Spinal Disfarizm’li Olgularda Manyetik Rezonans Görüntülemenin Etkinliği

Year 2011, Volume: 5 Issue: 3, 113 - 123, 26.12.2011

Aynur Turan

Abstract

Amaç: Spinal disrafizm (SD) şüphesi olan olgularda, manyetik resonans görüntüleme (MRG)’nin spinal malformasyonları saptamada ve sınıflandırmadaki etkinliğinin değerlendirilmesi amaçlanmıştır.

Gereç-yöntem: 3 gün ile 20 yaş aralığındaki spinal disrafizm şüphesi veya ön tanısı ile 40 hastaya spinal MRG tetkiki gerçekleştirildi. 40 hastanın 23’ü MRG tetkiki sonrası opere oldu. Operasyon ile MRG bulguları karşılaştırıldı. 40 hastanın 11’ine ultrason (US) tetkiki uygulandı. US incelemeleri lineer prob ile aksiyal ve sagital planda gerçekleştirildi. Posterior
eleman ossifikasyonu tamamlanan hastalara ve retrospektif olarak çalışmaya dahil edilen hastalara US tetkiki uygulanamadı. US bulguları ile MRG sonuçları karşılaştırıldı.

Bulgular; 40 hastanın 27’si (% 67.5) kadın, 13’ü(% 32.5) erkekti. 14 (% 35) olguda açık SD, 26 (%65’) olguda kapalı SD saptandı. Kapalı SD saptanan 26 olgunun 15’inde (%57.7) kutanöz bulgular mevcuttu.
40 hastanın lezyon dağılımı; (5) lipomyelosel, (2) lipomyelomeningosel, (14) myelomeningosel (MM), (18) tethered kord, (11) diastematomiyeli (DMM) (3) dermal sinüs trakt (DST),
(2) filum terminale, (9) siringohidromyeli, (5) hemivertebra, (2) kelebek vertebra, (2) epidural lipomatozis, (2) segmentasyon anomalisi (1) myelosistosel (MS), (5) skolyoz , (4) spinal
lipom, (5) subkutan lipom, (3) sirinks, (3) hidromyeli, (3) gergin spinal kord şeklinde idi. 40 hastanın 11’ine US tetkiki uygulandı. 9 olguda başarılı görüntüleme sağlanabildi; 2 olguda
yeterli düzeyde görüntüleme elde edilemedi. 9 hastanın 7’sinde elde edilen bulgular MRG sonuçları ile uyumlu bulundu.
40 hastanın 23’ü opere oldu. MRG ile bu hastalardan 14’inde MM, 1’inde MS, 6’sında DMM, 2’sinde DST saptandı. Operasyon sonuçları ile MRG bulguları uyumlu bulundu.

Sonuç: MRG, iyi kontrast rezolüsyonu, multiplanar ve multisekans görüntüleme ve yumuşak doku patolojilerinin gösterilmesindeki üstünlükleri ile SD olgularında ilk tercih edilecek yöntem olmalıdır. Olguların çoğunda, klinik, embriyolojik ve nöroradyolojik bilgilerin korelasyonuna dayalı rasyonel bir yaklaşım ile tanı kolaylaşmaktadır.

ABSTRACT
Objective: To evaluate the diagnostic efficiency of spinal Magnetic Resonance Imaging (MRI) in the detection and classifications of spinal malformations.

Materials and Methods: MRI was performed to 40 patients ( 3 day-20 years) who refer with spinal dysrafism prediagnosis. 23 of 40 patients were operated after MRI. MRI findings
were compared with the operation findings. Ultrasonography (US) was performed to 11 of 40 patients. The examination was performed with lineer transducers in the sagittal and axial
planes. US could not be performed to the patients with completed posterior element ossifications and to those included retrospectively in the study. US findings were compared with the MRI findings.

Results: Of the 40 patients, 27 (67,5%)were women, and 13 (32,5%) were men. Open spinal dysraphism was diagnosed in 14 (35%) patients while closed spinal dysraphism was
diagnosed in 26 (65%) patients. 15 (57,7%) patients in 26 cases with closed spinal dysraphism had cutaneous findings. The distribution of lesions of 40 patients were as follows;
(5) lipomyelocele, (2) lipomyelomeningocele, (14) myelomeningocele (MM), (18) tethered cord, (11) diastematomyelia (DMM), (3) dermal sinuses tract (DST), (2) filum terminale, (9)
syringohydromyelia (5) hemivertebrae, (2) butterfly vertebra, (2) epidural lipomatosis, (2) segmentation anomalies, (1) myelocystocele (MS), (5) scoliosis, (4) spinal lipom, (5) subcutaneous lipom, (3) syrincs, (3) hydromyelia, (3) tight spinal cord. Ultrasonography (US) was performed to 11 of the 40 patients. Successful imaging was
achieved in 9 cases; sonography was indetermined in 2 cases. Sonography findings were consistent with MR findings in 7 of 9 patients. 23 of 40 patients were operated. 14 MM,1MS, 6 DMM,2 DST were detected with the MRI of these patients. Operation results were consistent with the MRI findings.

Conclusions: MRI should be the first screening modality in detecting the origin and the characterisation of the spinal dysraphism cases with well-contrast resolution, multiplanar
and multisecans imaging and its superiority in detecting soft tissue pathologies. The diagnosis is easier with a rational approach based on the correlation of clinical, embryological and neuroradiological information in most cases.

Keywords

Meningosel, sipina bifida, spinal disrafizm

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