study is to elucidate the relationship between the MRI abnormalities and histopathological abnormalities in the hyperacute time period. In this study, a non-human primate model (NHP) primate model is used to characterize the histopathological and radiological features. Specifically, an experimental TSCI is created with an epidural catheter. This is followed by MRI imaging. The subject is then humanely euthanized and a post-mortem examination is completed. These results suggest that the noted radiological abnormalities are consistent with a combination of hemorrhage, edema as well as eosinophilic cellular matter in the central canal.

MRI and EM Observation of Repair Effect of Implantation of Microgene pSVPoMcat Modified SC on Injured Spinal Cord

Objective To approach the effect of microgene pSVPoMcat modified Schwan n cell (SC) on the regeneration and repair of injured spinal cord.Method Spinal cord hemi－transection models were made with the cutting method in healthy SD ra ts. Microgene pSVPoMcat modified SC(group A),highly purified SC(group B),and glu tin sponge (control group C)were randomly implanted into the cut. After 3 month living ,the host rats were scanned by MRI, and observed under EM. Result Spinal signals at the injury region nearly recovered to normal in group A.No recovery w as found in group B.Malacosis was found in group C.TEM findings: regeneration of large number of myelinated and nonmyelinated axons and SC proliferation in grou p A, myelinated axon regeneration and SC necrosis in group B, non myelinated and nonmyelinated axon in group C.Conclusion Implantation of microgene pSVPoMcat mo dified SC could promote the repair of injured spinal cord.

常规MRI在创伤性脊髓损伤预后评估中的研究进展

创伤性脊髓损伤(TSCI)常由直接的机械性损伤引起,是一种严重的致残性疾病。临床上常借助常规脊髓MRI对脊髓损伤(SCI)严重程度进行评估,所以探讨常规MRI在TSCI中的全面应用进展是非常必要的。MRI可显示TSCI不同时期的变化,急性期MRI能显示脊髓水肿和出血范围,在亚急性期,随着水肿和出血的消退,MRI指标可能对损伤严重程度诊断和预后预测有更大价值;而慢性期MRI能够观察TSCI后脊髓和脑内的萎缩情况。本文回顾近几年相关文献,对TSCI在MRI上的信号表现及MRI对评估神经功能缺损和预测恢复的价值进行阐述,以期为TSCI患者的诊疗和康复及未来研究方向提供建议。

The MRI manifestations of intramedullary germinoma of the spinal cord:a case report and review of the literature

Primary germinoma in the spinal cord is very rare. Preoperative diagnosis is important because germinomas are sensitive to radiation therapy and chemotherapy so that treatment trends and prognosis differ from other intramedullary spinal cord tumors. Preoperative radiologic diagnosis is very difficult because of this rarity. In this case a 22-year-old woman with a 4-month history of gradual numbness and weakness of both lower extremities was found to have a solid tumor in the thoracic cord between the T9 and T11 vertebral bodies. No other neoplastic lesion was found inside or outside the central nervous system. The patient underwent surgery, and the intrarnedullary lesion was almost totally resected. Serum HCG was elevated postoperatively without pregnancy. The pathological diagnosis was conclusively that of a germinoma. The previous 23 cases of primary spinal cord germinoma were reviewed for comparison.

Spinal Cord Infarction with a Negative MRI Finding: A Case Report and Literature Review

Introduction: Spinal cord infarction (SCI) is a relatively rare disease. Abnormality on magnetic resonance imaging (MRI) is an important diagnostic criterion. It may be normal on the first day. Then abnormal signal will appear a few days later. There were some reports with negative MRI findings at the beginning. However, those reports were neither found abnormalities on repeat MRI nor without repeat MRI. Case Presentation: We report a case of SCI presented as paralysis of lower limbs and chest pain with no abnormalities on MRI through the course of disease in a 74-year-old female. Anti-platelet aggregation drugs, stabilizing plaque treatments and rehabilitation exercise were performed. The patient recovered significantly. She could walk independently a month after the onset. Conclusions: Although MRI provides important evidence for diagnosis, clinical manifestations are the most important when diagnosing. For patients who were highly suspected of SCI clinically, treatment for vascular diseases should be applied as soon as possible even if no lesion is found on imaging examination.

