Horikoshi T, Hida K, Iwasaki Y, Abe H, Akino M
Department of Neurosurgery, Hokkaido University School of Medicine, Japan.
Surg Neurol. 2000 Mar;53(3):243-9. doi: 10.1016/s0090-3019(99)00168-8.
Intramedullary high-intensity changes on T2-weighted magnetic resonance images (MRI) occur in patients with spinal dural arteriovenous fistulas (AVF). Reduction of the high-intensity area after treatment has been noted; however, there are still questions about whether the change is related to preoperative clinical grade, postoperative improvement, or efficacy of treatment. This study tried to clarify the relationship between chronological changes in the high intensity area with the treatment and clinical course.
Chronological changes in an intramedullary high-intensity area after surgery were retrospectively analyzed in recent 13 patients with spinal dural AVFs who were treated and followed by MRI.
Preoperative intramedullary high-intensity areas were observed on T2-weighted images in all cases. The extent of the high-intensity area correlated with preoperative neurological deficits. The intramedullary high-intensity area was reduced or diminished after successful interruption of AVFs. The high-intensity area started to decrease within 1 to 4 months after treatment in all patients, and disappeared at 2 weeks to 23 months in seven patients. The reduction may suggest interruption of the fistula and improvement of venous circulation, but was not always correlated to clinical improvement. The intramedullary high-intensity areas rapidly disappeared in two patients, but did not clearly correspond to the clinical improvement.
The time course of postoperative MRI changes is helpful for evaluating the efficacy of treatment after surgery for spinal dural AVFs.
脊髓硬脊膜动静脉瘘（AVF）患者在T2加权磁共振成像（MRI）上会出现髓内高强度改变。已注意到治疗后高强度区域缩小；然而，关于这种变化是否与术前临床分级、术后改善或治疗效果相关仍存在疑问。本研究试图阐明高强度区域的时间变化与治疗及临床过程之间的关系。
对最近13例接受脊髓硬脊膜动静脉瘘治疗并通过MRI随访的患者术后髓内高强度区域的时间变化进行回顾性分析。
所有病例在T2加权图像上均观察到术前髓内高强度区域。高强度区域的范围与术前神经功能缺损相关。成功阻断动静脉瘘后，髓内高强度区域缩小或消失。所有患者的高强度区域在治疗后1至4个月内开始减小，7例患者在2周至23个月内消失。这种缩小可能提示瘘管阻断和静脉循环改善，但并不总是与临床改善相关。2例患者的髓内高强度区域迅速消失，但与临床改善并不明显对应。
术后MRI变化的时间过程有助于评估脊髓硬脊膜动静脉瘘手术后的治疗效果。
