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首页> 外文期刊>Annals of neurology >Specific pattern of gadolinium enhancement in spondylotic myelopathy
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Specific pattern of gadolinium enhancement in spondylotic myelopathy

机译：enhancement性脊髓病中enhancement增强的特定模式

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Objective To highlight a specific under-recognized radiological feature of spondylotic myelopathy often resulting in misdiagnosis. Methods Patients evaluated between January 1, 1996 and December 31, 2012 who met the following criteria were included: (1) spondylotic myelopathy was suspected, (2) gadolinium enhancement was detected, and (3) spinal surgery was performed. Results Fifty-six patients (70% men) whose median age was 53.5 years (range = 24-80) were included. Spinal cord magnetic resonance imaging (cervical in 52; thoracic in 4) revealed longitudinal spindle-shaped T2-signal hyperintensity (100%) and cord enlargement (79%) accompanied by a characteristic pancakelike transverse band of gadolinium enhancement in 41 (73%), typically immediately caudal to the site of maximal spinal stenosis. Forty (71%) patients were initially diagnosed with neoplastic or inflammatory myelopathies, and decompressive surgery was delayed by a median of 11 months (range = 1-64). Spinal cord biopsy in 6 did not reveal any alternative diagnosis. Ninety-five percent were stable or improved. Gadolinium enhancement persisted in 75% at 12 months, raising concern about the accuracy of the initial diagnosis. Twenty patients required a gait aid (36%) at last follow-up (median = 60 months, range = 10-172). The need for a gait aid preoperatively (p = 0.005), but not delay of surgery, predicted the need for gait aid at final follow-up. Interpretation Transverse pancakelike gadolinium enhancement associated with and just caudal to the site of maximal stenosis and at the rostrocaudal midpoint of a spindle-shaped T2 hyperintensity suggests that spondylosis is the cause of the myelopathy. Persistent enhancement for months to years following decompressive surgery is common. Recognition is important to prevent inappropriate interventions or delay in consideration of a potentially beneficial decompressive surgery. Ann Neurol 2014;76:54-65
机译：目的强调通常导致误诊的脊柱脊髓病的一种未被充分认识的放射学特征。方法在1996年1月1日至2012年12月31日期间进行评估的符合以下标准的患者包括：（1）怀疑是脊髓型脊髓病，（2）检测到enhancement增强，以及（3）进行了脊柱外科手术。结果纳入中位年龄为53.5岁（范围= 24-80）的56例患者（男性占70％）。脊髓磁共振成像（宫颈52例，胸廓4例）显示纵向纺锤状T2信号高信号（100％）和脐带增大（79％），伴有pan状特征性煎饼状横带增强（41％（73％）） ，通常直接在最大椎管狭窄部位尾部。最初有40名（71％）患者被诊断出患有肿瘤或炎症性骨髓病，并且减压手术被延迟了11个月（范围= 1至64）。 6例脊髓活检未显示任何其他诊断。 95％稳定或改善。 12增强在12个月时仍保持75％，引起人们对初始诊断准确性的关注。在最后一次随访中（中位= 60个月，范围= 10-172），有20位患者需要步态辅助（36％）。术前需要步态辅助（p = 0.005），但不延迟手术，预示了最终随访时需要步态辅助。解释与最大狭窄部位相关并仅在其尾部和纺锤状T2高血压的后尾状中点横穿煎饼样g表明，脊椎病是脊髓病的病因。减压手术后持续增强数月至数年是很常见的。考虑到可能有益的减压手术，识别对于防止不适当的干预或延迟很重要。 Ann Neurol 2014; 76：54-65

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