Electrical stimulation and denervated muscles after spinal cord injury

Spinal cord injury(SCI)population with injury below T10 or injury to the cauda equina region is characterized by denervated muscles,extensive muscle atrophy,infiltration of intramuscular fat and formation of fibrous tissue.These morphological changes may put individuals with SCI at higher risk for developing other diseases such as various cardiovascular diseases,diabetes,obesity and osteoporosis.Currently,there is no available rehabilitation intervention to rescue the muscles or restore muscle size in SCI individuals with lower motor neuron denervation.We,hereby,performed a review of the available evidence that supports the use of electrical stimulation in restoration of denervated muscle following SCI.Long pulse width stimulation(LPWS)technique is an upcoming method of stimulating denervated muscles.Our primary objective is to explore the best stimulation paradigms(stimulation parameters,stimulation technique and stimulation wave)to achieve restoration of the denervated muscle.Stimulation parameters,such as the pulse duration,need to be 100–1000 times longer than in innervated muscles to achieve desirable excitability and contraction.The use of electrical stimulation in animal and human models induces muscle hypertrophy.Findings in animal models indicate that electrical stimulation,with a combination of exercise and pharmacological interventions,have proven to be effective in improving various aspects like relative muscle weight,muscle cross sectional area,number of myelinated regenerated fibers,and restoring some level of muscle function.Human studies have shown similar outcomes,identifying the use of LPWS as an effective strategy in increasing muscle cross sectional area,the size of muscle fibers,and improving muscle function.Therefore,displaying promise is an effective future stimulation intervention.In summary,LPWS is a novel stimulation technique for denervated muscles in humans with SCI.Successful studies on LPWS of denervated muscles will help in translating this stimulation technique to the clinical level as a rehabilitation intervention after SCI.

Prevention against diffuse spinal cord astrocytoma: can the Notch pathway be a novel treatment target?

This study was designed to investigate whether the Notch pathway is involved in the develop-ment of diffuse spinal cord astrocytomas. BALB/c nude mice received injections of CD133＋and CD133？ cell suspensions prepared using human recurrent diffuse spinal cord astrocytoma tissue through administration into the right parietal lobe. After 7–11 weeks, magnetic resonance imaging was performed weekly. Xenografts were observed on the surfaces of the brains of mice receiving the CD133＋ cell suspension, and Notch-immunopositive expression was observed in the xenografts. By contrast, no xenografts appeared in the identical position on the surfaces of the brains of mice receiving the CD133？ cell suspension, and Notch-immunopositive expres-sion was hardly detected either. Hematoxylin-eosin staining and immunohistochemical staining revealed xenografts on the convex surfaces of the brains of mice that underwent CD133＋ astro-cytoma transplantation. Some sporadic astroglioma cells showed pseudopodium-like structures, which extended into the cerebral white matter. However,it should be emphasized that the sub-cortex xenograft with Notch-immunopositive expression was found in the fourth mouse received injection of CD133？ astrocytoma cells. However, these ifndings suggest that the Notch pathway plays an important role in the formation of astrocytomas, and can be considered a novel treat-ment target for diffuse spinal cord astrocytoma.

