Venous infarction of the spinal cord resulting from dural arteriovenous fistula: MR imaging findings.
Venous infarction of the spinal cord resulting from dural arteriovenous fistula: MR imaging findings.
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硬脑膜动静脉瘘引起的脊髓静脉梗塞：磁共振成像结果。
DOI：
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发表时间：
1991
期刊：
影响因子：
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通讯作者：
J. Jinkins
中科院分区：
文献类型：
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作者：
E. Larsson;P. Desai;C. W. Hardin;J. Story;J. Jinkins
3例硬脊膜动静脉瘘患者表现为急性和/或进行性脊髓病。其中2例患者在MR图像上可见胸椎脊髓局部扩大且界限不清。一人表现为局灶性脊髓萎缩，一人表现为鞘内血管异常。在所有患者中，MR研究显示静脉给药加多戊二胺后脊髓增强。MR的发现被认为是与脐带缺血和/或梗死相关的血脐带屏障的破坏，而血脐带缺血和/或梗死是由瘘管引起的静脉淤积引起的。每个病例的诊断都是通过脊髓造影、脊髓动脉造影和手术的综合结果来证实的。手术切除或栓塞瘘管产生了较差的恢复功能，但在麻痹的进展中停止。其中一名患者术后持续出现严重的背部和腿部疼痛，术后5个月的随访MR研究显示局灶性萎缩和胸脊髓持续增强。术前局灶性脊髓萎缩患者在手术前1年进行MR检查，显示脊髓增强，与术前立即MR检查相似。该患者术前还伴有严重的背部和下肢疼痛，并伴有进行性截瘫。我们认为，硬脑膜动静脉瘘患者脊髓的长期强化可能是由于慢性进行性静脉缺血，这可能是不可逆的，并引起中枢型疼痛。
Three patients with spinal dural arteriovenous fistula presented with acute and/or progressive myelopathy. The thoracic cord was focally enlarged and poorly defined on MR images in two of the patients. One individual showed focal cord atrophy, and one demonstrated abnormal intrathecal vessels. In all patients MR studies revealed cord enhancement after IV administration of gadopentetate dimeglumine. The MR findings are believed to represent disruption of the blood-cord barrier associated with cord ischemia and/or infarction, which, in turn, is caused by venous stasis resulting from the fistula. The diagnosis in each case was confirmed by the combined results of myelography, spinal arteriography, and surgery. Surgical excision or embolization of the fistula produced a poor return of lost function but an arrest in the progression of paresis. One of the patients had constant severe back and leg pain postoperatively, and a follow-up MR study 5 months after surgery showed focal atrophy and persistent enhancement of the thoracic cord. The patient with preoperative focal cord atrophy had an MR examination 1 year prior to surgery, which revealed enhancement of the cord similar to that seen on the immediate preoperative MR study. This patient also had severe pain in the back and lower extremities preoperatively, which accompanied her progressive paraparesis. It is believed that long-standing enhancement of the spinal cord in patients with dural arteriovenous fistula probably results from chronic progressive venous ischemia, which may be irreversible and cause pain of a central type.