应力性骨折影像诊断

目的应力性骨折,由于缺乏正确认识常造成误诊,本文重点强调影像诊断的价值。方法回顾性总结了1977～2000年间的应力性骨折64例,男性27例,女性37例。64例均进行X线检查,28例不典型者随后行ECT、MRI、CT检查。结果将应力性骨折分为疲劳性和衰竭性应力骨折两大类,其中疲劳性应力骨折12例占18.7%,衰竭性应力骨折52例占81.3%。36例为单纯平片诊断,28例平片结合ECT、MRI、CT诊断。疲劳性应力骨折以青少年胫骨常见;衰竭性应力骨折以老年妇女的胸、腰椎为多发区域。结论应力性骨折通常根据临床和X线平片即可明确诊断,疑难病例或早期诊断应结合ECT、MRI和CT扫描作出诊断。     

130例脊柱疾病核素骨显像与MRI、CT、X线诊断的比较研究

目的 比较核素全身骨平面显像和MRI、CT及X线在脊柱转移瘤及其他脊柱疾病诊断中的价值。方法 130例经手术病理诊断的脊柱疾病患者行^99mTc-MDP全身骨平面显像．显示局部异常浓聚、局部异常稀疏和局部加其他部位异常浓聚或稀疏为阳性结果。所有患者均行MRI、CT、X线片三种影像检查的一种以上．其中104例行MRI、61例行CT、107例行X线片检查。结果 骨显像诊断脊柱疾病的灵敏度为：转移瘤91．7％，原发恶性肿瘤73．3％，良性肿瘤54．2％．瘤样病损81．8%，炎性病变100％．压缩性骨折100％。61．1％的转移瘤患者伴有其他部位骨骼的异常浓聚或稀疏灶(58．3％可明确诊断为骨转移瘤)。非转移瘤的其他脊柱痰病．20．2％伴有异位异常浓聚或稀疏灶。MRI、CT和X线的灵敏度分别为：转移瘤96．8％、100％和79.3％；原发恶性肿瘤95．7％、93．3％和78．3％；良性肿瘤95．0%、92．3％和54．5％；瘤样病损100％、100%和80．0％；炎性病变100％、100％和69．2％；压缩性骨折均为100％。结论 核素骨显像是诊断骨转移瘤的最佳方法。对其他脊柱疾病，几种影像技术各有其优势。而核素骨显像对判断病灶是单发抑或多发及是否伴发其他骨骼病变有较大价值。     

Spect骨显像对应力性骨折的诊断价值及临床意义

应力性骨折常发生在运动员、入伍新兵等高强度、大运动量训练时,往往起病较突然,X线片常不能得到明确诊断,而骨显像对其则有较高的灵敏度,我们观察了1 8例应力性骨折患者的骨显像,现报道如下。1　临床资料1 1　一般资料　1 8例均为门诊男性病人,年龄1 7～2 5岁,平均2 1岁。其中新兵1 1例,运动员7例,发病前有长时间大运动量的病史,运动中或运动后出现疼痛,X线片检查阴性或仅有轻度骨膜反应,骨显像可以看到损伤部位放射性异常浓集,患者未作特殊处理或仅对症治疗后休息4周,进行X线片复查,看到骨损伤征象者可确诊。1 2　方法　受试者均作X线…     

CT、ECT在脊柱关节病诊断中的价值

目的 探讨CT、ECT核素骨显像对脊柱关节病（SpA)的诊断价值。方法 对临床诊断为SpA患者63例（其中强直性脊柱炎26例，未分化脊柱关节病37例）同时进行骶髂关节CT扫描和ECT全身及骶髂关节局部显像。结果 CT对未分化脊柱关节病检查阳性率为24.3%(9/37)。远低ECT检查阳性率64.9%(24/37)；ECT对强直性脊柱炎的诊断阳性率为53.8%(14/26)。结论 ECT核素骨显像早期诊断SpA较CT敏感，具有重要价值。     

髋部隐匿性骨折

隐匿性股骨转子间骨折属于特殊类型的低能量骨损伤,多发生于老年骨质疏松患者,是一种假阴性骨折。因常规X线片检查不易发现,如不进行其他影像学检查(如超声、CT、MRI、核素扫描等),常延误诊治或发展演变为明显移位的骨折,给患者带来本可避免的痛苦。本文介绍股骨转子间隐匿性骨折的特点、诊断方法、分型和处理的研究进展。     

