microcirculationРегионарное кровообращение и микроциркуляцияRegional blood circulation and microcirculation1682-66552712-9756Academician I.P. Pavlov First St. Petersburg State Medical University10.24884/1682-6655-2026-25-1-93-97microcirculation-1527Research ArticleКЛИНИЧЕСКИЙ СЛУЧАЙCLINICAL CASEДиагностические возможности спинальной МР-ангиографии и спинальной МР-трактографии у больного с сосудистой миелопатиейDiagnostic Utility of Spinal MR Angiography and Spinal MR Tractography in a Patient with Vascular Myelopathyhttps://orcid.org/0000-0001-5268-7033БеленькийВ. В.BelenkyV. V.

Беленький Вадим Викторович – врач-невролог.

188760, Ленинградская область, Приозерск, ул. Калинина, д. 43

Belenky Vadim V. – Neurologist.

43, Kalinina str., Priozersk, Leningrad Region, 188760

vad.belenky2017@yandex.ruhttps://orcid.org/0000-0001-9131-7924ПлахотинаН. А.PlakhotinaN. A.

Плахотина Надежда Александровна – канд. мед. наук, врач.

191144, Санкт-Петербург, ул. 6-я Советская, д. 24-26

Plakhotina Nadezhda A. – Candidate (PhD) of Medical Sciences, Radiologist.

24-26, 6th Sovetskaya str., Saint Petersburg, 191144

plahotina@ldc.ruhttps://orcid.org/0000-0002-8186-1878ДугаевП. А.DugaevP. A.

Дугаев Павел Андреевич – рентген-лаборант.

191144, Санкт-Петербург, ул. 6-я Советская, д. 24-26

Dugaev Pavel A. – Radiologic Technologist.

24-26, 6th Sovetskaya str., Saint Petersburg, 191144

underneaththestars@live.ruГосударственное бюджетное учреждение здравоохранения Ленинградской области «Приозерская межрайонная больница»РоссияPriozersk Interdistrict Central HospitalRussian FederationМедицинский институт им. Березина СергеяРоссияSergey Berezin Medical Institute (MIBS)Russian Federation2026270420262519397Copyright © Беленький В.В., Плахотина Н.А., Дугаев П.А., 20262026Беленький В.В., Плахотина Н.А., Дугаев П.А.Belenky V.V., Plakhotina N.A., Dugaev P.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.microcirc.ru/jour/article/view/1527

В статье описывается больной с острой нижней параплегией, у которого при спинальной МР-ангиографии отсутствовала визуализация артерии Адамкевича, были сужены и укорочены передняя спинальная артерия и артерия Депрож – Готтерона. МР-трактография показала неизмененный ход волокон нижних отделов спинного мозга. Данная картина обеднения спинального русла доказывает целесообразность использования спинальной МР-ангиографии для дифференциальной диагностики миелопатий. В 1968 году один из пионеров исследований сосудистой спинальной патологии Г. Лазорт писал, что «для невропатологов становится очевидно, что спинальная сосудистая патология встречается не реже, чем цереброваскулярная. Неврологические синдромы, ранее обозначавшиеся как миелиты, оказываются в большинстве случаев сосудистыми миелопатиями». Современные методы нейровизуализации подтверждают этот вывод.

This article describes a patient with acute lower paraplegia, in whom spinal MR angiography failed to visualize the artery of Adamkiewicz, while the anterior spinal artery and the artery of Desproges-Gottteron were narrowed and shortened. MR tractography demonstrated unchanged fiber pathways in the lower spinal cord. This pattern of spinal vascular depletion proves the expediency of using spinal MR angiography for the differential diagnosis of myelopathies. In 1968, one of the pioneers of research on vascular spinal pathology, G. Lazorthes, wrote that «it becomes obvious to neurologists that spinal vascular pathology is not less common than cerebrovascular pathology. Neurological syndromes, previously referred to as myelitis, turn out to be vascular myelopathies in most cases» (Lazorthes, 1992). Modern neuroimaging techniques confirm this conclusion.

