Heinz R, Wiener D, Friedman H, Tien R
Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA.
AJNR Am J Neuroradiol. 1995 May;16(5):1147-51.
To determine the sensitivity of contrast MR versus myelography followed by CT in the detection of cerebrospinal fluid metastases in children with primary central nervous system tumors.
Thirty-three patients who had primary central nervous system malignancies had spinal MR with gadolinium within 2 weeks of a myelogram followed by CT. MR technique included T1-weighted image sequences of the entire spine with and without gadolinium. CT scans were routinely performed at T-12 to L-2, L-4 to S-1, and foramen magnum to C-2. All studies were reviewed blindly; the number, character, and location of all metastases was recorded and the results of the two studies compared. Cerebrospinal fluid cytologic findings were recorded for each patient, and compared with the results of the imaging studies.
Seven of the 33 patients had metastases detected; metastases were seen on both MR and myelography followed by CT. However, MR showed 24 lesions and myelography followed by CT showed only 15. When a lesion was seen on both MR and myelography followed by CT, the MR was usually more convincing. Superficial lesions seen on MR sometimes would be missed on myelography followed by CT. Both MR and myelography followed by CT were quite sensitive in the detection of small lesions (2 to 3 mm) when present on spinal nerve roots. Whereas MR showed multiple lesions not seen on myelography followed by CT, CT failed to show any metastases not seen on MR. Imaging studies showed metastases in 3 patients who had normal cytologic findings.
MR shows significantly more cerebrospinal fluid metastases than myelography followed by CT.
确定对比增强磁共振成像（MR）与脊髓造影后CT在检测原发性中枢神经系统肿瘤患儿脑脊液转移瘤方面的敏感性。
33例原发性中枢神经系统恶性肿瘤患者在脊髓造影后2周内接受了钆增强脊髓MR检查，随后进行CT检查。MR技术包括整个脊柱的T1加权图像序列，有无钆增强。CT扫描常规在T12至L2、L4至S1以及枕骨大孔至C2水平进行。所有研究均进行盲法评估；记录所有转移瘤的数量、特征和位置，并比较两项研究的结果。记录每位患者的脑脊液细胞学检查结果，并与影像学研究结果进行比较。
33例患者中有7例检测到转移瘤；在MR和脊髓造影后CT上均可见转移瘤。然而，MR显示出24个病灶，而脊髓造影后CT仅显示15个。当在MR和脊髓造影后CT上均可见病灶时，MR通常更具说服力。MR上可见的浅表病灶有时在脊髓造影后CT上会被漏诊。当脊髓神经根上存在2至3毫米的小病灶时，MR和脊髓造影后CT在检测方面都相当敏感。虽然MR显示出脊髓造影后CT上未见的多个病灶，但CT未能显示出MR上未见的任何转移瘤。影像学研究显示，3例细胞学检查结果正常的患者存在转移瘤。
MR显示的脑脊液转移瘤明显多于脊髓造影后CT。
