磁共振对脊髓亚急性联合变性的诊断价值

摘要

目的 探讨磁共振对脊髓亚急性联合变性的诊断价值,以提高对本病诊断的准确性.方法 回顾性分析20例经临床证实的脊髓亚急性联合变性患者的资料,确诊前所有患者均行脊柱MRI检查,其中6例行增强扫描.结果 20例中,16例脊髓内可见异常信号(16/20,80%),颈髓受累8例,胸髓受累5例,颈胸髓同时受累3例,位于脊髓后索11例,侧索并后索3例,侧、后、前索同时受累2例,另1例扫描平面未在病灶水平;脊髓均未见明显肿胀;Gd-DTPA增强扫描1例轻度强化,余5例未见明显强化;血清VB12水平降低15例,正常3例,升高2例.治疗5~15个月后复查,MRI异常信号范围不同程度的缩小或消失.结论 磁共振结合临床及实验室检查对本病确诊及疗效随访具有重要价值.%Objective To investigate the diagnostic value of MRI in subacute combined degeneration of spinal cord so as to improve its diagnostic accuracy. Methods We retrospectively analyzed of clinic data of 20 patients suffered from subacute com-bined degeneration of spinal cord. All of the patients underwent MRI scan before clinical diagnosis. Six of them accepted en-hanced MRI scan. Results Of the 20 cases,16 cases show abnomal MRI signal in spinal cord(16/20,80%),8 cases involve cervical cord,5 involve thoracic cord,3 involve in both cervical and thoracic cord, the abnomal findings locate in posterior col-umn (11 cases),lateral and posterior column (3 cases), lateral column, posterior column and anterior column (2 cases). In addition,1 case scan is not shown the focus desion. All the cases present no obvious spinal cord swelling;1 case show slightly enhancement or 5 cases show no obvious enhancement after administration of Gd-DTPA. The level of vitamin B12 in 15 cases are lower than the normal value,3 cases are normal,and 2 cases were higher than the normal. lesions diminish or disappear in the follow-up MRI imaging after 5 to 15 months treatment. Conclusion MRI combined with clinical symptoms and laboratory exami-nation play an important role in the diagnosis and follow-up of SCD.