CAJ | 학술논문

目的分析脊膜脊髓结核的核磁共振(MRI)影像特点.方法回顾性分析我院201 1年6月至2014年10月收治的23例脊膜脊髓结核病例的MRI影像表现,男12例,女11例,年龄16 ～50岁,中位年龄为26岁;并与25例脊膜转移癌的MRI表现进行对照,男18例,女7例,年龄44～78岁,中位年龄56岁.所有病例均行MRI平扫和增强检查.计数资料采用x2检验,计量资料采用t检验,P＜0.05为差异有统计学意义.结果 23例脊膜脊髓结核中,单纯脊膜结核16例,脊膜脊髓结核7例.MR影像表现:(1)脊膜结核:脊膜(硬脊膜、蛛网膜及软脊膜)不规则线状、条带状及丘状增厚,增强扫描可见强化(23/23),厚度＜5 mm,累及长度平均为7个椎体节段,增强扫描可见强化(23/23),同时5例脊膜合并簇状或者串珠状排列的环形强化结节;蛛网膜下腔不规则狭窄(23/23),少部分合并局部闭塞(5/23);蛛网膜下腔不均质异常信号(20/23);脑脊液-脊髓交界面毛糙、不光滑(10/23);继发性蛛网膜囊肿形成(15/23);(2)脊膜脊髓结核:在脊膜结核影像表现的基础上合并脊髓内病变(7/23),其中结节4例呈典型的环形强化,3例小斑块呈不均匀强化.脊膜脊髓转移癌25例,其中脊膜转移癌20例,同时合并髓内转移结节5例.脊膜转移癌表现为结节状增厚8例、斑块状增厚10例和两者同时存在7例,其中19例为连续性增厚,平均长度为3个椎体节段,6例为多发局限增厚,增强扫描示增厚脊膜均见明显强化,髓内结节呈不均匀强化.结论脊膜脊髓结核的MRI表现有脊膜连续性增厚、继发性蛛网膜囊肿、脑脊液-脊髓交界面毛糙以及结核结节串珠样排列等特点,密切结合临床及原发疾病有助于诊断及鉴别诊断.
목적 분석척막척수결핵적핵자공진(MRI)영상특점.방법 회고성분석아원201 1년6월지2014년10월수치적23례척막척수결핵병례적MRI영상표현,남12례,녀11례,년령16 ～50세,중위년령위26세;병여25례척막전이암적MRI표현진행대조,남18례,녀7례,년령44～78세,중위년령56세.소유병례균행MRI평소화증강검사.계수자료채용x2검험,계량자료채용t검험,P＜0.05위차이유통계학의의.결과 23례척막척수결핵중,단순척막결핵16례,척막척수결핵7례.MR영상표현:(1)척막결핵:척막(경척막、주망막급연척막)불규칙선상、조대상급구상증후,증강소묘가견강화(23/23),후도＜5 mm,루급장도평균위7개추체절단,증강소묘가견강화(23/23),동시5례척막합병족상혹자천주상배렬적배형강화결절;주망막하강불규칙협착(23/23),소부분합병국부폐새(5/23);주망막하강불균질이상신호(20/23);뇌척액-척수교계면모조、불광활(10/23);계발성주망막낭종형성(15/23);(2)척막척수결핵:재척막결핵영상표현적기출상합병척수내병변(7/23),기중결절4례정전형적배형강화,3례소반괴정불균균강화.척막척수전이암25례,기중척막전이암20례,동시합병수내전이결절5례.척막전이암표현위결절상증후8례、반괴상증후10례화량자동시존재7례,기중19례위련속성증후,평균장도위3개추체절단,6례위다발국한증후,증강소묘시증후척막균견명현강화,수내결절정불균균강화.결론 척막척수결핵적MRI표현유척막련속성증후、계발성주망막낭종、뇌척액-척수교계면모조이급결핵결절천주양배렬등특점,밀절결합림상급원발질병유조우진단급감별진단.
Objective To explore the imaging features of spinal cord and spinal meningeal tuberculosis by magnetic resonance(MR).Methods We analyzed retrospectively the features of MRI in 23 patients with spinal cord and spinal meningeal tuberculosis compared to 25 patients with spinal cord meningeal metastatic carcinoma.All patients were admitted in our hospital from Jun.2011 to Oct.2014.There were 12 males and 11 females with a median age of 26 (range 16-50) years in the spinal cord meningeal tuberculosis group,and 18 males and 7 females with a median age 56 (range 44-78) years in the spinal cord meningeal metastatic carcinoma group.All patients underwent MR plain and contrastenhanced scanning.The enumeration data were compared with the x2 test and the measurement data were compared with t test.The difference was considered statistically significant when the P value was ＜ 0.05.Results Of the 23 cases,16 were spinal meningeal tuberculosis and 7 were spinal cord tuberculosis.The MR imaging features were as follows:(1) Spinal meningeal tuberculosis:Irregular and linear strip and hummocky thickening (thickness ＜ 5 mm) of the meninges (dura,arachnoid and pia mater),with the average length of involvement of 7 vertebral segments.Enhancement was present in all cases by contrastenhanced scanning,including clustering or moniliform enhancement in 5 cases.Subarachnoid irregular stenosis was seen in all cases,partial occlusion in 5,abnormal heterogeneous signal in 20,rough cerebrospinal fluid (CSF)-spinal interface in 10,and formation of secondary arachnoid cyst in 15.(2) Spinal cord meningeal tuberculosis:of the 7 cases,4 showed ring enhancement and 3 showed small plaque with heterogeneous enhancement.(3)There were 20 cases of meningeal metastatic carcinoma and 5 cases of meningeal metastatic carcinoma with spinal cord metastasis.Nodular thickening was present in 8 cases,plaque thickening in 10,and nodular and plaque thickening in 7.Continuous thickening involving 3 vertebral bodies was seen in 19 cases.Multiple localized thickening was present in 6 cases,with obvious enhancement in the meninges and heterogeneous enhancement in the spinal cord.Conclusions The MR imaging features of spinal cord meningeal tuberculosis include continuous meningeal thickening,secondary arachnoid cyst,rough and moniliform CSF-spinal cord interface.Diagnosis and differential diagnosis can be made based on these features combined with clinical data and disease history.