《急性及亚急性脊髓髓内病变MRI诊断与鉴别诊断思路》专题讲稿.ppt

Axial T2-weighted cervical magnetic resonance image shows an ovoid epidural hematoma (arrow) in the right postero-lateral aspect and spinal cord compression (arrowhead) Spinal Epidural Lubricant Grease CollectionMimicking Traumatic Spinal Epidural Hematoma we report an unusual presentation of a traumatic spinal epidural fluid collection, caused by a high-pressure injection injury of lubricant grease to the upper thorax and into the thoracic spinal canal. The spinal epidural fluid collection mimicked the appearance of an early subacute spinal epidural hematoma on spinal MR imaging. Again, the case of our patient illustrates the importance of detailed clinical information, including a thorough understanding of the mechanism of trauma at the time of interpretation of spinal imaging studies, since cord compression can rarely be caused by nonhemorrhagic fluid collection. 急性及亚急性脊髓髓内病变MRI诊断与鉴别诊断思路 脊髓病变 良性病变 脊髓空洞症 Ventriculus terminalis 挫伤 脓肿 梗塞 脊髓炎 多发性硬化 郝-伯二氏病（肉样瘤病） 动静脉的畸形 占位性病变 畸胎瘤 星形细胞瘤 室管膜瘤 成血管细胞瘤 淋巴瘤 成神经节细胞瘤 转移 The typical MR imaging protocol for evaluation of the spinal cord lesions unenhanced sagittal and axial T1-weighted and T2-weighted images post-gadolinium-enhanced sagittal and axial T1- weighted images. ideally with MRI of the entire spine. Contrast-enhanced images are helpful in determining the solid portion of an intramedullary neoplasm, tumoral vs nontumoral cysts, other enhancing pathologic entities, or other features that may modify the differential diagnosis. WHEN IT IS AN ACUTE MYELOPATHY ，WHAT CAUSES SHOULD BE CONSIDERED? In patients with recent onset symptoms, particularly ones that evolve rapidly, the initial priority is to exclude a surgical emergency such as epidural metastasis or abscess. immediate imaging is required, ideally with MRI of the entire spine. If imaging demonstrates spinal cord compression due to an acute lesion such as epidural metastasis, definitive management (i.e., surgery) should be pursued without