无骨折脱位型颈脊髓中央损伤综合征患者椎间隙前缘MRI异常信号分析

Analysis of abnormal signal on MRI at the anterior border of intervertebral space in patients with central cord syndrome without fracture and dislocation

中文关键词:  颈椎  脊髓中央损伤综合征  磁共振成像  体层摄影术  X线计算机

英文关键词:Cervical spine  Central cord syndrome  MRI  Tomography  X-ray computed

中文摘要:

  【摘要】 目的：探讨无骨折脱位型颈脊髓中央损伤综合征患者椎间隙前缘MRI异常信号的影像学表现及临床意义。方法：纳入2016年1月～2021年12月无骨折脱位型颈脊髓中央损伤综合征且伴单一椎间隙前缘T2加权像高信号患者50例（男34例、女16例），年龄26~83岁（57.2±12.4岁）。根据对应区域T1加权像信号分为单高信号组（T2加权像高信号、T1加权像等/低信号）和双高信号组（T2、T1加权像均高信号）。收集两组病例一般资料，通过CT矢状位重建图像观察局部高密度灶及对应椎间盘和脊髓T2加权像信号变化，并对椎间隙前缘信号异常区域及邻近节段对应区域进行CT值测量比较。结果：本研究中单高信号组27例，男20例、女7例，平均年龄52.7±10.4岁（26～71岁），受伤至影像学检查平均时间9.5±4.8d，致伤原因以交通伤（15/27，55.6%）最为常见；双高信号组23例，男14例、女9例，平均年龄62.6±12.7岁（32~83岁），受伤至影像学检查平均时间8.9±4.6d，致伤原因以交通伤（9/23，39.1%）和跌倒伤（7/23，30.4%）相对常见。双高信号组年龄显著大于单高信号组（P=0.004），两组受伤时间、椎间隙前缘异常信号分布节段均无统计学差异（P=0.455；P=0.975）。两组局部高密度灶的出现率虽未达到明显的统计学差异（P=0.052），但单高信号组的出现百分比（9/27，33.3%）明显低于双高信号组（14/23，60.9%）。单高信号组对应椎间盘异常高信号出现率为55.6%，远高于双高信号组的21.7%（P=0.031）；对应层面脊髓异常高信号出现率两组分别为70.4%、30.4%，存在明显的统计学差异（P=0.005）。单高信号组椎间隙前缘信号异常区域CT值为125±66HU，显著低于双高信号组的232±163HU（P=0.003）；两组病例组内对比显示椎间隙前缘信号异常区域CT值均显著大于邻近椎间隙前缘CT值（P=0.038；P<0.001）；两组椎间隙前缘信号异常区域CT值与邻近椎间隙前缘CT值比值，单高信号组（1.3±0.7）显著低于双高信号组（2.7±2.7）（P=0.013）。结论：无骨折脱位型颈脊髓中央损伤综合征患者椎间隙前缘异常信号在MRI上可以分为单高信号（T2加权像高信号、T1加权像等/低信号）和双高信号（T2、T1加权像均高信号）改变。单高信号改变与椎间盘损伤、脊髓损伤更具相关性；而双高信号改变则提示局部存在以钙化为主的病理变化。

英文摘要:

  【Abstract】 Objectives: To investigate the imaging manifestations and clinical significance of abnormal signal on MRI at the anterior border of intervertebral space in patients with central cord syndrome(CCS) without fracture and dislocation. Methods: A total of 50 patients(34 males and 16 females) aged 57.2±12.4 years(26-83 years) with CCS without fracture and dislocation and accompanied with high signal intensity on T2WI at the anterior border of one single intervertebral space from January 2016 to December 2021 were included. According to signal intensity on T1WI at the corresponding area, the patients were divided into the single-high group(high signal intensity on T2WI and iso/low signal intensity on T1WI) and double-high group(high signal intensity on both T2WI and T1WI). The general data, the high-density areas on CT sagittal reconstruction image, the signal changes on T2WI at the corresponding discs and spinal cord, and the CT values measured at the anterior border of intervertebral space with abnormal signals and those measured at the adjacent segment were compared and analyzed between the two groups. Results: There were 27 patients in single-high group(20 males and 7 females) with an average age of 52.7±10.4 years(26-71 years) and an average time from injury to imaging examination of 9.5±4.8d, and traffic injury was the most common cause of injury(15/27, 55.6%). In double-high group, there were 23 patients(14 males and 9 females) with an average age of 62.6±12.7 years(32-83 years) and an average time from injury to imaging examination of 8.9±4.6d, and the common causes of injury were traffic injury(9/23, 39.1%) and fall injury(7/23, 30.4%). The age of double-high group was significantly older than that of single-high group(P=0.004), and there were no statistical differences in the injury time or distribution of abnormal signals between the two groups(P=0.455; P=0.975). Although there was no statistical difference in the incidence of the high-density area on CT image between the two groups(P=0.052), the incidence percentage in the single-high group(9/27, 33.3%) was relatively lower than that in double-high group(14/23, 60.9%). The incidence of high signal intensity in the disc in single-high group was 55.6%, which was much higher than that in double-high group(21.7%, P=0.031). The incidence of high signal intensity in the corresponding spinal cord was 70.4% and 30.4% in the two groups respectively, with statistical difference(P=0.005). The CT value of the anterior border of intervertebral space with abnormal signals in single-high group was 125±66HU, which was significantly lower than that in double-high group(232±163HU, P=0.003). Intragroup comparison showed that the CT value of the anterior border of intervertebral space with abnormal signals was significantly higher than that of the adjacent segment(P=0.038; P<0.001); The ratio of CT values between the two areas was significantly lower in the single-high group(1.3±0.7 vs 2.7±2.7, P=0.013). Conclusions: The abnormal signals on MRI at the anterior border of intervertebral space in patients with CCS without fracture and dislocation could be divided into single-high(high signal intensity on T2WI and iso/low signal intensity on T1WI) and double-high(high signal intensity on both T2WI and T1WI) changes. The former was closely related to injury in the disc and spinal cord, while the latter indicated the presence of pathological changes mainly characterized with calcification.