多发椎体压缩骨折良恶性MRI鉴别诊断  

Multiple Vertebral Compression Fracture:Benign and Malignant MRI Differential Diagnosis

作　　者：顾华[1] 李莹[1] 戴敏红 邱清亮 

机构地区：[1]北京红十字朝阳医院放射科,北京100020 [2]MR Department,Providence Saint Joseph Medical Center

出　　处：《实用放射学杂志》2001年第5期346-350,共5页Journal of Practical Radiology

摘　　要：目的　MRI鉴别多发椎体良恶性压缩骨折。方法　 171个椎体压缩骨折 (良性 77个、恶性 94个 ) ,16个经椎体活检 ,其余经 3～ 6个月MRI追踪确诊。行T1WI,T2 /T2 WI,T1WI脂肪抑制增强扫描。观察 (1)异常信号形态和分布 ;(2 )压缩椎体形态 ;(3)椎旁软组织肿块 ;(4)多发椎体病变的排列方式 ;(5 )不同序列椎体信号变化 ;(6 )测量T1WI脂肪抑制增强扫描后病灶信号增强率。结果　恶性压缩骨折征象是 ,不均匀分布的穿凿样或片状异常信号 (91%长T1信号、73%长T2 信号 ) ,不同程度的团块样或片状强化 ,侵犯椎弓根 ,椎体后缘隆凸 ,椎旁软组织肿块 ,病变椎体呈跳跃排列。良性压缩骨折征象是椎体缘带状异常信号 (6 2 %长T1信号、42 %长T2 信号 ) ,带状强化 (急性压缩骨折 )或不强化 (陈旧性压缩骨折 ) ,椎体后角后翘 ,椎弓根正常 ,无软组织肿块 ,病变椎体呈连续排列。结论　鉴别良恶性压缩骨折最主要的MRI征象是椎体异常信号的形态和分布 ,T1WI脂肪抑制增强扫描有助于鉴别诊断。Objective To distinguish benign from malignant multiple vertebral collapses.Methods 171 vertebral collapses (77 benign,94 malignancy) were studied in 58 patients with T 1WI,T 2/T 2 WI,contrast enhancement T 1WI with fat saturation.Pathologic result was available in 16 vertebras,including 10 malignancy and 6 benign.The remaining patients were performed 3～6 months follow-up to confirm the final diagnosis.The following MR characteristics were reviewed:(1)The shape and distribution of abnormal signal intensity.(2)The shape of antero-or poster-border of compressive vertebral body.(3)Paravertebral soft tissue mass.(4)The change of lesions signal intensity on T 1WI,T 2WI and contrast enhanced MRI with fat saturation.(5)Signal intensity increasing ratio after contrast enhancement.Results The malignant vertebral compression fractures showed as the punch or patchy low signal intensity on T 1WI distributing anywhere in the compressive body and enhancement.It had the convex posterior cortex,pedicle involved,paravertebral soft tissue mass.The benign vertebral compression fractures showed as the band linear hypo-or-iso-intensity in end-plate,enhanced (acute fracture)or unenhanced(old fracture),retropulsion of posterior cortex,no pedicle involved and paravertebral soft tissue.Conclusion The most important MR characteristics for differentiation of malignant or bengin vertebral compression are the shapes and distributions of the abnormal signal intensities of vertebral collapses.The contrast enhancement T 1WI with fat saturation is helpful for imaging diagnosis.

关 键 词：压缩骨折 椎体 磁共振成像 诊断 MRI 

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