骨盆创伤的CT检查(附50例CT与X线平片检查对照)

目的分析急性骨盆损伤的CT征象,评价CT在骨盆损伤诊断中的应用价值和局限性。方法50例骨盆损伤的患者进行X线、薄层CT检查,分析CT检查征象,并与X线平片对照。结果50例中CT发现骨盆各骨骨折157处,X线显示骨折113处,X线平片及CT的检出率差异有显著性意义(χ2=38·72,P<0·01);CT发现关节脱位27处,X线显示脱位16处,X线平片及CT的检出率差异有显著性意义(χ2=9·09,P<0·01)。X线平片中有3处阳性征象CT检查未能显示。结论CT检查在显示骨、关节的骨折、脱位,盆腔脏器及软组织的损伤,判断骨盆骨折的严重程度等方面优于X线平片,并适合多发伤及危重患者同时进行多项检查时应用,为救治严重创伤患者的一种快速、准确的放射检查手段。     

X线平片、CT和MRI诊断滑膜骨软骨瘤病

目的比较X线、CT和MRI对滑膜骨软骨瘤病的诊断价值。方法回顾性分析20例经手术病理证实的滑膜骨软骨瘤病患者的X线平片（n=18）、CT（n=20）和MRI（n=10）表现。结果 X线平片正确诊断15例,CT正确诊断18例,MRI正确诊断8例。X线平片、CT和MRI均能显示关节周围及关节内形态多样、大小不一、数量不等的游离体;X线平片和CT均可显示游离体的钙化;MRI可显示早期软骨游离体;CT和MRI可发现关节腔积液。结论 X线平片、CT及MRI均能诊断本病,CT和MR检查能发现X线平片不能检出的病灶和征象。     

儿童系统性红斑狼疮骨梗死的影像表现

目的 :探讨MRI、X线片、CT检查在儿童系统性红斑狼疮(juvenile systemic lupus erythematosus,JSLE)骨梗死中的诊断价值。方法:自2015年1月至2017年1月,对行MRI、X线片、CT检查的11例SLE骨梗死儿童的影像学资料进行回顾性分析,其中男1例,女10例;年龄6~16岁,平均13岁。11例行MRI检查,9例行X线片检查,3例行CT检查,对其影像表现进行描述和分析。结果:骨梗死共计累及60个部位,30个骨干-干骺端,8个髌骨,21个骨骺,1个距骨。11例MRI检查均检出病灶,典型表现是地图样改变,病灶边缘可呈长T1长T2信号,"双环征""三环征"。9例X线片检查中5例检出病灶;3例行CT检查中2例检出病灶;X线片及CT早期常无明显异常,慢性期表现为硬化边环绕低密度灶。结论:MRI能显示早期骨梗死,X线及CT只能显示慢性期改变,MRI是诊断骨梗死的最有效方法。     

CT扫描在髋关节置换术后骨盆骨溶解诊断的价值

[目的]探讨CT扫描在全髋关节置换(total hip arthroplasty,THA)术后骨盆骨溶解诊断中的价值.[方法]2006～2009年,华西医院骨科共收治24例24髋THA术后骨盆骨溶解患者.收集24例患者的骨盆前后位、股骨颈正斜位、45°髓骨斜位、45°闭孔斜位X线片和髋关节CT扫描影像检查资料,对照术中发现,分析、比较CT扫描在临床诊断中的价值.[结果]骨盆前后位X线片明确骨溶解13例,占54.2%;骨盆前后位结合股骨颈正斜位X线片明确骨溶解病灶18例,占75%;骨盆前后位、股骨颈正斜位、髋骨斜位和闭孔斜位X线片明确骨溶解病灶22例,占91.7%; CT扫描发现骨溶解病灶24例,占100%.CT扫描评估骨盆骨溶解病灶部位和范围比X线片更加精确.[结论]CT扫描诊断骨溶解比X线片具有更高的灵敏度和特异度,并且可以精确确定骨溶解部位和范围.     

