Spinale Hämatome: Was der Radiologe wissen muss

Spinale Hämatome müssen wegen ihrer klinischen Auswirkungen von anderen Pathologien des Markes unterschieden werden, damit die Patienten in geeigneter Weise und zügig behandelt werden können und das Risiko einer bleibenden neurologischen Schädigung gesenkt wird. Diagnostisch spielt die MRT dabei eine entscheidende Rolle. Der folgende Beitrag fasst die erforderlichen Kenntnisse kompakt und verständlich zusammen.

Abstract

Spinal hematomas are a frequent indication for radiologic evaluation and can be a diagnostic dilemma for many radiologists and surgeons. There are four types of spinal hematomas: epidural, subdural, subarachnoid, and intramedullary (spinal cord) hematomas. Because they differ by their location in relationship to the meningeal membranes and spinal cord, unique radiologic appearances can be recognized to distinguish these types of spinal hemorrhage. Anatomic knowledge of the spinal compartments is essential to the radiologist for confident imaging diagnosis of spinal hematomas and to specify correct locations. MRI is the modality of choice to diagnose the location of the hematoma, characterize important features such as age of the hemorrhage, and detect associated injury or disease. Each type of spinal hematoma has imaging patterns and characteristics that distinguish it from the others, as these specific spinal compartments displace and affect the adjacent anatomic structures. Early detection and accurate localization of spinal hematomas is critical for the surgeon to address the proper treatment and surgical decompression, when necessary, as neurologic deficits may otherwise become permanent.

Kernaussagen

• Die 3 Rückenmarkhäute Dura mater, Arachnoidea mater und Pia mater umhüllen das Rückenmark, die Nervenwurzeln und die Cauda equina. Diese Häute bilden die Grenzen der 4 als Epidural-, Subdural- und Subarachnoidalraum sowie Rückenmark- oder intramedullärer Raum definierten Räume.

• Bei der Abklärung eines epiduralen Hämatoms ist es sinnvoll, auf eine Auslöschung des epiduralen Fettes, eine Verdrängung der Dura mater und eine Kompression des Thekalsacks innerhalb des Spinalkanals zu achten.

• Subdurale Hämatome befinden sich innerhalb der Wand des Thekalsacks. Das epidurale Fettgewebe ist erhalten und es besteht keine Verdrängung der hypointensen Dura mater nach innen. Das erleichtert die Unterscheidung zwischen subdural und epidural gelegenen Flüssigkeitsansammlungen.

• Die Feststellung, dass eine Flüssigkeitsansammlung primär im Subduralraum und nicht im Epiduralraum lokalisiert ist, hilft dem Chirurgen, da es bedeutet, dass die Dura mater eröffnet werden muss (Durotomie), um die Flüssigkeitsansammlung zu entfernen.

• Eine Schichtung von Blutprodukten im Subarachnoidalraum zeigt sich typischerweise in der abhängigen unteren Lendenwirbelsäule. Es besteht keine externe Kompression der Dura mater oder des Thekalsacks und das epidurale Fett erscheint normal.

Schlüsselwörter

Spinale Hämatome - Kompartimente des Spinalkanals - Klinik - Bildgebung

Keywords

Spinal hematomas - spinal spaces - clinical characteristics - imaging pattern

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