产前超声及MRI在胎儿闭合性脊柱裂诊断中的应用价值

目的探讨产前超声及MRI在胎儿闭合性脊柱裂诊断中的应用价值。方法选取我院经产后临床确诊的闭合性脊柱裂胎儿26例和未合并神经系统畸形的胎儿38例,比较产前超声、MRI单独及联合应用对胎儿闭合性脊柱裂的诊断结果。绘制受试者工作特征(ROC)曲线分析产前超声、MRI单独及联合应用对胎儿闭合性脊柱裂的诊断效能。结果26例闭合性脊柱裂胎儿中,产前超声检出20例,漏诊6例;产前MRI检出17例,漏诊9例;联合应用检出24例,漏诊2例。产前超声联合MRI与产后临床诊断相符者24例,其中7例为MRI漏诊经超声补充诊断,4例为超声漏诊经MRI补充诊断。ROC曲线分析显示,产前超声联合MRI诊断胎儿闭合性脊柱裂的曲线下面积为0.9120,高于其单独应用(0.8964、0.8757),差异均有统计学意义(P=0.023、0.014)。结论产前超声可作为诊断胎儿闭合性脊柱裂的首选检查方式,MRI可作为补充检查方式,二者联合应用可提高对胎儿闭合性脊柱裂的诊断效能。

Spinal Cord Injuries without Visible Bone Lesions: Analysis of Four Consecutive Cases

Objectives: Interest of this study is to report four cases of spinal cord injuries without bone lesion. Evolution of the injured patients according to the initial clinic assessment at admission and the treatment performed are discussed. Materials and Methods: From January to December 2016, we performed a retrospective study at the Neurosurgery Department of Hospital General Grand Yoff of Dakar. Four patients were followed for spinal cord injury without visible bone lesions. We analyzed the clinical, radiological, therapeutic and evolutionary data. Trauma caused by stabbing was excluded. Results: In a year, 83 cases of spinal trauma with neurological deficit were hospitalized in the department. Among them, 4 had spinal cord injuries without visible bone lesions. The average age was 31.7 years with extremes ranging from 14 to 47 years. The sex ratio of male/female was 3. We have recorded 2 cases of road traffic accidents, 1 case of fall from height and 1 case of sports accident. On the neurological level, we found 3 cases of tetraplegia, and 1 brachial monoplegia. Computed tomography in all patients was normal. All of them benefited from magnetic resonance imaging that showed spinal cord injury. All patients were under conservative treatment. One patient fully recovered, two partially and one passed away. Conclusion: In presence of any post traumatic myelopathy case, the absence of disco-vertebral lesions should bring to mind the SCIWORA as well as indicate the realization of magnetic resonance imaging.

颈脊髓MRI信号增强与脊髓型颈椎病手术指征

目的 :探讨脊髓MRI信号增强能否作为脊髓型颈椎病 (CSM)脊髓减压的指征。方法 :总结 87例轻型CSM病人保守治疗随访结果与颈脊髓T2加权信号增强 (ISI)的关系。结果 :有ISI组与无ISI组、ISI减少组与ISI无变化组治疗前、后JOA评分无明显差异 ;ISI减少、无变化或无ISI均不影响保守治疗满意率。结论 :对轻型CSM 。

胸腰段脊柱脊髓损伤后期的MRI研究

目的 :观察胸腰段脊柱脊髓损伤后期MRI的表现 ,探讨影响上升性脊髓病变的主要相关因素。方法 :选取胸腰段脊柱脊髓损伤 1年以上患者 144例的MRI,进行观察、测量分析并进行统计学处理。结果 :本组病例的MRI表现依次有变性、粘连、萎缩、囊变、空洞和外伤性拴系 ,上升性脊髓病变发生率 47 2 % ,包括变性、萎缩和空洞三种表现。结论 :完全性脊髓损伤、脊髓严重受压以及T11、T12骨折的患者更易出现上升性脊髓病变 ;完全性脊髓损伤。

外伤性脊髓损伤的MRI表现与临床对照分析

目的 评价MRI在脊髓损伤的临床应用价值。资料与方法 回顾性分析 6 6例脊髓损伤的临床及MRI表现 ,着重分析脊髓损伤的MRI征象与病理、临床的关系。结果 MRI显示椎体压缩性骨折 5 1例 ,椎间盘脱出 2例 ,椎体骨折并椎间盘脱出 5例 ;椎体部分性滑脱 2 0例 ,完全性滑脱 1例。显示脊髓完全性截断 4例 ,部分性截断 1例 ,脊髓受压 4 1例。 6 2例脊髓连贯者 5 9例显示脊髓信号异常。 5 9例有完整的住院治疗记录 ,治疗后显示病情好转 2 5例 ,症状无改善 2 6例 ,死亡 8例。结论 MRI检查能明确脊髓有无损伤以及损伤的程度 。

