CT、MRI对脊柱转移瘤的诊断价值

目的探讨CT、MRI诊断脊柱转移瘤的价值。方法回顾性分析55例经病理、临床证实脊柱转移瘤患者的CT和MRI表现。结果 CT、MRI检出55例脊柱转移瘤123个椎体受累,累及附件89个,累及椎管53处,椎旁软组织肿块65处,病理性骨折12处。CT表现为溶骨型、成骨型、混合型三种骨质改变。MRI表现为多数椎体形态无改变,少数椎体楔形变,双凹变形或伴前后径增大。椎体信号呈三种类型改变:均匀或略不均匀长T1、长T2信号;长T1短T2信号;T1WI不均匀低信号,T2WI混杂信号。MRI增强后病灶呈不同程度强化。结论 CT、MRI诊断脊柱转移瘤各有优势。CT显示脊柱转移瘤的骨质破坏改变优于MRI。MRI在鉴别诊断脊柱转移瘤病理性压缩骨折和诊断早期脊柱转移瘤中明显优于CT。     

几种影像方法对脊柱转移瘤诊断的比较

目的 :分析 93例脊柱转移瘤的MRI、ECT、SCT、X线平片征象 ,以提高脊柱转移瘤的早期诊断率。方法 :回顾性分析 93例经手术病理或随访证实的脊柱转移瘤的MRI、ECT、SCT、X线平片表现。结果 :93例脊柱转移瘤共发现2 79个椎骨异常、184处椎管受累、12 0处椎旁软组织肿块、12 0处椎体病理性骨折。MRIT1 WI表现为低信号 73 .3 %( 198/2 70 ) ,T2 WI表现为高信号 62 .2 %( 168/2 70 ) ,FS T2 WI表现为高信号 85 .2 %( 2 3 0 /2 70 ) ;ECT检出的 2 61处病灶表现为多处放射性浓聚或单发放射性浓聚 ;CT检出 184处病灶表现为局限性或大片骨质破坏 ;X线平片检出的 92处表现为骨质破坏。结论 :MRI及ECT敏感性高于SCT和X线平片 ,MRI、SCT、X线平片特异性高于ECT ;MRI是诊断脊柱转移瘤一种高敏感性和特异性的方法 ,优于ECT、SCT、X线平片 ;脊柱转移瘤首选ECT并结合X线检查 ,必要时SCT或 /和MRI检查。     

脊柱转移瘤的MRI诊断(附20例报告)

本文对20例经手术病理证实的脊柱转移肿瘤的原发肿瘤及转移部位进行了分析。脊柱转移瘤的MRI特征性表现：（1）受累椎体呈长T1低信号，长T2高信号表现。（2）多发转移瘤的“跳跃征”。（3）椎间盘一般不受侵犯。复习文献对脊柱转移瘤的诊断和鉴别诊断进行了讨论。     

脊柱转移瘤的MR诊断

目的 探讨脊柱转移瘤的MR诊断。方法 回顾性分析120例脊柱转移瘤的MR表现。结果 脊柱转移瘤灶的异常MR表现为：（1）信号异常,在T1WI上,112例（93.3%)呈低信号,8例（6.7%)为等或混杂的信号,在T2WI上,89例（74.1%)呈稍高信号,33例（27.5%)为低或混杂信号;（2）病灶可呈跳跃式破坏,椎体附件受累,出现椎旁软组织肿块,但椎间隙保持完整;（3）伴发椎体压缩性骨折的病灶可呈“楔形”、“盘状”或“倒楔形”。脂肪抑制增强扫描可显示病变范围并发现平扫中未能发现的病变。结论 MRI是诊断脊柱转移瘤的可靠而重要的手段。     

MRI、CT诊断脊椎转移瘤的比较分析

目的:探讨脊椎转移瘤的MRI及CT征象,以提高脊椎转移瘤的早期诊断率。方法:对138例脊椎转移瘤患者进行MRI与CT检查,比较脊椎转移瘤在MRI和CT上的表现。结果:138例脊椎转移瘤共发现399个椎体异常,237处椎管受累,190处椎旁软组织肿块,178处病理性骨折。MRI表现为T1加权低信号74%(294/399);T2加权表现为高信号62%(249/399);脂肪抑制T2加权表现为高信号86%(344/399)。CT检出273处病灶表现为不同形态的骨质破坏,溶骨型66%(179/273),成骨型24%(65/273),混合型10%(29/273)。结论:MRI的敏感性和特异性高于CT,MRI和CT联合应用可提高脊椎转移瘤诊断的敏感性和准确性。     

