颈椎病合并颈椎损伤的MRI诊断

目的：分析颈椎病合并颈椎损伤的磁共振(MRI)表现。方法：回颐性分析62例颈椎病患与35例非颈椎病患颈椎损伤的MRI扫描资料与临床资料。结果：颈椎病合并颈椎损伤的MRI表现包括稚体骨折与脱位、韧带撕裂．颈髓损伤、椎间盘损伤脱出、椎动脉受压扭曲与狭窄、椎前血肿等损伤性表现及椎间盘变性脱出、黄韧带肥厚、椎管狭窄、后纵韧带钙化等颈椎退变表现。颈椎病蛆颈椎损伤易合并颈髓损伤,且多为无骨折脱位型颈髓损伤．颈髓损伤的位置与范围与颈椎原有病变的位置与范围一致。结论：MRI能充分反映颈椎病合并颈椎损伤的表现特征,对治疗和预后有重要意义。     

慢性疼痛的静息态功能磁共振成像研究进展

慢性疼痛属于临床病症,其范围广泛涉及多个系统,病程通常在3个月以上。慢性疼痛患者的脑结构和功能均发生改变,学习和记忆能力受到影响。目前,慢性疼痛引发脑功能改变的机制尚未完全阐明。近年来,功能磁共振成像(functional MRI,f MRI)被广泛运用于慢性疼痛脑功能改变的神经病理机制研究。本文主要综述静息态f MRI在慢性疼痛脑功能改变的最新研究进展。     

对颈椎间盘突出症及脊髓型颈椎病的再认识

目的：阐述颈椎间盘突出症与脊髓型颈椎病的关系，并提出新的分型方法以指导治疗。方法：对经计算机体层摄影脊髓造影述(CTM)磁共振成像(MRI)明确诊断为颈椎间盘突出症106例患进行牵引加理疗疗效分析，着重讨论颈椎间盘突出症与脊髓型颈椎病的关系．并根据临床表现和CTM.MRI所示脊髓受累、受玉情况提出新分型方法。结果：牵引加理疗总有效率94.34％，显效率68．87％．新分型法χ^2=14.787．P<0．05，疗效有差异，Ⅱ型和Ⅲ型χ^2=11.73，P<0.01，有显差异。结论：认为颈椎间盘突出症和脊髓型颈椎病是疾病发展的两个阶段．在一定程度上为因果关系。当临床和影像学都提示脊髓明显受损．短期正规保守治疗无效时可考虑手术。     

颈椎病脊髓损伤MRI弥散张量成像(DTI)的评价

目的探讨MRI弥散张量成像(DTI)对颈椎病脊髓损伤评价。方法对30例临床综合诊断为颈椎病患者,行颈椎常规序列MRI和颈髓弥散张量成像(DTI)检查,测量并比较所有椎间盘相应层面脊髓的表观扩散系数(ADC)、各项异性(FA)值,同时重建分析弥散张量纤维束(DTT)。结果所有研究对象的DTI均可得到颈髓的ADC图和FA图。突出椎间盘和未突出椎间盘相邻层面的颈髓FA值和ADC值差别有统计学意义(P0.05)。不同突出程度间颈椎间盘相应层面的颈髓ADC值和FA值差别有统计学意义(P0.05)。30例弥散张量纤维束中23例患者均观察到神经纤维束的受压、移位,更有11例显示部分腹侧神经纤维束中断。结论 DTI对评价颈椎病脊髓损伤具有重要价值。     

对神经根型颈椎病诊断的影像学分析

目的分析神经根型颈椎病影像学特点,为基层放射诊断学医师提供合理的诊断策略。方法回顾性分析165例神经根型颈椎病患者的影像学特点。结果计算机摄影（CR）表现为颈椎生理曲度变直及反弓畸形120例;骨赘、椎间隙变窄90例;椎间孔变小或狭窄85例;过伸过屈位显示椎体滑动或失稳44例。CT表现为Luschka关节及椎间关节骨赘72例;椎间盘突出及椎体后缘软骨结节及钙化79例。磁共振成像（MRI）显示颈椎生理曲度变化112例,椎间盘变性113例,椎间盘突出102例,脊椎受压87例,合并颈椎脊髓水肿65例。结论对神经根型颈椎病的诊断CT与MRI各有特点。在轴状位和矢状位,MRI能清楚地显示脊髓结构;CT可作为MRI的有力辅助手段以鉴别是椎间盘组织还是骨赘。     

