急性横贯性脊髓炎的临床及磁共振特征分析
发布时间：2018-09-11 07:19
【摘要】：目的急性横贯性脊髓炎是一种复杂的病理生理学综合征,其典型临床表现为急性横贯性脊髓损害。尽管本病的发病率较低,但其预后差异较大,即使予以积极治疗,长期的随访研究显示仍有近1/3的患者将遗留永久性的严重神经功能障碍,降低患者的生存质量同时也给家庭及社会带来沉重负担。但本病如早期及时诊断、治疗,其致残率将大幅降低。本课题以ATM患者为研究对象,旨在分析探讨ATM首次发作的临床及MRI影像特征,协助该疾病的诊断和治疗以及判断预后。方法根据2002年横贯性脊髓炎联盟工作组(transverse myelitis consortium working group,TMCWG)制定的ATM的诊断标准,选取符合诊断及临床资料完整的56例ATM患者作为研究对象,且全部患者满足至少2年的随访结果以协助最终诊断。回顾性分析ATM患者首次发作的临床、MRI影像学特征。结果1)56例ATM患者首次发作后必须至少1次随访并随访时间超过2年,临床确诊为:多发性硬化(MS)19例(19/56,33.9%),视神经脊髓炎(NMO)10例(10/56,17.9%),系统性自身免疫性疾病3例(3/56,5.4%),类感染病因4例(4/56,7.1%),特发性横贯性脊髓炎20例(20/56,35.7%)。2)所有患者均有脊髓病变平面以下不同程度的运动、深浅感觉及自主神经功能障碍。3)MRI特征:颈髓18例,胸髓17例,颈胸髓受累13例,胸腰髓受累8例;33例病变脊髓轻度肿胀,23例脊髓形态未见异常;病灶平均长度为4.7个脊髓节段,病灶占据脊髓2/3以上横断面积29例,27例占据面积小于脊髓横断面的2/3;15例脊髓病变区无强化,41例病变区呈条状、斑片状等强化。结论结合临床和MRI影像特征,有利于ATM的诊断和鉴别诊断。
[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.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R744.3;R445.2
本文编号：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.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R744.3;R445.2
【参考文献】
相关期刊论文 前2条
1 冯逢;;多发性硬化的常见MRI征象分析[J];磁共振成像;2011年04期
2 李咏梅;谢鹏;罗天友;吕发金;胡梅;方维东;李信友;;脊髓MRI对多发性硬化的诊断和鉴别诊断价值[J];临床放射学杂志;2007年09期
，本文编号：2235999
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