CAJ | 학술논문

目的提高对自发性脊柱硬膜外血肿非典型MRI表现的认识.方法对2000年至2008年来院的10例自发性脊柱硬膜外血肿非典型MRI表现进行分析,男7例,女3例;年龄12--64岁,平均32.1岁.所有病例均无明显的外伤史.常规行矢状位T1WI、T2WI,横轴位TwI,8例行增强扫描.结果血肿呈梭形、椭圆形,位于脊髓的侧后方或后方的硬膜外腔.血肿发生于颈段5例,胸段3例,胸腰段2例.病灶与脊髓之间有一低信号线状影相隔,尤以T2WI显示最佳.血肿范围多在2～4个椎体,总量约5～10 ml,均值为(6.9±1.8)ml.在T1WI图像上,6例表现为等信号,4例表现为高信号;在T2WI图像上,6例表现为混杂高信号,4例表现为混杂低信号.5例血肿壁边缘轻度强化.6例血肿MRI信号比较典型.4例血肿MRI信号不典型.活动性出血以及血肿因时间而演变是血肿征象不典型的原因.本组4例误诊的原因:(1)活动性出血所致血肿征象不典型;(2)血肿位于狭窄的腔隙内;(3)临床上无外伤史.结论根据血肿演变的规律,结合起病时间及可能存在活动性出血对血肿MRI信号进行分析,有利于对非典型血肿的诊断和鉴别诊断.
목적 제고대자발성척주경막외혈종비전형MRI표현적인식.방법 대2000년지2008년래원적10례자발성척주경막외혈종비전형MRI표현진행분석,남7례,녀3례;년령12--64세,평균32.1세.소유병례균무명현적외상사.상규행시상위T1WI、T2WI,횡축위TwI,8례행증강소묘.결과 혈종정사형、타원형,위우척수적측후방혹후방적경막외강.혈종발생우경단5례,흉단3례,흉요단2례.병조여척수지간유일저신호선상영상격,우이T2WI현시최가.혈종범위다재2～4개추체,총량약5～10 ml,균치위(6.9±1.8)ml.재T1WI도상상,6례표현위등신호,4례표현위고신호;재T2WI도상상,6례표현위혼잡고신호,4례표현위혼잡저신호.5례혈종벽변연경도강화.6례혈종MRI신호비교전형.4례혈종MRI신호불전형.활동성출혈이급혈종인시간이연변시혈종정상불전형적원인.본조4례오진적원인:(1)활동성출혈소치혈종정상불전형;(2)혈종위우협착적강극내;(3)림상상무외상사.결론 근거혈종연변적규률,결합기병시간급가능존재활동성출혈대혈종MRI신호진행분석,유리우대비전형혈종적진단화감별진단.
Objective To improve the understanding of atypical MR imaging findings of patients with spontaneous spinal epidural hematoma.Methods MR imaging findings of 10 cases of spontaneous spinal epidural hematoma consisted of 7 males and 3 females were observed in our hospital from 2000 to 2008.The age was ranged from 12 to 64 years old with average age 32.1.All cases had not injury history.The routine TlWI sagittal,T2WI sagittal and transverse planes were performed with MR scanner.8 cases were examined by MR enhancement scan.Results The hematomas had shuttle or oval shape,were in lateral posterior or posterior epidural space,including 5 cases at cervical vertebral segment,3 cases at thoracic vertebral segment,and 2 case at thoracic and lumbar vertebral segment.There was a low signal septum between spinal cord and hematoma on TlWI and T2WI,especially clear on T2WI.The hematomas covered 2 to 4 vertebral bodies mostly,the gross were ranged from 5 ml to 10 ml with average(6.9±1.8)ml.Tl-weighted images showed isointensity(6 cases)to spinal cord and high-intensity(4 case);T2-weighted images revealed mixed high-intensity(6 cases)and mixed low-intensity(4 case).The wall of hematoma was enhanced in 5 eases on MRI enhancement scan.The hematoma signal was typical on 6 eases and atypical on 4 cases.The cause of atypical MR imaging findings of hematomas were active bleeding and the signal intensity of the hematoma varied with the hematoma age.The reasons of four misdiagnosis cases were:(1)Active bleeding result in atypical MR imaging findings of the hematoma;(2)The hematoma located in the narrow diastema;(3)No traumatic history on clinic.Conclusion It is usefid for diagnosis and differential diagnosis of hematoma on the analysis of the MR signal intensity based on the change of the hematoma and the hematoma age and active bleeding.