低场MRI对椎体骨质疏松急性骨折与转移瘤性骨折的鉴别  

The Role of Low--field MRI in Differentiating Metastasis from Acute Osteoporotic Vertebral Fractures

作　　者：邱书珺[1] 孙海辉[1] 王家强[1] 乔智红[1] 杨越[1] 

机构地区：[1]武警上海总队医院放射科,上海201103

出　　处：《实用放射学杂志》2009年第7期1011-1014,共4页Journal of Practical Radiology

摘　　要：目的探讨低场MRI序列选择在椎体急性骨质疏松性骨折与转移瘤性骨折鉴别诊断中的价值。方法应用0．35T低场磁共振设备对急性椎体骨折患者60例，87个病变椎体行T1WI、T2WI、脂肪抑制T2WI、横断位GRE T2WI、增强T1WI序列扫描。对所观察病变椎体进行病理及临床或影像随访证实。在常规观察病变椎体、附件及周围软组织肿块形态学改变的同时，重点分析其信号特征及T1WI强化特点，相关数据行统计学处理。结果转移瘤性骨折36个，骨质疏松性者51个。经矿检验，二者在MRI不同序列的信号表现均有各自特点：前者在T1WI上多为广泛性低信号，增强T1WI与脂肪抑制T2WI为广泛或不均匀高信号；后者T1WI多为局灶性低信号，增强T1WI与脂肪抑制T2WI为均匀等信号；有明显统计学差异（P〈0．001）。骨碎片向椎管突出对良性骨折的诊断具有特异性；横断位T2WI硬膜外软组织肿块、增强T1WI椎体呈高或不均匀强化对恶性骨折具有特异性。结论低场MRI对于椎体急性骨质疏松性骨折和转移瘤性骨折的鉴别具有重要的价值。Objective To determine the value of low-field MRI in differentiating metastatic vertebral fractures from acute osteoporotic compression fractures of the spine. Methods 60 patients with 87 acute compression fractures of vertebral bodies underwent low-field MR imaging scanning with the following sequences： T1 WI, T2 WI, fat-suppression T2 WI and gadolinium-enhanced T1WI. All cases were confirmed by biopsy or clinic and radiologic follow-up. The vertebral morphological appearances and MRI characteristics were analyzed qualitatively. Results 36 metastatic and 51 osteoporotic vertebrae were confirmed. According to the X^2 test, the characteristics of signal intensity of disordered vertebrae on T1WI, fat-suppression T2WI and gadolinium-enhanced T1 WI were distinctive （P〈0. 001 ）. Retropulsion of a posterior bone fragment was specific for acute osteoporotic compression fractures. Epidural mass and high or inhomogeneous enhancement were specific for metastatic compression. Conclusion Low-field MR imaging is useful in the differentiation of acute vertebral collapses.

关 键 词：脊椎 骨折 骨质疏松 转移瘤 磁共振成像 

分 类 号：R683.2[医药卫生—骨科学] R681[医药卫生—外科学]