SchatzkerⅡ型胫骨平台骨折的影像学评估及解剖钢板治疗

目的:探讨SchatzkerⅡ型胫骨平台骨折术前充分影像学评估的重要性及解剖钢板治疗的临床疗效。方法:SchatzkerⅡ型胫骨平台骨折患者67例,男48例,女19例;年龄16～69岁,平均45.4岁。开放性骨折10例,闭合性骨折57例。术前均行膝关节正、侧位X线摄片检查、螺旋CT薄层扫描和三维重建、MRI检查,根据影像学资料对患膝骨、软骨及软组织损伤进行评估。采用解剖钢板或结合关节镜进行治疗。结果:X线片、CT、MRI在明确诊断方面没有明显差异,在分型诊断中,CT、MRI明显优于X线片;经MRI检查均存在不同程度的软骨损伤,常多种表现并存;CT、MRI检查发现伴随的软组织损伤分别为17例、59例;参考CT、MRI扫描后手术方式发生改变21例(31.3%)。术后随访9～31个月,平均18.2个月,骨折均获临床愈合;Rasmussen影像学及临床评分优良率分别为86.7%(58例)、94.0%(63例),Resnick-Niwayama分级评价呈现骨性关节炎的患者21例(31.3%)。未出现切口不愈合或感染,无膝内、外翻畸形,无钢板、螺钉断裂。结论:结合X线片、CT、MRI能获得对手术方案制定及手术效果预测的重要图像信息;解剖钢板或结合关节镜治疗SchatzkerⅡ型胫骨平台骨折安全可靠、损伤小且疗效满意。     

Early magnetic resonance imaging compared with bone scintigraphy in suspected scaphoid fractures

We evaluated 100 consecutive patients with a suspected scaphoid fracture but without evidence of a fracture on plain radiographs using MRI within 24 hours of injury, and bone scintigraphy three to five days after injury. The reference standard for a true radiologically-occult scaphoid fracture was either a diagnosis of fracture on both MRI and bone scintigraphy, or, in the case of discrepancy, clinical and/or radiological evidence of a fracture. MRI revealed 16 scaphoid and 24 other fractures. Bone scintigraphy showed 28 scaphoid and 40 other fractures. According to the reference standard there were 20 scaphoid fractures. MRI was falsely negative for scaphoid fracture in four patients and bone scintigraphy falsely positive in eight. MRI had a sensitivity of 80% and a specificity of 100%. Bone scintigraphy had a sensitivity of 100% and a specificity of 90%. This study did not confirm that early, short-sequence MRI was superior to bone scintigraphy for the diagnosis of a suspected scaphoid fracture. Bone scintigraphy remains a highly sensitive and reasonably specific investigation for the diagnosis of an occult scaphoid fracture.     

Stress fractures and bone pain: are they closely associated?

The relationship between bone pain and stress fractures diagnosed by bone scintigraphy was investigated in military recruits during active training. In three patients pain appeared in the site of abnormal uptake 7-14 days after the bone scan in a previously asymptomatic site. One hundred and twenty-four sites of stress fractures were found in 64 patients; 32 (26 per cent) were asymptomatic. In 38 patients (59 per cent) there were multiple stress fractures; 32 (33 per cent) had asymptomatic stress fractures. Fifty-three per cent of the regions with abnormal uptake in the femur were painless, compared with 17 per cent in the tibia. The necessity for imaging all bones susceptible to stress fractures, even when asymptomatic, is stressed. It is suggested that diagnosis of stress fracture should be made when typical abnormal uptake appears on scintigraphy. Bone pain in such cases may be delayed.     

Diagnostic accuracy of imaging modalities for suspected scaphoid fractures: meta-analysis combined with latent class analysis

Follow-up radiographs are usually used as the reference standard for the diagnosis of suspected scaphoid fractures. However, these are prone to errors in interpretation. We performed a meta-analysis of 30 clinical studies on the diagnosis of suspected scaphoid fractures, in which agreement data between any of follow-up radiographs, bone scintigraphy, magnetic resonance (MR) imaging, or CT could be obtained, and combined this with latent class analysis to infer the accuracy of these tests on the diagnosis of suspected scaphoid fractures in the absence of an established standard. The estimated sensitivity and specificity were respectively 91.1% and 99.8% for follow-up radiographs, 97.8% and 93.5% for bone scintigraphy, 97.7% and 99.8% for MRI, and 85.2% and 99.5% for CT. The results were generally robust in multiple sensitivity analyses. There was large between-study heterogeneity for the sensitivity of follow-up radiographs and CT, and imprecision about their sensitivity estimates. If we acknowledge the lack of a reference standard for diagnosing suspected scaphoid fractures, MRI is the most accurate test; follow-up radiographs and CT may be less sensitive, and bone scintigraphy less specific.     