спинальная МР-трактографияспинальная МР-ангиографияартерия Адамкевичапередняя спинномозговая артериясосудистая миелопатияspinal MR tractographyspinal MR angiographyartery of Adamkiewiczanterior spinal arteryvascular myelopathyReferencesWong SH, Boggild M, Enevoldson TP, Fletcher NA. Myelopathy but normal MRI: where next? Pract Neurol. 2008;8(2):90–102. Doi: 10.1136/jnnp.2008.144121.Wong SH, Boggild M, Enevoldson TP, Fletcher NA. Myelopathy but normal MRI: where next? Pract Neurol. 2008;8(2):90–102. Doi: 10.1136/jnnp.2008.144121.Costamagna G, Meneri M, Abati E, et al. Hyperacute extensive spinal cord infarction and negative spine magnetic resonance imaging: a case report and review of the literature. Medicine (Baltimore). 2020;99(43):e22900. Doi: 10.1097/MD.0000000000022900.Costamagna G, Meneri M, Abati E, et al. Hyperacute extensive spinal cord infarction and negative spine magnetic resonance imaging: a case report and review of the literature. Medicine (Baltimore). 2020;99(43):e22900. Doi: 10.1097/MD.0000000000022900.Moore AP, Blumhardt LD. A prospective survey of the causes of non-traumatic spastic paraparesis and tetraparesis in 585 patients. Spinal Cord. 1997;35(6):361–7. Doi: 10.1038/sj.sc.3100422.Moore AP, Blumhardt LD. A prospective survey of the causes of non-traumatic spastic paraparesis and tetraparesis in 585 patients. Spinal Cord. 1997;35(6):361–7. Doi: 10.1038/sj.sc.3100422.Dokponou YCH, Ontsi Obame FL, Takoutsing B, et al. Spinal cord infarction: A systematic review and meta-analysis of patient’s characteristics, diagnosis accuracy, management, and outcome. Surg Neurol Int. 2024;15:325. Doi: 10.25259/SNI_477_2024.Dokponou YCH, Ontsi Obame FL, Takoutsing B, et al. Spinal cord infarction: A systematic review and meta-analysis of patient’s characteristics, diagnosis accuracy, management, and outcome. Surg Neurol Int. 2024;15:325. Doi: 10.25259/SNI_477_2024.Novy J, Carruzzo A, Maeder P, Bogousslavsky J. Spinal cord ischemia: clinical and imaging patterns, pathogenesis, and outcomes in 27 patients. Arch Neurol. 2006;63(8):1113–20. Doi: 10.1001/archneur.63.8.1113.Novy J, Carruzzo A, Maeder P, Bogousslavsky J. Spinal cord ischemia: clinical and imaging patterns, pathogenesis, and outcomes in 27 patients. Arch Neurol. 2006;63(8):1113–20. Doi: 10.1001/archneur.63.8.1113.Thurnher MM, Bammer R. Diffusion-weighted MR imaging (DWI) in spinal cord ischemia. Neuroradiology. 2006;48(11):795–801. Doi: 10.1007/s00234-006-0130-z.Thurnher MM, Bammer R. Diffusion-weighted MR imaging (DWI) in spinal cord ischemia. Neuroradiology. 2006;48(11):795–801. Doi: 10.1007/s00234-006-0130-z.Kobayashi M. The utility of diffusion-weighted imaging in patients with spinal cord infarction: difference from the findings of neuromyelitis optica spectrum disorder. BMC Neurol. 2022;22(1):382. Doi: 10.1186/s12883-022-02903-y.Kobayashi M. The utility of diffusion-weighted imaging in patients with spinal cord infarction: difference from the findings of neuromyelitis optica spectrum disorder. BMC Neurol. 2022;22(1):382. Doi: 10.1186/s12883-022-02903-y.Пономарев Г. В., Агафонов А. О., Бариляк Н. Л. и др. МРТ-диагностика сосудистых миелопатий: от базовых последовательностей к перспективным протоколам исследования // Анналы клинической и экспериментальной неврологии. 2024. Т. 18, № 3. С. 81–90. Doi: 10.17816/ACEN.1065.Ponomarev GV, Agafonov AO, Barilyak NL, et al. Magnetic resonance imaging diagnostics of vascular myelopathies: from basic sequences to promising imaging protocols. Annals of Clinical and Experimental Neurology. 2024;18(3):81–90. (In Russ.). Doi: 10.17816/ACEN.1065.Cheng SJ, Tsai PH, Lee YT, et al. Diffusion Tensor Imaging of the Spinal Cord. Magn Reson Imaging Clin N Am. 2021;29(2):195–204. Doi: 10.1016/j.mric.2021.02.002.Cheng SJ, Tsai PH, Lee YT, et al. Diffusion Tensor Imaging of the Spinal Cord. Magn Reson Imaging Clin N Am. 2021;29(2):195–204. Doi: 10.1016/j.mric.2021.02.002.Lazorthes G. Vascularization and vascular pathophysiology of the spinal cord. In: Holtzman R, Stein B eds. Surgery of the spinal cord. New York: Springer – Verlag; 1992. P. 71–95.Lazorthes G. Vascularization and vascular pathophysiology of the spinal cord. In: Holtzman R, Stein B eds. Surgery of the spinal cord. New York: Springer – Verlag; 1992. P. 71–95.Saliou G, Krings T. Vascular diseases of the spine. Handb Clin Neurol. 