MSCT及MRI在胸腰椎爆裂型骨折的临床应用价值分析

目的 探讨多层螺旋CT（MSCT）及磁共振成像（MRI）在胸腰椎爆裂型骨折中的临床应用价值.方法 回顾性分析52例胸腰椎爆裂型骨折临床、影像学资料,所有患者均行MSCT及MRI检查,比较两者诊断结果,分析骨折合并脊髓、韧带及椎间盘损伤等情况MSCT、MRI表现.结果 52例中,椎管内骨折片的显示MSCT优于MRI（49个比40个,P＜0.05）;韧带、脊髓及椎间盘等软组织损伤的显示MRI均优于MSCT,MRI发现韧带损伤15例,MSCT 1例（P＜0.01）;脊髓损伤CT检出6例,MRI 25例（P＜0.01）;椎间盘损伤MSCT检出5例,MRI 39例（P＜0.01）.结论 脊柱损伤应常规行MSCT检查,MRI应作为韧带、脊髓损伤的首选检查.胸腰椎爆裂型骨折尤其存在不稳定骨折者,应同时选用MSCT和MRI检查.     

MSCT与MR联合诊断颈椎外伤

目的 探讨MSCT与MR联合诊断颈椎外伤的价值.方法 收集54例经手术证实或脊柱外科及放射科共同确诊为颈椎外伤的病例,回顾性分析比较X线平片、MSCT与MR影像特征.结果 ①骨性结构损伤:颈椎骨折伴脱位者33例、无脱位骨折者17例、无骨折脱位4例,其中X线平片、MSCT、MR检出率分别为66.67%、98.15%、83.33%,MSCT与MR联合检出率为98.15%.椎管狭窄0级7例、1级32例、2级14例、3级1例,其中X线平片、MSCT、MR检出率分别为21.28%、74.47%、95.75%,MSCT与MRI联合检出率为100%.依据Denis诊断标准,MSCT诊断c柱或包括c柱在内的两柱或三柱联合受累发生率较高,且骨性椎管多发生狭窄,颈椎处于不稳定状态.②椎间盘、韧带、神经损伤:颈间盘外伤性突出者22例、周围韧带损伤21例、神经损伤2例.③脊髓损伤:MR诊断Ⅰ型25例;Ⅱ型28例;Ⅲ型1例.脊髓受压30例;未受压24例.结论 MSCT与MR在颈椎外伤的诊断中各具优势,二者联合诊断有益于颈椎外伤诊断与合理治疗方案的制定.     

脊柱骨折神经功能缺损的影像学评价

目的分析脊柱骨折脊髓损伤程度与螺旋CT(spiralCT,SCT)、磁共振成像(MRI)的相关性,探讨脊髓损伤的影像学诊断价值。方法回顾分析60例资料较齐全的胸腰段脊柱骨折患者临床资料与SCT后处理(MPR、SSD、VR法)及MRI表现。结果神经功能缺损程度与SCT表现的椎体压缩、后突畸形、椎管变形等无明确对应关系;中后柱结构损伤伴神经功能缺损者占86.4%;一部分MRI脊髓表现与SCT呈现出的间接征象有所不同。结论广义的后柱结构与神经功能损伤关系更为密切。     

MSCT和MRI对脊柱创伤的伤情评估的比较

目的:比较MSCT和MRI对脊柱创伤的评估。方法:收集65例脊柱创伤的MSCT和MRI资料进行对比分析。结果:MSCT对显示椎体及其附件骨折线和骨折片的移位较MRI清晰,MRI对显示脊柱骨组织水肿挫伤、韧带损伤、椎管内血肿及脊髓挫伤等明显优于MSCT。结论:MRI对脊柱的创伤评估方面明显优于MSCT,有利于治疗方法的选择和手术时机的掌握,提高脊柱脊髓创伤的诊断治疗水平。     

脊柱爆裂型骨折影像学表现及检查价值分析

目的：评价DR平片、CT、MRI三种影像学检查对脊柱爆裂型骨折诊断价值和限度。材料与方法：对35例脊柱不同部位爆裂骨折影像平片表现进行分析，比较其优缺点。结果：爆裂型骨折以胸腰段最常见，占脊柱骨折的77％，常伴有骨碎片突入椎管致椎管狭窄，椎间盘突出，脊髓受压、水肿、出血。脊髓横断是最严重的脊髓创伤。结论：影像学检查是脊柱、脊髓创伤的重要手段。DR平片是脊柱爆裂骨折的基本诊断方法，CT对判断椎体纵行、矢状方向骨折、椎管狭窄及移位有着重要价值。MRI是准确判断脊髓损伤程度的首选最佳方法。     