脊髓血管畸形的MRI与DSA对照研究

目的 对照分析脊髓血管畸形的MRI和DSA表现 ,评价其分类价值。方法 65例有不同程度的脊髓神经功能障碍患者 ,均行MRI及DSA检查 ,其中 13例行手术治疗。结果 MRI显示髓内病变 18例、累及髓内外病变 19例、髓外病变 2 8例 ;DSA检出髓内球型AVM 5例、幼稚型AVM 12例 ;髓外硬膜内AVF 2 4例 ,其中Ⅰ型 5例、Ⅱ型 12例、Ⅲ型 7例 ;硬膜AVF 8例 ;颅内硬脑膜AVF向颈段椎管内静脉引流 2例 ;14例无阳性发现 ,其中 13例手术后病理结果显示毛细血管扩张症 3例、微小动静脉畸形 6例、海绵状血管瘤 2例、混合型 2例。结论 MRI对隐匿型AVM的诊断优于DSA ,可明确病变的部位 ,有无合并出血 ;可初步鉴别诊断髓内、髓外AVM ;DSA是确定AVM的供血动脉、数目、瘘口部位、引流静脉的最佳方法 ,是AVM分型的黄金标准。MRI和DSA结合 。

慢性脊髓创伤的MRI表现

目的 探讨慢性脊髓损伤的MRI表现及其形成机制。材料与方法 分析 2 8例慢性脊髓损伤者的MRI表现及临床资料 ,其中男 2 1例 ,女 7例 ,平均年龄 39岁。伤后行MRI复查时间为 1个月～ 12年。MRI取常规SE序列T1WI、T2 WI矢状、横断面。结果 2 8例中有 16例发生在颈髓 ,上胸髓及脊髓圆锥各 6例。其中脊髓囊变 13例 ;慢性脊髓受压 5例 ,均合并有其他类型的病理改变 ;脊髓软化 4例 ;脊髓空洞 2例 ;脊髓萎缩 3例 ;脊髓栓系 1例。结论 慢性脊髓损伤分别表现为脊髓囊变、空洞、萎缩、软化、栓系及慢性受压 6种病变 ,脊髓囊变与脊髓瞬间压迫伤有关 ,其病变局限。脊髓空洞及脊髓萎缩均与脊髓持续受压有关 ,病变潜在进展。脊髓软化可能由伤后脊髓缺血引起 。

脊髓外伤的MRI与临床相关性分析

目的 :分析脊柱外伤的MRI与临床表现的相关性。方法 :回顾性分析 5 0例脊髓外的临床与MRI表现 ,重点讨论脊髓损伤的临床表现、MRI信号改变和预后的关系与MRI表现 ,重点讨论脊髓损伤的临床表现、RMI信号改变和预后的关系。结果 :3例脊髓完全截断者 ,5个断端的T1WI呈低等信号 ,1个断端为高信号 ;6个断端T2 WI均为高信号。 4 7例脊髓连贯者 ,4 4例显示脊髓异常 ,其中T1WTI呈低信号 36例 ,等信号 6例 ,高信号 2例 ;T2 WI呈均匀性高信号 37例 ,呈高低不均斑点、斑片状混杂性信号 10例。 3例仅局部脊髓受压 ,信号无异常改变。结论 :MRI能显示脊髓有无损伤以及损伤的程度 。

