单个椎体压缩骨折:恶性和急性良性压缩骨折MR鉴别诊断  

Solitary Acute Vertebral Collapse Due to Osteoporosis or Malignancy: Differentiation on MRI

作　　者：李莹[1] 顾华[1] 戴敏红 邱清亮 

机构地区：[1]首都医科大学附属北京红十字会朝阳医院放射科 [2]MRI Devision Providence Saint Joseph Medical Center CA 91505

出　　处：《实用放射学杂志》2001年第4期250-254,共5页Journal of Practical Radiology

摘　　要：目的　通过对３１例单个椎体压缩骨折（包括恶性和由于骨质疏松造成的良性急性压缩骨折）的ＭＲ征象进行观察统计，鉴别其良恶性。方法　３１例单发椎体压缩骨折患者，其中恶性压缩骨折１６例，良性急性压缩骨折１５例。均通过活检及３～６个月随访观察证实。进行ＭＲ平扫（Ｔ１ＷＩ，Ｔ２ＷＩ）及增强扫描。结果　单个椎体的恶性和急性良性压缩骨折的ＭＲ鉴别诊断主要通过形态学改变及增强后病变形态（共７个征象）进行分析。（１）急性良性压缩骨折：椎体压缩程度大；病变不累及整个椎体；多数病灶沿终板分布，椎体前缘或后缘多正常或略凹陷，椎体后缘骨折可形成骨碎片后突；椎弓根多不受累；很少累及周围软组织；椎体静脉多清晰；典型强化方式为沿终板的带状强化。（２）恶性压缩骨折：椎体压缩程度小；病变多侵及整个椎体；压缩后椎体前缘和／或后综多向外凸；多侵及椎弓根；周围软组织受侵；椎体静脉多受侵显示不清；病灶多呈结节状强化。结论　区分良性急性压缩骨折和恶性压缩骨折主要依靠形态学的改变和增强后病灶强化的形态，增强后信号增强程度对鉴别上述两种压缩骨折没有显著作用。Objective: To distinguish malignant from osteoporotic acute vertebral collapses at the single location. Methods Fifteen osteoporotic and sixteen malignant vertebral collapses were studied in thirty - one patients with T1 WI, gadolinium enhanced T1 WI and T2 WI MRI. All the patients had the follow - up periods of 3 - 6 months or pathologic results from biopsy. Results Seven findings were suggestive of osteoporotic: 1. The compression of vertebral body was severe. 2. The lesion extended to the whole vertebral body was uncommon. 3. The location of the lesion was closed to the end plate of the vertebral body and the anterior and /or posterior of the vertebra was straight or concave. The posterior bone fragment can be seen. 4. Pedicles were normal. 5. No epidural soft tissue mass. 6. The vertebral vein was normal. 7. The bandilike or flakelike enhancement under the end plate. Another seven findings were suggestive of malignancy: 1. The compression of vertebral body was mild. 2. The lesion extended to the whole vertebral body was common. 3. The anterior and /or posterior of the vertebra cortex was convex. 4. Pedicles were involoved. 5:Epidural soft tissue mass was usually seen. 6. The vertebral vein was involved and disappeared. 7. The lesion was usually nodulus enhancement. Conclusion To distinguish malignant from osteoporotic acute vertebral collapses,the MRI findings of the morphology and the shape of the lesion postcontrast are useful in the differentiation of solitary acute vertebral collapses.

关 键 词：脊椎压缩骨折 良性 恶性 磁共振成像 MR 鉴别诊断 

分 类 号：R683.2[医药卫生—骨科学] R445.2[医药卫生—外科学]