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目的探讨特发性急性横贯性脊髓炎(IATM)的临床特征及MRI特点,提高对其诊断准确性。方法对41例首次发病并住院诊治的IATM患者的临床资料及MRI图像进行回顾性分析。结果 (1)临床症状:首发症状为肢体麻木无力共28例(68.29%);截瘫12例(29.27%),尿便障碍/失禁25例(60.98%)。查体所有患者均有感觉障碍并伴有明确的感觉平面,其中39例(95.12%)表现为痛觉减退,2例(4.88%)表现为痛觉过敏。(2)MRI特征:41例患者中38例(92.68%)MRI显示异常,表现为T2WI条片状高信号,其中颈髓11例(28.95%),胸髓22例(57.89%),颈胸髓1例(2.63%),胸髓及马尾4例(10.53%);脊髓肿胀11例(28.95%)。21例患者行增强扫描检查,13例(61.90%)轻-中度强化。结论肢体麻木无力、尿便障碍及确切感觉平面以下的痛觉减退为IATM较主要的临床表现。临床表现与MRI特征相结合,有利于IATM的诊断。
Objective To investigate the clinical features and MRI features of idiopathic acute transverse myelitis (IATM) and to improve its diagnostic accuracy. Methods The clinical data and MRI images of 41 first-onset IATM patients were analyzed retrospectively. Results (1) Clinical symptoms: The first symptom was numbness of limb numbness in 28 cases (68.29%); paraplegia in 12 cases (29.27%), urine stool / incontinence in 25 cases (60.98%). All patients in the examination had sensory disturbances accompanied by a definite sensory plane, 39 (95.12%) showed pain relief, and 2 (4.88%) showed hyperalgesia. (2) MRI features: MRI findings of 38 patients (92.68%) in 41 patients showed abnormal MRI findings, including 11 cases of cervical spinal cord (28.95%), 22 cases of cystic marrow (57.89%), 1 case of marrow (2.63%), 4 cases of chest and cauda equina (10.53%), 11 cases of spinal cord swelling (28.95%). Twenty - one patients underwent enhanced scan and 13 (61.90%) had mild to moderate enhancement. Conclusion It is the main clinical manifestation of IATM that the numbness of limbs is weak, urinary stool disorder and the degree of pain decrease below the exact sensory level. The combination of clinical manifestations and MRI features facilitates the diagnosis of IATM.