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目的:探讨3.0T MR腰骶丛神经成像在探究神经源性膀胱(NB)病因中的价值。方法:回顾性分析119例NB患者的临床和影像资料。结果:影像诊断包括神经根肿瘤69例,骶神经多发异常T2WI高信号28例,脊髓栓系18例,隐性脊柱裂14例,骶尾部软组织包块3例,神经节细胞瘤2例,神经纤维瘤病1例,骶椎转移瘤1例,骶神经无异常27例。骶神经占位最常发生于S2神经根(62根),其次为S1(41根)、S3(28根)、S4-S5(24根);病变直径≥15mm者34枚,10~14mm者36枚,5~10mm者37枚,≤5mm者61枚。神经根占位MRI表现为椭圆形T2WI高信号,T1WI等信号;脊髓栓系MRI可见骶管内脂肪瘤、圆锥低位和马尾牵拉。骶尾部成熟畸胎瘤表现为T1WI、T2WI混杂高、低信号;神经节细胞瘤多呈T1WI低信号、T2WI高信号。神经纤维瘤病表现为位于脊柱旁的T1WI等信号、T2WI稍高信号;隐形脊柱裂表现为椎管畸形、棘突及椎板缺损。结论:MRI能准确、直观显示骶丛神经的特征及病灶的数量、位置,有助于NB的诊断、鉴别诊断及规范化治疗。
Objective: To investigate the value of 3.0T MR lumbosacral plexus neuroimaging in exploring the etiology of neurogenic bladder (NB). Methods: A retrospective analysis of 119 cases of NB patients with clinical and imaging data. Results: Imaging diagnosis included 69 cases of nerve root tumor, 28 cases of T2WI high signal of abnormal sacral nerve, 18 cases of tethered cord, 14 cases of recessive spina bifida, 3 cases of sacral soft tissue mass, 2 cases of ganglioneuroma, 1 case of fibromatosis, 1 case of sacral metastases, no abnormality of sacral nerves in 27 cases. Sacral nerve occupancy occurred most often in S2 nerve roots (62), followed by S1 (41), S3 (28) and S4-S5 (24), 34 lesions with diameter ≥15 mm and 10-14 mm 36, 5 ~ 10mm 37, ≤ 5mm 61. Nerve root MRI showed oval T2WI high signal, T1WI and other signals; spinal cords MRI showed sacral lipoma, cone low and pony traction. MALT teratoma showed T1WI, T2WI mixed high and low signal; ganglioneuroma mostly T1WI low signal, T2WI high signal. Neurofibromatosis manifested as T1WI and other signals located in the spine, T2WI slightly higher signal; invisible spina bifida showed spinal canal deformity, spinous process and lamina defect. Conclusion: MRI can accurately and intuitively show the features of sacral plexus and the number and location of lesions, which is helpful for the diagnosis, differential diagnosis and standardization of NB.