胸腰椎外伤性骨折MRI诊断与X线平片对照分析

目的 评价MRI在胸腰椎损伤诊断中的价值。方法 对比分析21例胸腰椎骨折的MRI及X线平片表现/。结果 X线平片21例共32节胸腰椎发生椎体骨折，其中单椎体骨折者11例，多椎体骨折者10例；单纯屈曲压缩型13例，爆裂型4例，骨折脱位型4例；附件骨折3例，MRI扫描所见椎体骨折的类型与X线平片均相同，但对附件骨折显示较差（仅显示1例），另外MRI发现椎体轻度骨挫伤10例共计19节，脊髓损伤8例，韧带损伤10例，硬膜外血肿6例，结论 X线平片是脊椎损伤的基本检查手段，MRI是脊柱损伤必要的补充手段。能发现X线平片无法显示的隐匿性骨折及脊髓损伤，韧带损伤，硬膜外血肿，另外MRI对于骨折分型，判断脊柱失稳，椎管狭窄程度，鉴别急慢性骨折及制定治疗方案均有重要价值。     

胸腰椎体骨折及内固定术后的磁共振评价

目的:探讨MRI在胸腰椎骨折及内固定术后的诊断价值。材料与方法:创伤后不同时间的54例58个椎体骨折进行MRI检查,观察判定骨折稳定性和脊髓情况,对骨折区骨髓信号进行分类研究。结果:MRI准确显示椎体三柱损伤和脊髓操作的情况,并显示椎体创伤后信号表现为Ⅰ型(水肿型)、Ⅱ型(不均匀型)、Ⅲ型(复原型)和Ⅳ型(脂肪型)。结论:MRI能够判定胸腰椎骨折的稳定性和脊髓损伤情况,并能准确反映胸腰椎骨折及内固定术后椎体情况。     

CT与MRI对脊柱外伤的临床诊断意义探折

目的:探讨CT与MRI对脊柱外伤的临床诊断价值。方法:收集我院2013年7月~2015年6月收治的40例脊柱外伤患者的CT、MRI资料,统计CT、MRI对椎体、椎弓骨折及骨碎片移位检出率,比较CT、MRI检出脊髓、神经根、前、后纵韧带及后方韧带复合体损伤率,探析CT、MRI在诊断脊柱外伤中的应用价值。结果:本组40例脊柱外伤患者骨折椎体共51个,椎体碎骨片206个,椎体、附件压迫脊髓碎骨片分别为50个、38个,压迫神经跟骨碎片28个。CT、MRI对骨折椎体、椎体压迫脊髓碎骨片、附件压迫脊髓碎骨片、压迫神经根碎骨片数目检出率对比无差异(P0.05),CT检出椎体碎骨片数目多于MRI,MRI对脊髓损伤、韧带损伤检出率均高于CT(P0.05)。结论:MRI对脊柱外伤空间定位优势好,诊断更为全面,CT对椎弓根损伤、椎管容积改变显示优势好,两者联合诊断可提高脊柱外伤诊断准确率。     

多层螺旋CT联合核磁共振对腕关节损伤的临床诊断价值分析

目的:探究分析多层螺旋CT(MSCT)联合核磁共振(MRI)对腕关节损伤的临床诊断价值。方法:选取2016年5月至2018年5月期间医院收治的腕关节损伤患者132例进行分析,采用双盲法随机分为3组,包括MSCT组44例、MRI组44例及MSCT联合MRI组44例,分别予以MSCT检查、MRI检查及联合检查,对比分析三种方法检测腕关节损伤的结果。结果:MSCT组与MRI组的骨折检出率和脱位检出率比较无明显差异(p0.05),而MSCT联合MRI组的骨折检出率和脱位检出率比MSCT组和MRI组均明显更高(p0.05);MSCT组移位碎骨折片和MRI组隐匿性骨折检出率与MSCT联合MRI组比较无明显差异(p0.05),而MSCT组隐匿性骨折和MRI组移位碎骨折片检出率均低于MSCT联合MRI组(p0.05)。结论:多层螺旋CT联合核磁共振诊断腕关节损伤有助于提高骨折、脱位检出率,有效发现移位骨折片、隐匿性骨折等损伤,为临床治疗提供有利依据,值得推广。     