脊髓栓系综合征的MRI评价

目的：评价ＭＲＩ在诊断脊髓栓系综合征（ＴＳＣＳ）中的作用。材料和方法：对３９例ＴＳＣＳ患者的ＭＲＩ资料进行了回顾性分析，所有病例均经手术证实。结果：全部患者圆锥尖部位置低于Ｌ２椎体中部以下、脊髓受牵拉固定，根据脊髓栓系的原因将ＴＳＣＳ分为４型：Ⅰ，终丝粗大紧张型６例，占１５％；Ⅱ，脂肪堆积型１１例，占２８％；Ⅲ，脊膜或脊膜脊髓膨出型１６例，占４１％；Ⅳ，肿瘤型６例，占１６％，其中畸胎瘤３例，上皮样囊肿２例，皮样囊肿１例。结论：ＭＲＩ具有优良的软组织分辨率、多方位成像等优点，诊断ＴＳＣＳ优于其他影像检查方法。

颈髓角的MRI影像测量及其临床意义

目的:在颈椎MRI片上测量国人正常颅椎区的颈髓角,探讨其临床意义。方法:选择116例国人正常颅椎区的MRI片,测量其上颈髓腹侧与延髓腹侧两直线间的夹角,即颈髓角。结果:116例颈髓角最小值140.0°,最大175.5°,平均158.7°,95%可信区间为144.5°～172.9°。结论:颈髓角对于量化延髓、颈脊髓压迫程度以及评价术后压迫解除情况等有重要价值。

脊髓缺血性损伤的MRI与病理演变对照实验研究

目的 :研究脊髓缺血性损伤的MRI变化规律及其特征 ,及相应的病理机制。方法 :以家犬为实验模型 ,采用颈前路手术入路 ,损伤颈脊髓前动脉 ,进行肉眼、光镜观察。同时观察MRI异常信号演变过程和特征性表现。结果 :脊髓前动脉损伤后出现脊髓水肿、出血 ,运动神经元变性坏死等病理性变化。MRI异常信号出现在脊髓前动脉损伤节段的前 2 /3 ,多表现为一侧受累及或偏向一侧。结论 :脊髓缺血性损伤后的脊髓出血、水肿在MRI得到不同程度的反映。MRI能确定脊髓缺血性损伤的部位。

无骨折脱位颈脊髓损伤颈髓MRI表现与治疗策略

目的：根据伤后颈脊髓MRI不同表现对无骨折脱位颈脊髓损伤（ CSCIWFD）采取不同的治疗策略,观察临床疗效和安全性,分析疗效差异原因并探讨治疗方案选择。方法回顾分析接受治疗并获得完整随访的56例中老年CSCIWFD患者的临床资料。对颈椎MRI提示有颈髓受压伴髓内高信号且有神经症状者建议手术,对颈髓无压迫伴或不伴髓内高信号者建议非手术治疗。按治疗建议和患者选择分为3组：建议手术且患者接受手术组（ A组,39例）,建议手术但患者拒绝手术组（ B组,11例）,非手术治疗组（ C组,6例）。神经功能评估按ASIA分级,对3组治疗后神经功能的恢复结果进行比较。结果患者均获得随访,时间20-88个月。结果显示,神经功能改善情况A组好于B组, C组神经功能改善满意。结论颈髓MRI表现是中老年CSCIWFD患者是否手术的重要参考依据。颈髓受压或颈髓接触伴髓内高信号,手术治疗效果优于非手术治疗；如颈髓无压迫、无明显失稳,即使有神经症状且髓内有高信号,应采用非手术治疗。

颈段脊柱损伤的MRI诊断

目的 探讨MRI在颈段脊柱创伤中的应用价值。材料与方法 3 0例颈椎外伤患者行MRI检查。所有患者均行X线检查 ,其中 6例行CT检查。结果 3 0例中伤及颈5～ 7占 80 %。根据MRI表现将颈段脊柱外伤分为 5类 :单纯压缩性骨折 ;泪滴性骨折 ;爆裂性骨折 ;骨折脱位 ;无骨折脱位。全部病例MRI均清楚显示伴有脊髓信号的异常 ,2例可见脊髓断裂。结论 MRI可以对颈椎损伤形态及脊髓、韧带、间盘等软组织损伤作出准确的评价 。