中国神经再生研究(英文版)

中国神经再生研究(英文版) ›› 2013, Vol. 8 ›› Issue (26): 2484-2494.doi: 10.3969/j.issn.1673-5374.2013.26.010

• 原著:脊髓损伤修复保护与再生 • 上一篇    

脊髓炎性脱髓鞘假瘤的影像及临床特点

  

  • 收稿日期:2013-03-21 修回日期:2013-08-29 出版日期:2013-09-15 发布日期:2013-09-15

Imaging and clinical properties of inflammatory demyelinating pseudotumor in the spinal cord

Ying Wang, Min Wang, Hui Liang, Quntao Yu, Zhihui Yan, Min Kong   

  1. Department of Neurology, Yantai Shan Hospital, Yantai 264000, Shandong Province, China
  • Received:2013-03-21 Revised:2013-08-29 Online:2013-09-15 Published:2013-09-15
  • Contact: Hui Liang, Master, Chief physician, Master’s supervisor, Department of Neurology, Yantai Shan Hospital, Yantai 264000, Shandong Province, China, wangyrq@163.com.
  • About author:Ying Wang, Master, Chief physician, Master’s supervisor.

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摘要：

炎性脱髓鞘假瘤常发生于脑，发生在脊髓者少见，脊髓炎性脱髓鞘假瘤的影像学表现与髓内肿瘤例如胶质瘤等十分相似，临床上常被误诊为髓内肿瘤。鉴于此，文章对脊髓炎性脱髓鞘假瘤患者36例的临床表现、核磁共振、病理特点进行回顾性分析总结。患者多为急性或亚急性起病，主要为感觉运动障碍，其中6例在外科手术前误诊为髓内胶质瘤，手术后病理确诊。患者病变部位常见颈胸段磁共振成像显示病灶周边有不同程度的水肿及占位效应，非闭合性花环样强化的“开环征”为其重要特征。病理检查显示，6例误诊的手术患者静脉周围有较密集的以淋巴细胞为主的袖套状浸润，均可见大片髓鞘脱失。结果说明，脊髓瘤样炎性脱髓鞘病是一种较为特殊的脱髓鞘病，属于炎性假瘤，单发病灶易与髓内肿瘤混淆，核磁共振显示的斑片状或非闭合性强化为其重要特征，病理检查提示为病变部位炎性细胞浸润及髓鞘脱失。

关键词: 神经再生, 脊髓损伤, 脊髓, 肿瘤, 脱髓鞘病, 核磁共振, 影像增强, 神经胶质瘤 , 病理学, 炎性细胞浸润, 髓鞘脱失, 肾上腺皮质激素

Abstract:

Inflammatory demyelinating pseudotumor usually occurs in the brain and rarely occurs in the spinal cord. On imaging, inflammatory demyelinating pseudotumor appears very similar to intramedullary tumors such as gliomas. It is often misdiagnosed as intramedullary tumor and surgically resected. In view of this, the clinical and magnetic resonance imaging manifestations and the pathological fea-tures of 36 cases of inflammatory demyelinating pseudotumor in the spinal cord were retrospec-tively analyzed and summarized. Most of these cases suffered from acute or subacute onset and exhibited a sensorimotor disorder. Among them, six cases were misdiagnosed as having intrame-dullary gliomas, and inflammatory demyelinating pseudotumor was only identified and pathologi-cally confirmed after surgical resection. Lesions in the cervical and thoracic spinal cord were com-mon. Magnetic resonance imaging revealed edema and space-occupying lesions to varying de-grees at the cervical-thoracic junction, with a predominant feature of non-closed rosette-like rein-forcement (open-loop sign). Pathological examination showed perivascular cuffing of predominantly dense lymphocytes, and demyelination was observed in six of the misdiagnosed cases. These re-sults suggest that tumor-like inflammatory demyelinating disease in the spinal cord is a kind of special demyelinating disease that can be categorized as inflammatory pseudotumor. These solitary lesions are easily confused with intramedullary neoplasms. Patchy or non-closed reinforcement (open-ring sign) on magnetic resonance imaging is the predominant property of inflammatory de-myelinating pseudotumor, and inflammatory cell infiltration and demyelination are additional patho-logical properties.

Key words: neural regeneration, spinal cord injury, spinal cord, neoplasms, demyelinating disease, magnetic resonance imaging, image enhancement, multiple sclerosis, gliomas, inflammatory cell infiltration, neuroregeneration