MRI不同序列对脊柱骨折及合并症的诊断价值

目的:探讨MRI对脊柱骨折及合并症扫描的最佳序列选择。材料与方法:收集经临床随访与手术证实的42例脊柱骨折患者的临床及全脊柱MRI检查资料,比较MRI扫描序列TSE/T1WI,TSE/T2WI,STIR对病变的敏感性。结果:42例患者,临床诊断脊柱新鲜骨折37例,陈旧性骨折5例,骨挫伤27例,脊椎滑脱7例,脊髓损伤12例,硬膜下血肿6例,软组织损伤42例。T1WI检出新鲜骨折26例(70.2%),骨挫伤5例(13.5%),脊髓损伤7例(18.9%);T2WI检出新鲜骨折31例(83.8%),骨挫伤12例(32.4%),脊髓损伤9例(24.3%);STIR检出例数与临床诊断完全符合。三种序列检出脊椎滑脱及硬膜下血肿例数符合临床诊断。T1WI/T2WI对软组织损伤敏感性不高,并误诊陈旧性骨折2例。本组5例加扫颈部TSE/PDWI冠状位,检出C2椎体骨折2例。结论:STIR序列对病变敏感,检出率达100%,其诊断准确性高于T1WI/T2WI序列。     

MRI观察成人无骨折、脱位型颈髓损伤

目的 分析成人无骨折、脱位颈椎外伤合并颈脊髓损伤的MR表现及其临床意义.方法 收集该病患者38例,入院时均行颈椎X线、CT及MR检查,其中男32例,女6例,年龄24～62岁,平均(42.0±0.4)岁.结果 本组病例X线、CT及MR检查均未见颈椎骨折及脱位.脊髓MRI信号改变包括脊髓信号无改变4例,髓内水肿30例,髓内出血9例,脊髓软化或囊性变4例以及增强后有强化13例.其他MRI表现包括颈椎后纵韧带骨化或颈椎间盘退变或损伤后突出等,为脊髓受压迫的原因.结论 MRI可为无骨折、脱位型颈脊髓损伤患者的诊断与正确治疗提供依据.MRI无信号改变或仅有水肿表现者预后较好,髓内出血或者异常强化者预后较差.     

急性脊柱外伤影像诊断价值比较分析

目的：探讨急性脊柱挫伤的影像诊断价值.材料与方法：搜集60例脊柱外伤患者行X线、CT和MRI检查,对其三者进行对比分析.结果：椎体骨折45例：X线显示椎体骨折41例,累及115节椎体（90.6％）,伴附件骨折32处（61.5％）.CT显示椎体骨折45例,累及127节椎体（100.0％）,伴附件骨折52处（96.2％）,脊髓损伤3例,硬膜外下血肿2例.MR显示椎体骨折44例,累及123节椎体（96.9％）,伴附件骨折48处（92.3％）,韧带损伤16处,脊髓损伤10例,硬膜外下血肿6例.椎体挫伤15例：MRI显示23节椎体挫伤,伴附件挫伤7处;X线和CT均未发现异常.结论：显示骨折CT敏感度优于MRI和X线平片,显示骨挫伤和韧带、脊髓损伤MRI明显优于CT和X线平片.     

Prehospital clinical findings associated with spinal injury

Objective. The objective of this study was to identify clinical findings that are associated with spinal fracture and/or spinal cord injuries in prehospital trauma patients.

Methods. A retrospective chart review was performed at three tertiary referral centers in Southeastern Michigan. All charts of patients with spinal fractures or spinal cord injuries during 1992 and 1993 were reviewed. Patients with available pre-hospital records were included in the study analysis. Prehospital data points included documentation of head injury; altered mental status; neurologic deficit; evidence of intoxication; cervical, thoracic, and lumbar pain or tenderness; nonspecified back pain or tenderness; and a narrative for all other documented injuries. Hospital data collected included type and level of spinal injury and age and sex of the patient.