脊柱转移瘤MRI诊断(附45例报告)

目的　探讨MRI对脊柱转移瘤的敏感性 ,以提高脊柱转移瘤MRI表现的认识。方法　回顾性分析 45例脊柱转移瘤的MRI表现 ,结合文献进行讨论。结果　 45例中共累及 14 9节椎体 ,累及椎弓根 19例 3 2根 ,棘突及横突 7例 11处。椎体压缩呈盘状 8例 2 1节 ,呈楔状 7例 11节 ,病椎轻度膨胀 4例 ,有软组织肿块 18例 ,硬膜囊、脊髓受压 15例 ,脊髓受侵 2例。病椎信号均匀 2 8例 ,不均匀 17例。T1WI为明显低信号 15例 ,略低信号 2 7例 ,等信号 3例。T2 WI为明显高信号 17例 ,略高信号 2 5例 ,等信号 3例。增强 18例 ,病灶明显强化 11例 ,轻度强化 6例 ,不强化 1例。软组织肿块边缘水肿、受压和受侵脊髓在MRI上均显示阳性。结论　MRI检查脊柱转移瘤的敏感性明显优于CT和X线平片 ,尤其肿瘤浸润椎骨尚属水肿、出血、坏死阶段时。     

脊柱转移瘤的MRI诊断(附34例分析)

目的：探讨MRI对脊柱转移瘤诊断和鉴别诊断的价值。方法：回顾性分析34例脊柱转移瘤的MRI表现，均有明确原发瘤灶。结果：①6例为单椎体病变，28例为多椎体病变；②在T1WI上34例均呈低信号，在T2WI上26例(76．5％)呈高信号，7例(20．6％)呈等信号，1例(2．9％)呈低信号；③椎体骨质破坏分溶骨型、成骨型、混合型三种类型；④椎旁肿块形成者7例(20．6％)；⑤椎管狭窄者13例(38．2％)；⑥跳跃式分布者20例(59．9％)；⑦34例椎间盘的形态及信号均大致正常。结论：脊柱转移瘤具有特征性的MRI表现，综合分析有助于诊断和鉴别诊断。     

葡萄膜转移瘤的MRI表现

目的探讨葡萄膜转移瘤的MRI表现特点。方法回顾性分析20例经病理或临床随访证实的葡萄膜转移瘤的MRI表现。1例仅行平扫，19例同时行平扫和增强扫描，其中4例行动态增强扫描。结果20例葡萄膜转移瘤中，位于虹膜和睫状体2例，18例位于脉络膜；2例表现为略长T1、等T2信号，9例表现为等T1、等T2信号，3例表现为等T1、略长T2信号，3例表现为等T1、略短T2信号，2例表现为略短T1、略短T2信号，1例表现为略短T1、略长T2信号；8例表现为眼球壁轻度增厚，3例呈新月形，7例呈梭形，2例呈结节状。19例呈中度至明显强化；行动态增强扫描的4例时间-信号强度曲线均呈速升、缓降型。伴有视网膜脱离11例和玻璃体信号异常2例。结论MRI能显示葡萄膜转移瘤的部位、形态、信号及强化特点，有助于葡萄膜转移瘤的诊断与鉴别诊断。     

MRI STIR技术在诊断脊柱转移瘤中的应用价值

目的: 探讨STIR技术在MRI诊断脊柱转移瘤中的应用价值.材料和方法: 回顾性对照分析42例脊柱转移瘤之常规T1WI、T2WI及STIR序列的表现.结果: 42例共累及196个椎体.71个椎体T1WI呈低信号,T2WI呈高信号,11个椎体T1WI、T2WI均呈低信号,114个椎体T1WI或T2WI呈混杂信号,病灶STIR序列均呈异常高信号.105个椎体形态无明显改变,91个椎体伴有后缘膨隆或压缩性骨折,11例继发椎管狭窄,14例伴椎旁软组织肿块,STIR序列能清晰显示以上所有异常.结论: STIR序列易于发现脊柱转移灶,可较准确地判断肿瘤的侵袭范围及程度,并有助于转移瘤的鉴别诊断.     

MRI在脊柱转移瘤中的诊断价值(附85例分析)

目的 探讨MRI在脊柱转移瘤诊断中的价值.方法 回顾分析85例脊柱转移瘤的MR表现,其中46例曾做平片或/和CT检查.结果 85例共累计388个椎体.所有病椎T1WI均呈低信号,T2WI中354个椎体呈混杂信号,34个椎体为低信号,T2WI/STIR病椎均呈高信号改变.54个椎体不同程度病理性骨折,53个被压缩椎体后缘隆起,54例病变附件破坏,30例伴椎旁软组织肿块及侵犯椎管.46例有平片或/和CT资料,其中18例发现病变,总阳性率39.11%(18/46).结论 MRI较平片及CT更早发现脊柱转移灶,并可较准确地判断肿瘤的范围及程度.     

