儿童髓外硬膜下结核瘤的临床特点及MRI诊断.doc

儿童髓外硬膜下结核瘤的临床特点及MRI诊断 秦勇1 ,蔡金华1,兰秀夫2 ,李禄生3 (400014 重庆，重庆医科大学：附属儿童医院放射科1，神经外科3；400042，第三军医大学，第三附属大坪医院骨科2) ［摘要］目的 探讨儿童髓外硬膜下结核瘤（IET）的临床特点及MRI表现。方法 回顾性分析7例儿童IET患者的临床资料和MRI表现。所有病例均经手术及组织病理学证实。结果 7例患者均有其它部位结核病史，临床主要表现为不同程度的进行性肢体瘫痪及感觉功能障碍、尿潴留或尿失禁等脊髓压迫症状。初发症状出现于抗结核治疗后3个月以内3例，3~6个月1例，6~9个月3例。MR平扫及增强扫描可发现全部IET，病灶呈长梭形或扁豆状位于椎管内脊髓后方纵向走行，胸段多发，相应脊髓节段有不同程度受压征象。T1WI呈稍低信号或等信号，T2WI等信号或混杂高信号，增强后病灶呈均匀或不均匀明显强化。结论 IET可能是机体对抗结核药物治疗所发生的矛盾反应的结果，MRI检查特别是增强扫描可清楚显示病变的范围、形态和信号特点，结合临床可对IET做出及时、正确的诊断。 ［关键词］结核瘤；硬膜下；髓外；核磁共振成像 ［中图法分类号］ R816.8;R816.92 ［文献标识码］ A Clinical features and MRI diagnosis of Intradural extramedullary tuberculomas in children Qin Yong1, Cai Jinhua1,Lan Xiufu2,Li Lusheng3 (1Department of Radiology, 3Neurosurgery,Children Hospital of Chongqing Medical University, Chongqing 400014;2Department of Orthopedics,The Third Military University,Chongqing,400042) 【Abstract】 Objective To study the clinical and MRI features of intradural extramedullary tuberculomas(IET) in children. Methods The clinical data and MRI findings in seven children with IET confirmed by surgery and pathology were analyzed retrospectively. Results All 7 cases of IET had a history of tuberculosis in other organs. The main clinical manifestations were progressive paresis and sensory disturbance in extremities accompanying with urinary retention or urinary incontinence，which were caused by spinal compression. The compressive myelopathy was first discovered within 3 months in 3 cases, 3 to 6 months in 1 case, and 6 to 9 months in 3cases respectively after initiation of antituberculous chemotherapy. All the tuberculomas were detected with plain and enhanced MR scanning. The lesions showed longitudinal fusiform or bean-shaped, and located posterior to the spinal cord, with a high incidence of thoracic segments. The spinal cord segments corresponding to the lesions were compressed to different degree. The tuberculomas presented with isointensity or hypointensity on T1WI, and isointensity or inh