Results. Of 867 injury patients identified, 536 were excluded, leaving 346 analyzable fractures in 331 patients. The 346 spinal fractures/spinal cord injuries were distributed as: 100 (29%) cervical, 83 (24%) thoracic, 128 (37%) lumbar, and 35 (10%) sacral. Prehospital documentation of altered mental status, neurologic deficit, evidence of intoxication, spinal pain, or suspected extremity fracture was found for every patient with a cervical injury, 82/83 patients with thoracic injuries (99%), and 124/128 patients with lumbar injuries (97%). All five patients who were not documented as having one of the predictors had stable injuries.

Conclusion. Prehospital clinical findings of altered mental status, neurologic deficit, evidence of intoxication, spinal pain, and suspected extremity fracture were documented for all patients with significant spinal injuries in this series. These findings may be useful to identify patients who require prehospital spinal immobilization.     

广州管圆线虫病患者头颈部MR检查

目的 分析广州管圆线虫感染人体后有症状患者的头颈部MRI表现.方法 对74例有症状患者进行MRI和CT检查.MRI检查包括常规T1WI、T2WI、T2-FLAIR序列以及静脉注射钆对比剂后T1WI增强扫描.脑部CT检查均为平扫, 分析CT和MRI所见.对影像表现异常的患者,MR 随访1~3次.结果 33例患者MRI表现异常,包括单纯软脑膜异常强化17例,单纯脑实质异常信号3例,单纯脊髓异常信号1例,脑实质与软脑膜同时受累11例,脊髓与软脊膜同时受累1例.脑实质与脊髓内病变多表现为长T1、长T2信号,灶性分布;T1WI增强扫描时病灶多呈结节状强化.5例脑实质和脊髓的长T1、长T2异常信号无强化表现.结论 头颈部MRI检查有助于了解中枢神经系统广州管圆线虫病的病变程度,但绝大多数MRI所见缺乏特征性.     

脊椎、脊膜、脊髓结核的MRI表现

目的 分析脊椎、脊膜、脊髓结核的MRI表现.方法 回顾性分析经病理和临床治疗证实的50例脊椎、脊膜、脊髓结核患者的MR平扫及增强扫描资料.结果 40例脊椎结核中,显示病变椎体137个,椎间盘受累52个,椎旁冷脓肿30处,椎管内脓肿并脊髓受压23例,椎体病理性骨折29个,脊柱后突畸形12例,附件破坏2例;脊膜结核4例;结核性脊髓炎4例;脊膜合并脊髓结核2例;合并脊髓空洞4例.结论 MRI(特别是MRI增强)能准确、早期显示脊椎、脊膜和脊髓结核的形态学和病理学改变,为临床治疗提供可靠依据.     

Dynamics of spinal cord compression with different patterns of thoracolumbar burst fractures: Numerical simulations using finite element modelling

BackgroundIn thoracolumbar burst fractures, spinal cord primary injury involves a direct impact and energy transfer from bone fragments to the spinal cord. Unfortunately, imaging studies performed after the injury only depict the residual bone fragments position and pattern of spinal cord compression, with little insight on the dynamics involved during traumas. Knowledge of underlying mechanisms could be helpful in determining the severity of the primary injury, hence the extent of spinal cord damage and associated potential for recovery. Finite element models are often used to study dynamic processes, but have never been used specifically to simulate different severities of thoracolumbar burst fractures.MethodsPreviously developed thoracolumbar spine and spinal cord finite element models were used and further validated, and representative vertebral fragments were modelled. A full factorial design was used to investigate the effects of comminution of the superior fragment, presence of an inferior fragment, fragments rotation and velocity, on maximum Von Mises stress and strain, maximum major strain, and pressure in the spinal cord.FindingsFragment velocity clearly was the most influential factor. Fragments rotation and presence of an inferior fragment increased pressure, but rotation decreased both strains outputs. Although significant for both strains outputs, comminution of the superior fragment isn't estimated to influence outputs.InterpretationThis study is the first, to the authors' knowledge, to examine a detailed spinal cord model impacted in situ by fragments from burst fractures. This numeric model could be used in the future to comprehensively link traumatic events or imaging study characteristics to known spinal cord injuries severity and potential for recovery.     