2016;136:707–716. Doi: 10.1016/B9780-444-53486-6.00034-X.Saliou G, Krings T. Vascular diseases of the spine. Handb Clin Neurol. 2016;136:707–716. Doi: 10.1016/B9780-444-53486-6.00034-X.Скоромец А. А., Афанасьев В. В., Скоромец А. П., Скоромец Т. А. Сосудистые заболевания спинного мозга. Руководство для врачей. Санкт-Петербург: Политехника, 2019. 341 с. Doi: 10.25960/7325-1131-4.Skoromets AA, Afanasiev VV, Skoromets AP, Skoromets TA. Vascular diseases of the spinal cord: Handbook for practitioners. St. Petersburg: Politekhnika; 2019. 341 p. (In Russ.). Doi: 10.25960/7325-1131-4.Тиссен Т. П. Диагностика и лечение сосудистых заболеваний спинного мозга. Обнинск: Эрмис, 2017. 470 c.Tissen TP. The diagnosis and treatment of vascular diseases of the spinal cord. Obninsk: Ermis; 2017. 470 p. (In Russ.).Wiszniewska M, Sankowska M. Spinal cord ischemia – from diagnosis to treatment. Postep Psychiatr Neurol. 2024;33(2):93–97. Doi: 10.5114/ppn.2024.141367.Wiszniewska M, Sankowska M. Spinal cord ischemia – from diagnosis to treatment. Postep Psychiatr Neurol. 2024;33(2):93–97. Doi: 10.5114/ppn.2024.141367.Caton MT, Huff JS. Spinal cord ischemia. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023.Caton MT, Huff JS. Spinal cord ischemia. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023.Naik A, Houser SL, Moawad CM, et al. Noniatrogenic spinal cord ischemia: A patient level meta-analysis of 125 case reports and series. Surg Neurol Int. 2022;13:228. Doi: 10.25259/SNI_1252_2021.Naik A, Houser SL, Moawad CM, et al. Noniatrogenic spinal cord ischemia: A patient level meta-analysis of 125 case reports and series. Surg Neurol Int. 2022;13:228. Doi: 10.25259/SNI_1252_2021.McBride F, Anketell J, McDonnell GV, et al. Non-surgical spinal cord infarction: case series & long-term follow-up of functional outcome. Spinal Cord Ser Cases. 2024;10(1):73. Doi: 10.1038/s41394-024-00665.McBride F, Anketell J, McDonnell GV, et al. Non-surgical spinal cord infarction: case series & long-term follow-up of functional outcome. Spinal Cord Ser Cases. 2024;10(1):73. Doi: 10.1038/s41394-024-00665.Bowen BC. MR angiography of spinal vascular disease: what about normal vessels? AJNR Am J Neuroradiol. 1999;20(10):1773–1774.Bowen BC. MR angiography of spinal vascular disease: what about normal vessels? AJNR Am J Neuroradiol. 1999;20(10):1773–1774.Kawaharada N, Morishita K, Hyodoh H, et al. Magnetic resonance angiographic localization of the artery of Adamkiewicz for spinal cord blood supply. Ann Thorac Surg. 2004;78(3):846–51. Doi: 10.1016/j.athoracsur.2004.02.085.Kawaharada N, Morishita K, Hyodoh H, et al. Magnetic resonance angiographic localization of the artery of Adamkiewicz for spinal cord blood supply. Ann Thorac Surg. 2004;78(3):846–51. Doi: 10.1016/j.athoracsur.2004.02.085.Almeida AI, Vasconcelos-Castro S, Sampaio L. Successful technical note-identification of the Adamkievicz artery with 1.5 Tesla MR angiography in a 14-month-old child. Radiol Case Rep. 2022;18(1):188–191. Doi: 10.1016/j.radcr.2022.10.004.Almeida AI, Vasconcelos-Castro S, Sampaio L. Successful technical note-identification of the Adamkievicz artery with 1.5 Tesla MR angiography in a 14-month-old child. Radiol Case Rep. 2022;18(1):188–191. Doi: 10.1016/j.radcr.2022.10.004.Mizushima S, Mine T, Abe M, et al. Comparison of slow-infusion magnetic resonance angiography with sequential k-space filling and computed tomography angiography to detect the Adamkiewicz artery. Ann Vasc Surg. 2023;94:369–377. Doi: 10.1016/j.avsg.2023.02.027.Mizushima S, Mine T, Abe M, et al. Comparison of slow-infusion magnetic resonance angiography with sequential k-space filling and computed tomography angiography to detect the Adamkiewicz artery. Ann Vasc Surg. 2023;94:369–377. Doi: 10.1016/j.avsg.2023.02.027.Slavkov D. Artery of Adamkiewicz. Korean J Neurotrauma. 2022;18(2):399–403. Doi: 10.13004/kjnt.2022.18.e60.Slavkov D. Artery of Adamkiewicz. Korean J Neurotrauma. 2022;18(2):399–403. Doi: 10.13004/kjnt.2022.18.e60.Panuganti KK, Tadi P, Lui F. Transient ischemic attack. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026.Panuganti KK, Tadi P, Lui F. Transient ischemic attack. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026.

The authors declare that there are no conflicts of interest present.