CAJ | 학술논문

目的：回顾性分析儿童无骨折脱位型脊髓损伤（SCIWORA）的MR影像学表现及临床特点，提高对儿童SCI-WORA MRI特征的认识。方法：对2004年4月－2011年10月我院诊断为 SCIWORA 的10例患儿的临床及脊柱 MRI资料进行回顾性分析。结果：10例患儿均于外伤后（车祸碾压腰腹部1例，外力打击腰部2例，舞蹈练习下腰7例），立即至3天后出现下肢无力、疼痛等脊髓损伤症状，10min～3d（中位时间3．5h）后症状达高峰，出现下肢瘫痪，症状稳定不再进展。伤后2～10 d行首次脊柱 MRI检查，病变累及全脊髓的1例，累及下颈段、胸段、腰段1例，累及胸段者2例，累及胸、腰段的6例。MRI显示脊髓水肿4例，呈长T2长T1信号；脊髓水肿伴出血6例，出血呈短T1信号。11～18d复查者10例，病变范围减小1例，范围增大2例，范围无变化7例。复查时出血者3例。伤后32～42d 复查者4例，均发现脊髓萎缩。本组合并非神经性软组织损伤1例，可见前纵韧带损伤。结论：全脊柱 MRI检查是用于诊断儿童SCIWORA的最佳影像学检查方法，不仅可进行脊髓损伤的神经影像学评估，还可显示脊柱X线及CT 无法直接显示的脊柱韧带、椎间盘、终板及骨髓等非神经性软组织损伤情况，有利于临床治疗方案的制定及预后评估。
목적：회고성분석인동무골절탈위형척수손상（SCIWORA）적MR영상학표현급림상특점，제고대인동SCI-WORA MRI특정적인식。방법：대2004년4월－2011년10월아원진단위 SCIWORA 적10례환인적림상급척주 MRI자료진행회고성분석。결과：10례환인균우외상후（차화년압요복부1례，외력타격요부2례，무도연습하요7례），립즉지3천후출현하지무력、동통등척수손상증상，10min～3d（중위시간3．5h）후증상체고봉，출현하지탄탄，증상은정불재진전。상후2～10 d행수차척주 MRI검사，병변루급전척수적1례，루급하경단、흉단、요단1례，루급흉단자2례，루급흉、요단적6례。MRI현시척수수종4례，정장T2장T1신호；척수수종반출혈6례，출혈정단T1신호。11～18d복사자10례，병변범위감소1례，범위증대2례，범위무변화7례。복사시출혈자3례。상후32～42d 복사자4례，균발현척수위축。본조합병비신경성연조직손상1례，가견전종인대손상。결론：전척주 MRI검사시용우진단인동SCIWORA적최가영상학검사방법，불부가진행척수손상적신경영상학평고，환가현시척주X선급CT 무법직접현시적척주인대、추간반、종판급골수등비신경성연조직손상정황，유리우림상치료방안적제정급예후평고。
Objective:To improve the understanding of MRI features of the spinal cord injury without radiologic ab-normality (SCIWORA)in children,by reviewing the MRI findings and the clinical characteristics of the pediatric SCIWORA respectively.Methods:The clinical data and MR images of ten patients who were diagnosed as SCIWORA from April 2004 to October 2011 were analyzed retrospectively.Results:In 10 cases lower limb weakness,pain and other spinal cord injury symptoms appeared,immediately to the 3rd day after trauma.The symptoms progressed to the peak from 10 min to the 3rd day (median time 3 .5 hours)after trauma,and the lower limbs paralysis was stable.The causes of SCIWORA included the abdominal trauma in the car accident (n= 1 ),external force hitting on the waist (n= 2 )and low back inj ury in the dance practice (n= 7).The first spinal MRI was performed from 2 to 10 days after the trauma.The lesion involved the whole spi-nal cord in 1 case,thoracic segment in 2 cases,lower cervical,thoracic and lumber segments in 1 case,and thoracic and lum-ber segments in 6 cases.MR findings of the injured spinal cord included spinal cord edema in 4 cases with prolonged T1- and T2-signal,spinal cord edema with hemorrhage in 6 cases with high signal on T1-weighted images and low signal on T2-FFE. The first follow-up of spinal MRI was performed for 10 cases from 8 to 11 days after the trauma.The lesion extent in-creased in 2 cases,decreased in 1 case,and had no change in 7 cases.Spinal cord hemorrhage was found in the additional 3 cases by the follow-up MRI.The myelatrophy was found in 4 cases by the follow-up MRI 32~42 days after the trauma.Of 4 cases,extraneural soft tissue injury was identified in 1 case,with anterior longitudinal ligament injury.Conclusion:Whole spinal MRI is the best imaging modality for the diagnosis of the pediatric SCIWORA,by providing the comprehensive ima-ging evaluation of the spinal cord injuries.In addition,whole spinal MRI can also display the extraneural soft tissue injuries including the injuries of spinal ligaments,discs,endplates and bone marrow,which can not be identified by the spinal X-ray and CT directly.These advantages will help the decision making of the clinical treatment and the prognostic assessment.