脊柱转移瘤的MRI表现(附43例分析)

目的：探讨脊柱转移瘤的ＭＲＩ特点,并和其它疾病鉴别。方法：回顾性分析４３例经临床或病理证实的脊柱转移瘤的ＭＲＩ表现。结果：（１）椎体破坏者占９７．７％（４２／４３）,附件破坏者高达７４．４％（３２／４３）;（２）全组病例均有信号异常,其特点依破坏类型不同而异;（３）伴有椎体盘状压缩者占７２．１％（３１／４３）,伴有附件增大者２７．９％（１２／４３）,椎管狭窄者６７．４％（２９／４３）,椎间孔狭窄者６０．５％（２６／４３）;（４）跳跃征及椎旁肿块的发生率分别为５８．１％（２５／４３）、２５．６％（１１／４３）。结论：脊柱转移瘤具有特征性ＭＲＩ表现,全面观察有助于诊断和鉴别诊断。     

脊柱结核与转移瘤的MRI鉴别诊断

目的:分析脊柱结核与转移瘤的MRI表现并探讨其鉴别诊断价值。材料与方法:选择经临床或手术病理证实的40例结核与36例转移瘤,采用SIEMENS 1.0T超导型磁共振仪,快速自旋回波序列,矢状、冠位、轴位T_1WI和T_2WI检查。结果:脊柱结核和转移瘤均表现有多个椎体骨质破坏,结核累及椎体附件较转移瘤明显少。转移瘤一般不伴有椎间隙的狭窄。结核压迫硬膜囊和脊髓主要是由于楔状变形的椎体后移及寒性脓肿的形成。转移瘤压迫硬膜囊和脊髓主要是由于塌陷椎体前后径的加大以及椎旁硬膜外转移灶从硬膜囊后方压迫所致。结论:脊柱结核和转移瘤均有各自的特征性MRI表现,注意观察受累椎体形态、椎间盘和附件是否受累、有无脓肿和对脊髓及硬膜囊的压迫情况有助于病变的诊断和鉴别诊断。     

Whole spine MRI in the assessment of acute vertebral body trauma

Objective To determine the incidence and types of multilevel vertebral body injury in association with acute spinal trauma as assessed by whole spine MRI.Design and patients All acute admissions to a regional spinal injury unit had whole spine MRI carried out, to detect occult vertebral body injury. Two radiologists assessed 127 cases prospectively, over a period of 3 years. All cases had T2-weighted sagittal imaging of the whole spine (where possible using a T2-weighted fat-suppressed sequence), with T1-weighted imaging in both sagittal and axial planes covering the primary injury. The incidence of secondary injury (defined as either bone bruising, wedge compression fracture or burst fracture) was determined and defined by type, site and relationship to the primary injury.Results Seventy-seven per cent of cases had a secondary injury level. Of these, bone bruising was the commonest but often occurred in combination with secondary wedge compression fracture or burst fracture. MRI detected 27 non-contiguous wedge compression fractures and 16 non-contiguous burst fractures, giving an incidence of secondary level, non-contiguous fracture of approximately 34%.Conclusion A higher frequency of secondary vertebral body injury may be defined by MRI than has been described in previous studies based on radiographic evaluation of the whole spine. Whole spine MRI in assessment for occult vertebral body fracture enables increased confidence in the conservative or surgical management of patients with severe spinal injury.     

低场强MRI对脊椎转移瘤的诊断及鉴别诊断

目的:为了提高脊椎转移瘤诊断及其与其他椎体病变的鉴别诊断水平。方法:回顾性分析经病理证实的转移瘤79例和误诊病例15例的MRI特点,归纳其影像表现的差异。结果:79例转移瘤中,累及椎体125个,多为跳跃式分布;累及附件骨92个,占73.6%;椎体破坏变形81个,占64.8%;椎间盘均无变化;有软组织肿块22例(17.6%),软组织肿块常以破坏区为中心生长。T1WI均呈低信号,T2WI信号改变可以多种多样。结论:MRI检查在诊断脊椎转移瘤及与其他脊椎病变的鉴别诊断中更敏感、更具特异性。     

Are Spinal or Paraspinal Anatomic Markers Helpful for Vertebral Numbering and Diagnosing Lumbosacral Transitional Vertebrae?

