摘要
目的 分析自发性椎管内血肿的MRI特征,加强对本病的认识,提高临床诊治能力。资料与方法 回顾性收集2021年1月—2023年12月青岛市城阳区人民医院5例自发性椎管内血肿患者,在发病后6~24 h行MRI平扫及增强扫描,分析影像学特征。结合美国脊髓损伤协会动态脊髓损伤神经分类评分标准(ASIA)分级评分及病情进展,3例行手术治疗,2例行药物保守治疗。结果 5例患者均随访6~15个月。5例患者血肿分布:颈胸交界处2例,上胸段1例,胸腰段2例;2例覆盖3~6个节段,2例覆盖2~3个节段,1例覆盖1个节段;2例血肿位于硬膜囊腹侧,3例位于硬膜囊背侧。术后病理显示1例为单纯血凝块,2例为血凝块伴多量中性粒细胞浸润。1例超急性期T1WI呈等信号,T2WI呈高信号,3例急性期T1WI呈等信号,T2WI呈低信号,1例亚急性期T1WI呈高信号,T2WI呈低信号;增强扫描显示1例为不均匀强化,1例为不规则边缘强化,3例未见明显强化。术后2例ASIA分级恢复至E级,1例恢复至C级,保守治疗2例下肢肌力均恢复至E级,复查MRI示血肿均吸收。结论 MRI对于自发性椎管内血肿患者的病灶敏感性强,可以准确显示血肿的位置和大小,有助于判别疾病的进展时期,对于临床诊断和治疗具有重要意义。
Purpose To summarize the MRI characteristics of patients with spontaneous spinal subdural hematoma,so as to strengthen the awareness to this disease,and to improve the clinical diagnosis and treatment ability.Materials and Methods A retrospective analysis was performed on five patients with spontaneous spinal subdural hematoma diagnosed and treated in Qingdao Chengyang District People's Hospital from January 2021 to December 2023.Plain MRI and enhanced MRI were performed 6-24 hours after onset,and the imaging characteristics were analyzed.Combined with the dynamic American Spinal Injury Association(ASIA)grading score and disease progression,three patients were treated with surgery and two patients with conservative treatment.Results All patients were followed up for 6-15 months.Among the five patients,the hematoma was distributed at the cervicothoracic junction in two cases,the upper thoracic segment in one case and the thoracolumbar segment in two cases;covering 3-6 segments in two cases,2-3 segments in two cases and 1 segment in one case;hematoma was located at the ventral side of the dural sac in two cases,and the dorsal side of the dural sac in three cases.Postoperative pathology showed that one case was simple blood clot,and two cases were blood clot with a large number of neutrophil infiltration.One case was hyperacute phase with isointensity on T1WI and high signal on T2WI,three cases were acute phase with isointensity on T1WI and low signal on T2WI,and one case was subacute phase with high signal on T1WI and low signal on T2WI.Enhanced scanning showed that one case was uneven enhancement,one case was irregular edge enhancement and three cases had no obvious enhancement.ASIA grade of two cases returned to E,one case returned to C after surgery,and lower limb muscle strength of two cases returned to E after conservative treatment,and MRI reexamination showed that the hematoma was absorbed.Conclusion MRI has strong sensitivity for the lesions of patients with spontaneous spinal subdural hematoma,which can accurately show the location and size of the hematoma,help to distinguish the progression of the disease,and has great significance for clinical diagnosis and treatment.
作者
高海燕
高慧珊
黄浩然
李亮
陈俊
GAO Haiyan;GAO Huishan;HUANG Haoran;LI Liang;CHEN Jun(Department of OncologgyⅢ,Qingdao Municipal Hospital,Qingdao 266000,China;不详)
出处
《中国医学影像学杂志》
北大核心
2025年第7期775-779,共5页
Chinese Journal of Medical Imaging
关键词
磁共振成像
椎管
血肿
血肿
硬膜下
血肿
硬膜外
颅
保守治疗
外科手术
Magnetic resonance imaging
Spinal canal
Hematoma
Hematoma,subdural
Hematoma,epidural,cranial
Conservative treatment
Surgical procedures,operative