多层螺旋CT足踝部隐匿性骨折的诊断价值

目的：通过对隐匿性骨折的诊断,提示足踝部外伤后X线检查阴性、临床高度怀疑有骨折的患者进行多层螺旋CT检查的必要性,以期减少漏诊、误诊。方法：收集2007年1月至2010年6月31例足踝部外伤病例,男18例,女13例;年龄21～67岁,平均35岁。均有明确外伤史,主要表现为足踝部疼痛,局部肿胀,压痛点固定,压痛明显,活动受限。31例X线检查均阴性,因临床高度怀疑骨折而行多层螺旋CT检查。结果：螺旋CT检查发现11例骨折,共累及17处。单发骨折6例,多发骨折5例。单发骨折中,外踝骨折1例,距骨骨折1例,足舟骨骨折1例,第5跖骨基底部骨折1例,跟骨骨折2例;多发骨折中,内、外踝骨折1例,内踝、跟骨、距骨骨折1例,距骨、足舟骨骨折1例,足第1、2楔骨骨折1例,第2、3跖骨基底部骨折1例。结论：足踝部外伤后X线片检查阴性、临床高度怀疑有骨折的患者进行多层螺旋CT检查,可明显提高隐匿性骨折的检出率,为临床治疗及司法鉴定提供可靠的影像学依据,具有重要的应用价值。     

Stress fractures presenting as tumours: a retrospective analysis of 22 cases

Frequently, the imaging features of stress fractures may be misinterpreted as tumour-like lesions. The aim of this study was to analyse the quality of different examinations in detecting stress fractures mimicking tumour-like lesions in magnetic resonance imaging (MRI). We evaluated 22 cases which were referred to our department with the suspected diagnosis of bone tumours turning out to be stress fractures. Whenever the MRI did not lead to a diagnosis after a second review, computed tomography (CT) scans and, if still required, additional examinations were performed until the fracture was detected. A stress fracture was diagnosed in 15 cases after the additional CT scan, in five cases with the review of the MRI and in two cases with a combination of several examinations. Especially in stress fractures of the tibia and the femur, CT scanning was essential for making a diagnosis by detecting the fracture line. Bone scans and biopsies, in contrast, were not helpful in making a correct diagnosis.     

Fehldiagnose “Knochentumor” bei Stressfraktur am medialen Tibiaplateau

Stress fractures occur in 13.2-37.0% in running athletes. There is a decreasing incidence of these fractures in the tibia (33%), navicular (20%), metatarsus (20%), femur (11%), fibula (7%) and pelvis (7%). Clinically stress fractures present themselves with uncharacteristic local pain under weightbearing conditions. In 75% the medial tibial crest is involved. Usually the pain disappears when the patient is non-weightbearing. As causal factors wrong training methods, oligomenorrhoe (6x incidence), low nutrition input (8x incidence) and a genu recurvatum-morphotype can be found. Misinterpretation can result from a similar clinical and radiological (conventional x-ray, scintigraphy, MRI) early course in stress fractures and bone tumors. We present a patient with a clinical diagnosis of a meniscus lesion. The following MRI was suspect for a malignant lymphoma or histiocytoma. Biopsy was performed and showed the final diagnosis of a stress fracture.     

Intérêt de l’échographie ostéo-articulaire dans le diagnostic précoce de fracture de contrainte métatarsienne

Stress fractures are bone lesions occurring without trauma or focal bone defects. Early diagnosis is currently based on bone scintigraphy or MRI, but these techniques are expensive and not widely accessible. We report three cases of metatarsal stress fracture diagnosed by sonography and confirmed by MRI. Easily accessible and inexpensive, sonography appears to be an excellent method of early diagnosis of metatarsal stress fractures, complementing clinical examination and standard radiography. A prospective study of this promising method against the gold standard diagnosis is needed to test its sensitivity and specificity.     

四肢地震伤的影像诊断价值

目的探讨四肢地震伤的影像诊断价值。方法103例四肢地震伤患者均行X线平片检查,其中28例行CT检查,5例行MRI检查。结果经影像学检查明确四肢骨骨折81例,其中单发骨折34例,多发骨折47例;开放性骨折6例,闭合性骨折75例。关节脱位7例,软组织内异物5例,膝关节半月板损伤1例,气性坏疽1例。结论影像学检查有利于四肢地震伤的及时准确诊断和治疗方式的选择。