Spinal cord swelling with abnormal gadolinium-enhancement mimicking intramedullary tumors in cervical spondylosis patients: Three case reports and review of the literature
Spinal cord swelling with abnormal gadolinium-enhancement mimicking intramedullary tumors in cervical spondylosis patients: Three case reports and review of the literature
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颈椎病患者脊髓肿胀伴异常钆增强模仿髓内肿瘤：三例报告及文献复习
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发表时间：
2010
期刊：
影响因子：
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通讯作者：
Y. Iwasaki
中科院分区：
文献类型：
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作者：
Toru Sasamori;K. Hida;S. Yano;Aoyama Takeshi;Y. Iwasaki
目的：脊髓肿胀伴异常钆增强是颈椎病患者术前罕见的影像学表现。对于进行性脊髓病，及时的手术减压是可以治愈的。病例介绍：我们报告3例脊髓型颈椎病患者。术前磁共振成像（MRI）显示颈椎病改变和髓内病变。我们注意到t2加权MRI显示高强度的颈髓肿胀和异常的Gd-DTPA增强。椎板成形术显著改善了患者的神经系统状况，术后MRI显示髓内病变在第一年逐渐消退。结论：我们认为我们患者的髓内病变反映了脊髓水肿和颈髓血脑屏障障碍，可能是由于轻微的复发性脊髓损伤和静脉循环紊乱。脊髓水肿在颈椎病患者中是一种罕见的疾病，准确的诊断和及时的手术是治疗的必要条件。因此，在颈椎MRI表现为髓内病变的颈椎病患者中，必须考虑这种不寻常的情况。术后病程的仔细评估可用于确认诊断并帮助选择后续治疗策略。
Objective: Spinal cord swelling with abnormal gadolinium (Gd) enhancement is a rare preoperative radiological finding in patients with cervical spondylosis. In the presence of progressive myelopathy, timely surgical decompression can be curative. Case presentation: We report 3 patients with cervical spondylotic myelopathy. Preoperative magnetic resonance imaging (MRI) revealed spondylotic changes and intramedullary lesions in the cervical spine. We noted cervical cord swelling with high intensity on T2-weighted MRI and abnormal Gd-DTPA enhancement. Laminoplasty resulted in marked improvement of their neurological condition and postoperative MRI revealed gradual regression of the intramedullary lesions during the first year. Conclusion: We posit that the intramedullary lesions in our patients were reflective of spinal cord edema with blood-brain-barrier disturbance in the cervical cord, possibly due to minor recurrent spinal cord injury and disturbed venous circulation. Spinal cord edema is a rare condition in patients with cervical spondylosis and an accurate diagnosis and timely surgery are necessary for cure. Therefore, this unusual condition must be considered in spondylosis patients manifesting as intramedullary lesions on MRI of the cervical spinal cord. Careful evaluation of the postoperative course can be used to confirm the diagnosis and help in selecting a subsequent therapeutic strategy.