脊髓髓内病变课件

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1、急性及亚急性脊髓髓内病变MRI诊断与鉴别诊断思路（一）脊髓病变良性病变脊髓空洞症Ventriculusterminalis挫伤脓肿梗塞脊髓炎多发性硬化郝-伯二氏病（肉样瘤病）动静脉的畸形占位性病变畸胎瘤星形细胞瘤室管膜瘤成血管细胞瘤淋巴瘤成神经节细胞瘤转移ThetypicalMRimagingprotocolforevaluationofthespinalcordlesionsunenhancedsagittalandaxialT1-weightedandT2-weightedimagespost-gadolinium-enhancedsagittalandaxialT1-weightedi

2、mages.ideallywithMRIoftheentirespine.Contrast-enhancedimagesarehelpfulindeterminingthesolidportionofanintramedullaryneoplasm,tumoralvsnontumoralcysts,otherenhancingpathologicentities,orotherfeaturesthatmaymodifythedifferentialdiagnosis.WHENITISANACUTEMYELOPATHY，WHATCAUSESSHOULDBECONSIDERED?Inpatient

3、swithrecentonsetsymptoms,particularlyonesthatevolverapidly,theinitialpriorityistoexcludeasurgicalemergencysuchasepiduralmetastasisorabscess.immediateimagingisrequired,ideallywithMRIoftheentirespine.Ifimagingdemonstratesspinalcordcompressionduetoanacutelesionsuchasepiduralmetastasis,definitivemanagem

4、ent(i.e.,surgery)shouldbepursuedwithoutdelaytopreventrapidandirreversibleworsening.一、与肿瘤有关SagittalT1-weightedMRimage(a)ofthethoracicspineillustratesdiffusemarrowhypointensityGadolinium-enhancedT1-weightedMRimage(b)depictsmultipleheterogeneouslyenhancinglesions(yellowarrows).TheSTIRMRimage(c)showsabn

5、ormallyincreasedsignalintheposteriorelementsandthevertebralbodies.Acompressionfractureisseenintheupperthoracicspine(redarrow).Epidurallymphoma.A62-year-oldmanwithknownhistoryoflymphomapresentswithprogressivebackpainandlowerextremityweaknessandparesthesias.SagittalandaxialT2(A,C)andpostcontrastT1(B,

6、D)imagesdemonstrateanelongatedenhancingepiduralmass(longarrow)attheposterioraspectofthespinalcanalwithextensionintotheneuralforamina,causingcompressionanddisplacementofthethecalsacandspinalcordanteriorly.Ahypointensedura(arrowhead)isdisplacedanteriorly.Themassisinthesameposteriorepiduralspaceastheep

7、iduralfat(shortarrow).Intradural-extramedullaryschwannoma.A55-year-oldpatientwithrightlowerextremityweakness.SagittalandaxialT2(A,D)andpre-(B,E)andpostcontrastT1(C,F)imagesdemonstratearelativelyhomoge