Radiological assessment of indications for surgical treatment of spinal metastases

Background. The purpose is to assess the risk of spinal cord compression in patients with spine metastases using radiological data.
Material and methods. We evaluate 103 patients with the thoraco-lumbar vertebral body metastases - 52 with neurological symptoms of spinal cord compression and 51 symptoms free. We measured the statistical relation between spinal cord compression, pathological fracture, angle deformity of the spine and metastasis location. We divide spine into 3 columns and named pediculum as the fourth. We used statistical multiple regression analysis.
Results. The risk of spinal cord compression is depended on the location of the metastasis in vertebral body (p < 0,01). We found spinal cord compression symptoms in 25 out of 31 patients in group with pediculum involvement and in 27 out of 72 in group with other locations. It was highly statistically important (p < 0.001). In 45 out of 68 patients with vertebral fractures we found spinal cord compression symptoms (p < 0.01). We did not found statistical correlation between angle deformity and compression symptoms.
Conclusions. The risk of spinal cord compression is higher if the metastases are localised in thoraco-lumbar part of spine and if the pediculum is involved. The pathological fracture increases the risk of the compression, too.     

Evaluating the potential for cone beam CT to improve the suspected scaphoid fracture pathway: InSPECTED: A single-centre feasibility study

BackgroundThe suspected scaphoid fracture remains a diagnostic conundrum with over-treatment a common risk-averse strategy. Cross-sectional imaging remains the gold standard with MRI recommended but CT used by some because of easier access or limited MRI availability. The aim of this feasibility study was to evaluate whether cone beam computed tomography (CBCT) could support early diagnosis, or exclusion, of scaphoid fractures.MethodsPatients with a suspected scaphoid were recruited fracture between March and July 2020. All underwent a 4-view X-ray. If this examination was normal, they were immediately referred for a CBCT scan of the wrist. Those with a normal scan were discharged to research follow-up at 2 and 6-weeks.Results68 participants were recruited, 55 had a normal or equivocal X-ray and underwent CBCT. Nine additional radiocarpal fractures (16.2%) were demonstrated on CBCT, the remainder were discharged to research follow-up. Based on the 2-week and 6-week follow up three patients (4.4%) were referred for MRI to investigate persistent symptoms with no bony injuries identified.ConclusionsCBCT scans enabled a rapid pathway for the diagnosis or exclusion of scaphoid fractures, identifying other fractures and facilitating early treatment. The rapid pathway also enabled those with no bony injury to start rehabilitation, suggesting that patients can be safely discharged with safety-net advice following a CBCT scan.     

Review article: Indications for thoracolumbar imaging in blunt trauma patients: A review of current literature

Thoracolumbar spine injury is a common complication of blunt multitrauma and up to one third of fractures are associated with spinal cord dysfunction. Delayed fracture diagnosis increases the risk of neurological complications. While validated screening guidelines exist for traumatic c‐spine injury equivalent guidelines for thoracolumbar screening are lacking. We conducted a literature review evaluating studies of thoracolumbar injury in trauma patients to generate indications for thoracolumbar imaging. We performed MEDLINE and Pubmed searches using MeSH terms “Wounds, Nonpenetrating”, “Spinal Fractures”, “Spinal Injuries” and “Diagnostic Errors”, MeSH/subheading terms “Thoracic Vertebrae/injuries” and “Lumbar Vertebrae/injuries” and keyword search terms “thoracolumbar fractures”, “thoracolumbar injuries”, “thoracolumbar trauma”, “missed diagnoses” and “delayed diagnoses”. Limits and inclusion criteria were defined prior to searching. We evaluated 16 articles; 5 prospective observational studies (1 cohort study) and 11 retrospective observational studies. Predictors of TL injury in prospective studies – high‐risk injury mechanism, distracting injury, impaired cognition, symptoms/signs of vertebral fracture and known cervical fracture – were defined and used to construct a decision algorithm, which in a total of 14189 trauma patients from all eligible studies recommended TL screening in 856(99.1%) of 864 patients with TL fractures and would probably have directed TL imaging in the remaining 8 patients. There is limited low level evidence guiding surveillance TL imaging in adult blunt trauma patients. Despite this, we propose and evaluate an algorithm with a high negative predictive value for TL fractures. This should be incorporated into spinal injury assessment protocols.