Neurological severity evaluation using magnetic resonance imaging in acute spontaneous spinal epidural haematomas
Neurological severity evaluation using magnetic resonance imaging in acute spontaneous spinal epidural haematomas
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DOI：
10.1007/s00264-022-05513-y
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发表时间：
2022-07-19
影响因子：
2.7
通讯作者：
Matsuda, Shuichi
中科院分区：
文献类型：
--
作者：
Honda, Shintaro;Fujibayashi, Shunsuke;Matsuda, Shuichi
目的本研究旨在通过磁共振成像（MRI）来阐明大量急性自发性脊髓硬膜外血肿（SSEH）患者神经功能缺损的严重程度。方法我们纳入了57例在11个机构接受急性SSEH治疗的患者，并回顾性分析了他们入院时的人口统计学和MRI数据。我们调查了MRI结果，如血肿长度和椎管占用率（COR）。根据入院时美国脊髓损伤协会评分评估SSEH的神经系统严重程度。结果57例患者中，35例（61%）表现为严重瘫痪。MRI分析显示，SSEH常位于颈椎，脊髓背侧，并分布在三个以上的椎骨。在有和没有严重瘫痪的患者之间没有发现年龄、性别和病因方面的差异。在重度瘫痪组中，血肿周围的低强度层、血肿内异质性和COR增加更常见。此外，对1例低强度层患者的解剖血肿进行病理学检查，发现血肿周围有胶原蛋白层，血肿内异质性患者更可能有出血倾向。结论：在这一大系列的SSEH患者中，我们发现了一些与严重瘫痪相关的MRI特征，如低信号层、血肿内异质性和COR增加。因此，具有这些MRI特征的患者应考虑早期手术干预。
Purpose This study aimed to elucidate the severity of neurological deficits in a large series of patients with acute spontaneous spinal epidural haematoma (SSEH) using magnetic resonance imaging (MRI). Methods We included 57 patients treated for acute SSEH at 11 institutions and retrospectively analysed their demographic and MRI data upon admission. We investigated MRI findings, such as the haematoma length and canal occupation ratio (COR). The neurological severity of SSEH was assessed based on the American Spinal Injury Association score on admission. Results Of the 57 patients, 35 (61%) presented with severe paralysis. The MRI analysis showed that SSEH was often located in the cervical spine, dorsal to the spinal cord, and spread over more than three vertebrae. No differences in age, sex, and aetiology were found between patients with and without severe paralysis. The hypo-intensity layer encircling the haematoma, intra-haematoma heterogeneity, and increased CORs were observed more frequently in the severe paralysis group. Furthermore, pathological examination of a dissected haematoma from one patient with a hypo-intensity layer revealed a collagen layer around the haematoma, and patients with intra-haematoma heterogeneity were more likely to have a bleeding predisposition. Conclusions In this large series of patients with SSEH, we identified some MRI features associated with severe paralysis, such as the hypo-intensity layer, intra-haematoma heterogeneity, and increased COR. Accordingly, patients with these MRI characteristics should be considered for early surgical intervention.