骨质疏松与溶骨性转移瘤致椎体压缩骨折的多模态影像应用研究  

Application of multimodal imaging in vertebral compression fractures caused by osteoporosis or osteolytic metastases

作　　者：李孟磊 葛英霖[1] 韩海林[1] LI Menglei;GE Yinglin;HAN Hailin(Department of Radiology,the Second People's Hospital of Liaocheng,Liaocheng 252600,China)

机构地区：[1]聊城市第二人民医院放射科,山东聊城252600

出　　处：《实用放射学杂志》2020年第1期95-98,共4页Journal of Practical Radiology

摘　　要：目的探讨骨质疏松与溶骨性转移瘤致椎体压缩骨折在骨密度、X线、CT、MRI影像表现中的鉴别要点及诊断价值.方法选取经临床确诊或病理证实的86例椎体压缩骨折患者,回顾性分析患者骨密度值及X线、CT、MRI影像表现,归纳骨质疏松与溶骨性转移瘤2组病因在椎体压缩骨折中的鉴别要点,并对比各检查方式的诊断价值.结果骨质疏松组36例患者行骨密度测量,其中2例骨密度值正常;溶骨性转移瘤组19例患者行骨密度测量,其中11例骨密度值正常,2组骨密度值正常发生率比较,差异有统计学意义(P=0.000<0.05).X线平片、CT及MRI 3种方法对椎体压缩变形的检出率均为100%.骨质疏松性椎体压缩骨折中,CT对椎体骨折线的检出率(95.7%)最高,与X线检出率(68.1%)及MRI检出率(80.9%)比较,P值分别为0.000及0.025,差异均有统计学意义.溶骨性转移瘤致椎体压缩骨折中,CT及MRI对椎体骨质破坏的检出率分别为79.5%、87.2%,两者检出率比较,差异无统计学意义(P=0.362>0.05),2种方法均明显高于X线对骨质破坏的检出率(46.2%).结论骨密度测量可诊断骨质疏松,结合其他影像检查可明确诊断骨质疏松性椎体压缩骨折;对于骨密度值正常的椎体压缩骨折患者,应警惕其他病理性骨折的可能.X线平片结合骨密度测量可以更好地指导选择下一步检查方案,对于骨质疏松患者,首选CT检查,对于无骨质疏松、有恶性肿瘤病史或者有神经压迫症状的患者,MRI检查更具优越性.Objective To explore the differential diagnosis and diagnostic value of vertebral compression fracture caused by osteoporosis or osteolytic metastases in bone mineral density(BMD),X-ray,CT and MRI.Methods 86 patients with vertebral compression fracture confirmed by clinical or pathological methods were selected.The data of BMD,X-ray,CT and MRI of patients were analyzed retro-spectively.'The main points of differential diagnosis between osteoporosis and osteolytic metastasis in vertebral compression fracture were summarized.And the diagnostic value of each imaging examination was com pared.Results BMD was measured separately in two groups and there were normal 2 of 36 patients in osteoporosis group and normal 11 of 19 patients in osteolytic metastasis group,which showed statistically significant differences(P=0.000<0.05).The detection rate of X ray,CT and MRI in detecting vertebral compression and deformation were all 100%.In osteoporotic vertebral compression fractures,the detection rate of vertebral fracture line with CT was the highest(95.7%),compared with X-ray(68.1%,P=0.000)and MRI(80.9%,P=0.025).In vertebral com-pression fracture caused by osteolytic metastases,the detection rates of vertebral bone destruction with CT and MRI were 79.5%and 87.2%respectively and there was no significant difference between the two methods(P-0.362>0.05).The detection rates of both methods were significantly higher than that of X-ray(46.2%).Conclusion BMD measurement can diagnose the osteoporosis.When combining BMD measurement with other imaging examinations,osteoporotic vertebral compression fracture can be diagnosed defi-nitely.For patients with vertebral compression fracture with normal BMD,we should be alert to the possibility of other pathological fractures.X-ray in combination with BMD measurement can better guide the next selection of imaging examination.For patients with osteoporosis,CT is the first choice.For patients without osteoporosis but having the history of malignant cancer or neurological symptoms,MRI maybe more

关 键 词：骨密度 骨质疏松 压缩骨折 多模态影像 

分 类 号：R681[医药卫生—骨科学] R683[医药卫生—外科学]