Objective

To evaluate the value of spinal and paraspinal anatomic markers in both the diagnosis of lumbosacral transitional vertebrae (LSTVs) and identification of vertebral levels on lumbar MRI.

Materials and Methods

Lumbar MRI from 1049 adult patients were studied. By comparing with the whole-spine localizer, the diagnostic errors in numbering vertebral segments on lumbar MRI were evaluated. The morphology of S1-2 disc, L5 and S1 body, and lumbar spinous processes (SPs) were evaluated by using sagittal MRI. The positions of right renal artery (RRA), superior mesenteric artery, aortic bifurcation (AB) and conus medullaris (CM) were described.

Results

The diagnostic error for evaluation of vertebral segmentation on lumbar MRI alone was 14.1%. In lumbarization, all patients revealed a well-formed S1-2 disc with squared S1 body. A rhombus-shaped L5 body in sacralization and a rectangular-shaped S1 body in lumbarization were found. The L3 had the longest SP. The most common sites of spinal and paraspinal structures were: RRA at L1 body (53.6%) and L1-2 disc (34.1%), superior mesenteric artery at L1 body (55.1%) and T12-L1 disc (31.6%), and AB at L4 body (71.1%). CM had variable locations, changing from the T12-L1 disc to L2 body. They were located at higher sacralization and lower lumbarization.

Conclusion

The spinal morphologic features and locations of the spinal and paraspinal structures on lumbar MRI are not completely reliable for the diagnosis of LSTVs and identification on the vertebral levels.     

脊柱原发性骨质疏松椎体压缩的MRI表现

目的探讨脊柱原发性骨质疏松椎体压缩的ＭＲＩ表现。方法对３年间Ｘ线诊断、临床证实的６０例脊柱原发性骨质疏松的ＭＲＩ表现进行回顾分析，并与对照组比较。结果１６２个椎体表现为压缩变形，其中凹陷形９８个，楔形５１个，扁平形１３个。压缩椎体邻近椎间盘常膨突到椎体凹陷区内；矢状位Ｔ１ＷＩ４７个椎体表现为椎体内不同范围、不同类型的低信号。结论压缩椎体后上角突入椎管内，Ｔ１ＷＩ椎体终板下呈带状低信号和除椎体后角外全椎体呈低信号，为原发性骨质疏松椎体压缩ＭＲＩ比较典型的表现。     

外伤性脊髓损伤的MRI表现与临床对照分析

目的评价MRI在脊髓损伤的临床应用价值。资料与方法回顾性分析66例脊髓损伤的临床及MRI表现，着重分析脊髓损伤的MRI征象与病理、临床的关系。结果MRI显示椎体压缩性骨折51例，椎间盘脱出2例，椎体骨折并椎问盘脱出5例；椎体部分性滑脱20例，完全性滑脱1例。显示脊髓完全性截断4例，部分性截断1例，脊髓受压4l例。62例脊髓连贯者59例显示脊髓信号异常。59例有完整的住院治疗记录，治疗后显示病情好转25例，症状无改善26例，死亡8例。结论MRI检查能明确脊髓有无损伤以及损伤的程度，有助于临床治疗措施的选择以及对预后的评估。     

Pedicle involvement in tuberculous spondylitis and pyogenic spondylitis: Comparative magnetic resonance imaging study

Aim

Magnetic resonance imaging (MRI) comparison of the pedicle involvement in TB spondylitis and pyogenic spondylitis in relation to degree of spinal deformity, degree of vertebral body and disc damage and paravertebral and epidural abscess formation.

Materials and methods

MRIs of 38 patients who had been diagnosed with and treated for spinal infection, 22 patients for TB spondylitis and 16 patients for pyogenic spondylitis were retrospectively evaluated for pedicle involvement, degree of spinal deformity, vertebral body and disc damage and paravertebral and epidural abscess formation.

Results

Incidence of pedicle involvement was highly significant more in TB spondylitis than in pyogenic spondylitis (P value <0.01). Incidence of vertebral body collapse in vertebral bodies with pedicle involvement was equal in both groups, however more than 50% vertebral body collapse only reported in TB spondylitis (P value = 0.0001). Kyphotic deformity was reported only in TB spondylitis. There was no significant difference in disc damage, paravertebral or epidural abscess formation between both groups.

Conclusion

Pedicle involvement is a common MRI finding in TB spondylitis, and significantly less common in pyogenic spondylitis. Kyphotic deformity and advanced degree of vertebral body collapse might play a significant role in pedicle involvement in cases of spinal infection.