摘要
目的 探讨急性硬脊膜外血肿 (ASEH)的发病机制、MRI表现特征及鉴别诊断。方法15例ASEH病人 ,男 8例 ,女 7例 ,平均 37.8岁。 5例有脊柱损伤史 ,1例有脊柱手术史 ,1例有腰硬脊膜穿刺史 ,其余 8例无特殊病史。 11例经手术证实 ,2例经CT引导穿刺抽吸治疗并证实 ,2例经临床相应检查及随访证实。所有病人均行矢状面SET1WI和快速SE(FSE)或SET2 WI。 12例行横轴面FSET2 WI ,8例行SET1WI。 4例行SET1WI增强扫描。结果 15例血肿共发生于 18个脊柱节段 ,其中 6例次 (6 /18)位于颈段、9例次 (9/18)位于胸段、3例次 (3/18)位于腰段。 7例次 (7/18)血肿位于硬膜囊前方 ,11例次 (11/18)位于硬膜囊后方。血肿累及 1～ 13个椎体高度 ,平均 4 .87个椎体高度。T1WI上 ,所有血肿与脊髓之间均显示有线样低信号区。T2 WI矢状面和横轴面上 ,分别有 4例(4/15 )和 8例 (8/12 )在血肿与蛛网膜下腔之间显示有低信号线。矢状面上 13例 (13/15 )血肿呈长梭形 ,横轴面上均呈双凸镜形或半圆形。SET1WI上 ,5例呈等T1信号 ,6例呈短T1信号 ,4例呈等、短T1混杂信号 ;T2 WI上 ,5例呈短T2 信号 ,10例呈短、长T2 混杂信号。 4例增强扫描无特异性。结论 ASEH的MRI表现具有特征性 。
Objective To study the pathogenesis of acute spinal epidural hematomas (ASEHs), MRI features, and its value on diagnosis and differential diagnosis. Methods Fifteen patients with ASEHs (8 males, 7 females, mean age 37.8 years) were reviewed. Seven of the patients were secondary to spinal injuries(5 spinal trauma, 1 post-spinal operation, and 1 post-lumbar puncture)and 8 were spontaneous. Eleven patients were confirmed by operation. MRI was performed in all patients in sagittal SE T 1WI and SE or FSE T 2WI, 12 in axial FSE T 2WI, 8 in axial SE T 1WI, and 4 in contrast-enhanced SE T 1WI. Results Fifteen ASEHs involved 18 spinal segments, 6 of the segments (6/18) in cervical spine, 9 segments (9/18) in thoracic spine, and 3 segments (3/18) in lumbar spine. The hematomas located at pre-epidural space in 7 segments (7/18) and at posterolateral epidural space in 11 segments (11/18). The craniocaudal extent of the hematomas varied from 1 to 13 vertebral levels (average 4.87 vertebral level). There were low signal intensity lines between hematomas and spinal cord in all of the cases on T 1WI. The low signal intensity line between hematoma and subarachnoid space was demonstrated in 8 cases (8/12) and 4 cases (4/15) on axial T 2WI and sagittal T 2WI, respectively. The figure of hematomas was biconvex on axial imaging in all of the cases, and long lentiform on sagittal imaging in 13 cases (13/15). The hematomas showed variable signal intensity. On T 1WI, 5 showed isointensity to cord, 6 with hyperintensity, and 4 with inhomogeneous iso-hyperintensity. On T 2WI, 5 showed hypointensity, 10 with inhomogeneous hypo-hyperintensity. There was no special MR manifestation after contrast administration. Conclusion ASEHs is a rare disorder, and MRI features are characteristic for the diagnosis and differential diagnosis.
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2003年第10期912-916,共5页
Chinese Journal of Radiology
