急性橫貫性脊髓炎的臨床及磁共振特征分析
發(fā)布時(shí)間：2018-09-11 07:19
【摘要】：目的急性橫貫性脊髓炎是一種復(fù)雜的病理生理學(xué)綜合征,其典型臨床表現(xiàn)為急性橫貫性脊髓損害。盡管本病的發(fā)病率較低,但其預(yù)后差異較大,即使予以積極治療,長期的隨訪研究顯示仍有近1/3的患者將遺留永久性的嚴(yán)重神經(jīng)功能障礙,降低患者的生存質(zhì)量同時(shí)也給家庭及社會(huì)帶來沉重負(fù)擔(dān)。但本病如早期及時(shí)診斷、治療,其致殘率將大幅降低。本課題以ATM患者為研究對(duì)象,旨在分析探討ATM首次發(fā)作的臨床及MRI影像特征,協(xié)助該疾病的診斷和治療以及判斷預(yù)后。方法根據(jù)2002年橫貫性脊髓炎聯(lián)盟工作組(transverse myelitis consortium working group,TMCWG)制定的ATM的診斷標(biāo)準(zhǔn),選取符合診斷及臨床資料完整的56例ATM患者作為研究對(duì)象,且全部患者滿足至少2年的隨訪結(jié)果以協(xié)助最終診斷。回顧性分析ATM患者首次發(fā)作的臨床、MRI影像學(xué)特征。結(jié)果1)56例ATM患者首次發(fā)作后必須至少1次隨訪并隨訪時(shí)間超過2年,臨床確診為:多發(fā)性硬化(MS)19例(19/56,33.9%),視神經(jīng)脊髓炎(NMO)10例(10/56,17.9%),系統(tǒng)性自身免疫性疾病3例(3/56,5.4%),類感染病因4例(4/56,7.1%),特發(fā)性橫貫性脊髓炎20例(20/56,35.7%)。2)所有患者均有脊髓病變平面以下不同程度的運(yùn)動(dòng)、深淺感覺及自主神經(jīng)功能障礙。3)MRI特征:頸髓18例,胸髓17例,頸胸髓受累13例,胸腰髓受累8例;33例病變脊髓輕度腫脹,23例脊髓形態(tài)未見異常;病灶平均長度為4.7個(gè)脊髓節(jié)段,病灶占據(jù)脊髓2/3以上橫斷面積29例,27例占據(jù)面積小于脊髓橫斷面的2/3;15例脊髓病變區(qū)無強(qiáng)化,41例病變區(qū)呈條狀、斑片狀等強(qiáng)化。結(jié)論結(jié)合臨床和MRI影像特征,有利于ATM的診斷和鑒別診斷。
[Abstract]:Objective Acute transverse myelitis (ATM) is a complex pathophysiological syndrome characterized by acute transverse spinal cord injury. Although the incidence of the disease is low, the prognosis varies greatly. Even with active treatment, long-term follow-up studies show that nearly one third of the patients will still have permanent severe neurological impairment. However, if the disease is diagnosed and treated early and promptly, the disability rate will be greatly reduced. The purpose of this study is to analyze the clinical and MRI features of the first attack of ATM, to help the diagnosis, treatment and prognosis of the disease. According to the diagnostic criteria of ATM established by the transverse myelitis consortium working group (TMCWG) in 2002, 56 patients with ATM who met the diagnostic criteria and clinical data were selected as the study subjects. All patients met the follow-up results of at least 2 years to assist in the final diagnosis. Results 1) Fifty-six patients with ATM must be followed up at least once after the first attack for more than two years. The clinical diagnosis was multiple sclerosis (MS) in 19 cases (19/56,33.9%), optic neuromyelitis (NMO) in 10 cases (10/56,17.9%), systemic autoimmune diseases in 3 cases (3/56,5.4%) and infection-like causes in 4 cases (4/56,7.1%) and idiopathic diseases. Twenty patients (20/56,35.7%) with transverse myelitis had different degrees of motor, deep and shallow sensory and autonomic dysfunction below the level of myelopathy. Among the 4.7 spinal segments, 29 lesions occupied more than 2/3 of the transverse area of the spinal cord, 27 lesions occupied less than 2/3 of the transverse area of the spinal cord, 15 lesions showed no enhancement, 41 lesions showed stripe and patchy enhancement.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R744.3;R445.2
本文編號(hào)：2235999
[Abstract]:Objective Acute transverse myelitis (ATM) is a complex pathophysiological syndrome characterized by acute transverse spinal cord injury. Although the incidence of the disease is low, the prognosis varies greatly. Even with active treatment, long-term follow-up studies show that nearly one third of the patients will still have permanent severe neurological impairment. However, if the disease is diagnosed and treated early and promptly, the disability rate will be greatly reduced. The purpose of this study is to analyze the clinical and MRI features of the first attack of ATM, to help the diagnosis, treatment and prognosis of the disease. According to the diagnostic criteria of ATM established by the transverse myelitis consortium working group (TMCWG) in 2002, 56 patients with ATM who met the diagnostic criteria and clinical data were selected as the study subjects. All patients met the follow-up results of at least 2 years to assist in the final diagnosis. Results 1) Fifty-six patients with ATM must be followed up at least once after the first attack for more than two years. The clinical diagnosis was multiple sclerosis (MS) in 19 cases (19/56,33.9%), optic neuromyelitis (NMO) in 10 cases (10/56,17.9%), systemic autoimmune diseases in 3 cases (3/56,5.4%) and infection-like causes in 4 cases (4/56,7.1%) and idiopathic diseases. Twenty patients (20/56,35.7%) with transverse myelitis had different degrees of motor, deep and shallow sensory and autonomic dysfunction below the level of myelopathy. Among the 4.7 spinal segments, 29 lesions occupied more than 2/3 of the transverse area of the spinal cord, 27 lesions occupied less than 2/3 of the transverse area of the spinal cord, 15 lesions showed no enhancement, 41 lesions showed stripe and patchy enhancement.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R744.3;R445.2
【參考文獻(xiàn)】
相關(guān)期刊論文 前2條
1 馮逢;;多發(fā)性硬化的常見MRI征象分析[J];磁共振成像;2011年04期
2 李詠梅;謝鵬;羅天友;呂發(fā)金;胡梅;方維東;李信友;;脊髓MRI對(duì)多發(fā)性硬化的診斷和鑒別診斷價(jià)值[J];臨床放射學(xué)雜志;2007年09期
，本文編號(hào)：2235999
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