Mehta Deepakkumar Vinodary
Professor, Department of Radiodiagnosis, Pramukhswami Medical College and Shree Krishna Hospital, Gokal Nagar, Karamsad, Anand, Gujarat, India.
J Clin Diagn Res. 2017 Aug;11(8):TC17-TC22. doi: 10.7860/JCDR/2017/30134.10393. Epub 2017 Aug 1.
Spinal dysraphism occurs due to failure of fusion of parts along dorsal aspect of midline structures lying along spinal axis from skin to vertebrae and spinal cord. Congenital spinal anomalies may be minimal and asymptomatic like spinal bifida occulta, or severe with marked neurological deficits like Arnold-Chiari malformation or caudal regression syndrome. Magnetic Resonance Imaging (MRI) is the modality of choice to diagnose mild to severe spinal dysraphism.
To diagnose type and extent of clinically suspected spinal anomalies by MRI scan and to compare various sequences for identifying neural tissue and fatty tissue in anomalies.
Fifty paediatric patients referred with clinical suspicion of spinal anomalies for MRI scan to radiodiagnosis department and diagnosed as having spinal dysraphism on 1.5 Tesla MRI Scan, were included in this observational analytic study. Various MRI sequences were taken in multiple planes. MRI findings of spinal dysraphism were compared with detailed clinical examination or surgical findings. Osseous anomalies like spina bifida occulta were confirmed by radiographs or CT scan.
Out of 50 patients, type II Arnold-Chiari Malformation (34%), Spina Bifida Occulta (22%) and Diastematomyelia (18%) were common anomalies. MRI findings were well correlated with surgical findings in 20 operated cases. Nerve roots with/ without neural placode in thecal sac/outpouching were detected in combination of 3D HASTE myelographic sequence with SE/ TSE T1W sequence in 24 cases; which was significantly high as compared to combinations of SE/TSE T1W sequence with TSE T2W, with STIR and with Single Shot Myelographic sequence {p-value 0.002, < 0.001 and 0.008 respectively}. Fatty component was present in dysraphism in five cases, commonly as isolated anomaly; which was detected by combination of STIR and SE/TSE T1W sequences in all five cases.
Paediatric spinal dysraphism and associated malformations are accurately diagnosed on MRI scan. MR myelographic 3D-HASTE and STIR sequences should be a part of protocol to evaluate spinal dysraphism.
脊柱裂是由于沿脊柱轴从皮肤到椎骨和脊髓的中线结构背侧部分融合失败所致。先天性脊柱异常可能很轻微且无症状，如隐性脊柱裂，也可能很严重并伴有明显的神经功能缺损，如阿诺德 - 奇亚里畸形或尾椎退化综合征。磁共振成像（MRI）是诊断轻至重度脊柱裂的首选检查方法。
通过MRI扫描诊断临床疑似脊柱异常的类型和程度，并比较不同序列在识别异常中神经组织和脂肪组织方面的效果。
本观察性分析研究纳入了50例因临床怀疑脊柱异常而转诊至放射诊断科进行MRI扫描，并在1.5特斯拉MRI扫描中被诊断为脊柱裂的儿科患者。在多个平面上采用了各种MRI序列。将脊柱裂的MRI表现与详细的临床检查或手术结果进行比较。隐性脊柱裂等骨异常通过X线片或CT扫描得以确诊。
50例患者中，II型阿诺德 - 奇亚里畸形（34%）、隐性脊柱裂（22%）和脊髓纵裂（18%）是常见的异常情况。在20例接受手术的病例中，MRI表现与手术结果高度相关。24例患者通过3D HASTE脊髓造影序列与SE/TSE T1W序列相结合检测到了硬脊膜囊/突出囊中带有/不带有神经基板的神经根；与SE/TSE T1W序列与TSE T2W序列、STIR序列以及单次激发脊髓造影序列的组合相比，这一组合的检出率显著更高（p值分别为0.002、<0.001和0.008）。5例脊柱裂病例中存在脂肪成分，通常为孤立性异常；在所有5例中均通过STIR序列与SE/TSE T1W序列的组合检测到了脂肪成分。
MRI扫描可准确诊断儿科脊柱裂及相关畸形。MR脊髓造影3D - HASTE序列和STIR序列应作为评估脊柱裂方案的一部分。
