Whiteman M L, Dandapani B K, Shebert R T, Post M J
Department of Radiology, University of Miami School of Medicine, FL 33136.
J Comput Assist Tomogr. 1994 Jan-Feb;18(1):7-11. doi: 10.1097/00004728-199401000-00002.
We describe the unusual syndrome of cytomegalovirus (CMV) polyradiculomyelitis and its MR findings in two patients with AIDS.
The clinical records and MRI studies of two patients with AIDS and CMV polyradiculomyelitis were reviewed. The MR images were performed on a Picker 1.0 or 1.5 T MR unit. Axial and sagittal T1-weighted images of the lumbar spine were obtained, pre- and post-Gd-DTPA (0.1 mmol/kg) administration. Gradient echo sagittal images were also obtained.
Precontrast images demonstrated a thickened cauda equina in both patients. In one patient the conus was ill defined on precontrast images. Post-contrast images demonstrated diffuse enhancement of the cauda equina in both patients as well as enhancement along the surface of the conus. In one patient the nerve roots were clumped and adherent to the walls of the thecal sac as well as to other nerve roots.
The clinical presentation of urinary retention, flaccid paraparesis, back and/or leg pain, and "saddle anesthesia" in a patient with AIDS should suggest the diagnosis of CMV polyradiculomyelitis. Although diffuse enhancement of the cauda equina on postcontrast MRI is a nonspecific finding, it would strongly support this diagnosis in the appropriate clinical setting. The diagnosis may be easily missed without the use of a contrast agent.
我们描述了巨细胞病毒（CMV）多神经根脊髓炎这一罕见综合征及其在两名艾滋病患者中的磁共振成像（MR）表现。
回顾了两名患有艾滋病及CMV多神经根脊髓炎患者的临床记录和MRI研究。MR图像在Picker 1.0或1.5 T MR设备上获取。在注射钆喷酸葡胺（Gd - DTPA，0.1 mmol/kg）前后，获取腰椎的轴位和矢状位T1加权图像。还获取了梯度回波矢状位图像。
增强前图像显示两名患者的马尾神经均增粗。在一名患者中，增强前图像上圆锥界限不清。增强后图像显示两名患者的马尾神经均有弥漫性强化，以及圆锥表面的强化。在一名患者中，神经根聚集并附着于硬膜囊壁以及其他神经根。
艾滋病患者出现尿潴留、弛缓性截瘫、背部和/或腿部疼痛以及“鞍区感觉缺失”的临床表现应提示CMV多神经根脊髓炎的诊断。尽管增强后MRI上马尾神经的弥漫性强化是一个非特异性表现，但在适当的临床背景下，它将有力支持这一诊断。若不使用造影剂，该诊断可能容易被漏诊。
