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中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2015, Vol. 12 ›› Issue (02) : 155 -159. doi: 10.3877/cma.j.issn.1672-6448.2015.02.014

所属专题： 文献；

中枢神经系统超声影像学

婴幼儿脊髓栓系综合征的超声诊断价值
刘磊1, 夏焙1,†(), 冯霞1, 林洲1, 王娟1, 许娜1, 周蔚1, 黄兵旋1, 吴姗1, 陈伟玲1   
  1. 1. 518038　汕头大学医学院附属深圳市儿童医院超声影像科
  • 收稿日期:2014-10-02 出版日期:2015-02-01
  • 通信作者: 夏焙
  • 基金资助:
    2014年度深圳市卫生计生系统科研项目-医疗卫生类(201402052)

Ultrasound in tethered cord syndrome in infants

Lei Liu1, Bei Xia1,†(), Xia Feng1, Zhou Lin1, Juan Wang1, Na Xu1, Wei Zhou1, Bingxuan Huang1, Shan Wu1, Weiling Chen1   

  1. 1. Department of Medical Ultrasound, Shenzhen Children’s Hospital, Shantou University Medical College, Shenzhen 518038, China
  • Received:2014-10-02 Published:2015-02-01
  • Corresponding author: Bei Xia
  • About author:
    Corresponding author: Xia Bei, Email:
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刘磊, 夏焙, 冯霞, 林洲, 王娟, 许娜, 周蔚, 黄兵旋, 吴姗, 陈伟玲. 婴幼儿脊髓栓系综合征的超声诊断价值[J]. 中华医学超声杂志（电子版）, 2015, 12(02): 155-159.

Lei Liu, Bei Xia, Xia Feng, Zhou Lin, Juan Wang, Na Xu, Wei Zhou, Bingxuan Huang, Shan Wu, Weiling Chen. Ultrasound in tethered cord syndrome in infants[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2015, 12(02): 155-159.

目的

探讨婴幼儿脊髓栓系综合征（TCS）的超声诊断价值。

方法

2005年12月至2013年7月深圳市儿童医院经手术确诊的TCS患儿25例，对其术前超声、MRI图像进行回顾性分析，评价超声诊断TCS的准确性及临床意义。

结果

25例经手术证实的TCS中，超声定位脊髓圆锥终止位置的符合率为96%（23/24），MRI符合率为100%（25/25）。超声显示脊髓振动减弱4例，脊髓振动消失21例，其中2例超声显示脊髓振动减弱者术中所见脊髓振动消失，超声显示脊髓振动消失诊断TCS的符合率为91%（21/23）。超声显示脊髓骶尾段形态与MRI完全相符，其中存在脊髓膨大4例，无脊髓膨大13例，脊髓末端鼠尾状8例。超声检查结果：25例TCS伴发畸形，其中脊膜膨出7例，伴脂肪瘤3例；脊髓脊膜膨出14例，伴脂肪瘤5例、脊髓积水1例；椎管-表皮瘘3例，均伴脂肪瘤；单发脂肪瘤1例。与手术结果比较，超声检查将2例脊髓脊膜膨出误诊为脊膜膨出，漏诊1例脊膜膨出伴发的脂肪瘤，MRI漏诊2例椎管-表皮瘘。

结论

婴幼儿脊柱超声检查可准确定位脊髓圆锥终止位置、精确显示脊髓形态。与MRI比较，超声检查可反复实时直观显示脊髓振动情况来判定脊髓栓系与否。超声检查具有便捷性、可重复操作以及费用低等优势，因此可作为诊断脊髓栓系的首选筛查手段。

关键词: 超声检查, 神经管缺损, 婴儿
Objective

To investigate the value of ultrasound in tethered cord syndrome (TCS) in infants.

Methods

From December 2005 to July 2013, 25 cases TCS were confirmed by surgery in Shenzhen children＇s hospital. The ultrasonogram and MRI of 25 infants were analysed retrospectively. The diagnostic accuracy of ultrasound and its clinical significance were evaluated.

Results

In 25 cases of TCS confirmed by surgery, the coincidence rate of conus level detected by ultrasound [96% (23/24)] was lower than that by MRI (100%(25/25)). Ultrasound showed reduced spinal cord vibration in 4 cases, disappeared spinal cord vibration in 21 cases. Two cases of reduced spinal cord vibration detected by ultrasound were confirmed as disappeared spinal cord vibration by surgery. The coincidence rate of disappeared spinal cord vibration detected by ultrasound was 91% (21/23). The sacral spinal segments form showed by ultrasound were entirely consistent with those of MRI, including 4 cases of enlarged spinal cord, 13 cases of spinal cord without enlargement and 8 cases of spinal cord ended with rat caudate. Twenty-five cases of TCS had malformations: 7 cases meningocele (3 cases combined lipoma), 14 cases myelomeningocele (5 cases combined lipoma, 1 case combined hydromyelia), 3 cases spinal canal-epidermis fistula (all combined lipoma) and 1 case solitary lipoma. Compared with the operation findings, ultrasound misdiagnosed 2 cases of myelomeningocele as meningocele, missed 1 of case lipoma which combined with meningocele. MRI missed two cases of spinal canal-epidermis fistula.

Conclusions

Infantile spinal ultrasound examination can accurately locate the position of conus, accurately display the spinal cord. Compared with MRI, ultrasound examination can real-time visually display spinal cord vibration and help to diagnose tethered cord. Ultrasound examination are convenient, repeatable operation with low cost, therefore it can be used as the preferred screening method to diagnose of tethered spinal cord.

Key words: Ultrasonography, Neural tube defects, Infant
图3 脊髓栓系综合征患儿脊髓圆锥呈鼠尾状者超声声像图（箭头示脊髓尾段）
图10，11 骶尾部脊髓终丝脂肪瘤超声和MRI图像。图10为超声声像图，显示脊髓内中等回声团块，未显示马尾、终丝回声；图11为MRI图像，T2加权像矢状图显示脊髓末端回声杂乱，形状不规则，呈中等信号
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