颈椎病合并颈椎损伤的MRI诊断

目的：分析颈椎病合并颈椎损伤的磁共振（ＭＲＩ）表现。方法：回顾性分析６２例颈椎病患者与３５例非颈椎病患者颈椎损伤的ＭＲＩ扫描资料与临床资料。结果：颈椎病合并颈椎损伤的ＭＲＩ表现包括椎体骨折与脱位、韧带撕裂,颈髓损伤、椎间盘损伤脱出、推动脉受压扭曲与狭窄、椎前血肿等损伤性表现及椎间盘变性脱出。黄韧带肥厚、椎管狭窄、后纵韧带钙化等颈椎退变表现。颈椎病组颈椎损伤易合并颈髓损伤,且多为无骨折脱位型颈髓损伤,颈髓损伤的位置与范围与颈椎原有病变的位置与范围一致。结论：ＭＲＩ能充分反映颈椎病合并颈椎损伤的表现特征,对治疗和预后有重要意义。     

颈椎病的MRI影像特点（附12例报告）

颈椎病是一种常见病和多发病,主要由椎间盘退变,脊椎骨质增生引起脊髓与神经根受压等临床表现。过去仅靠X线颈椎平片或颈段椎管造影,但敏感性低,不能早期、准确诊断。随着磁共振技术的开展,MRI以     

中药散剂热敷治疗椎间盘源性颈痛的临床观察及护理体会

椎间盘源性颈痛(Cervical Discogenic Pain,CDP)以颈、肩、枕、臂部慢性疼痛为特征,或伴有颈部活动受限、臂部感觉异常,并向头、颈、肩及上臂放射,常伴有麻木,但无沿皮节分布的运动和感觉神经障碍,影像学检查可见明显颈椎间盘退变表现,本病相当于颈型颈椎病[1].由于疼痛涉及到头枕部和肩胛区,因此有学者称之为颈椎间盘源性头痛和颈椎间盘源性背痛.CDP为常见病、多发病,在人群中的发生率约为5％～10％[2].临床上采用推拿、理疗、中成药、针灸等治疗方法,能取得一定疗效.     

磁共振成像在糖尿病心肌病心肌评价中的进展

糖尿病心肌病是引起糖尿病患者心力衰竭的主要原因之一。通过磁共振结构和功能成像技术可准确评估糖尿病心肌病的病理学变化,现已应用于糖尿病心肌病临床治疗的疗效评估中。评估糖尿病心肌病的MRI技术主要包括电影成像、MRS、T1 Mapping等。本文主要对MRI技术在糖尿病心肌病心肌评价方面的应用进展进行综述。     

定量磁共振T2映射成像在椎间盘退变中的研究进展

椎间盘退变是引起下腰背痛的主要原因之一,影像学的检查是诊断椎间盘退变的重要手段。传统MRI技术虽可显示椎间盘的信号强度和形态学改变,但很难客观量化椎间盘退变的程度。T2 mapping技术能够检测椎间盘内水含量、蛋白多糖含量及胶原纤维排列顺序等多种生化成分,为椎间盘退变早期临床评估提供新的方法。本文从T2 mapping与其他定量磁共振技术对比,及其与椎间盘退变分级、日本骨科学会评分、视觉模拟评分及年龄、性别等联系论述定量磁共振T2映射成像在椎间盘退变中的研究进展。      

Adolescent disc degeneration--no headache association

The objective of the study was to determine whether adolescents with headache have more disc degeneration in the cervical spine than headache-free controls. This study is part of a population-based follow-up study of adolescents with and without headache. At the age of 17 years, adolescents with headache at least three times a month (N = 47) and adolescents with no headache (N = 22) participated in a magnetic resonance imaging (MRI) study of the cervical spine. Of the 47 headache sufferers, 17 also had weekly neck pain and 30 had neck pain less than once a month. MRI scans were interpreted independently by three neuroradiologists. Disc degeneration was found in 67% of participants, with no difference between adolescents with and without headache. Most of the degenerative changes were located in the lower cervical spine. In adolescence, mild degenerative changes of the cervical spine are surprisingly common but do not contribute to headache.     

Imaging the back pain patient

Imaging is an integral part of the clinical examination of the patient with back pain; it is, however, often used excessively and without consideration of the underlying literature. The primary role of imaging is the identification of systemic disease as a cause of the back or limb pain; magnetic resonance imaging (MRI) excels at this. Systemic disease as a cause of back or limb pain is, however, rare. Most back and radiating limb pain is of benign nature, owing to degenerative phenomena. There is no role for imaging in the initial evaluation of the patient with back pain in the absence of signs or symptoms of systemic disease. When conservative care fails, imaging may be undertaken with due consideration of its risks: labeling the patient as suffering from a degenerative disease, cost, radiation exposure, and provoking unwarranted minimally invasive or surgical intervention. Imaging can well depict disc degeneration and disc herniation. Imaging can suggest the presence of discogenic pain, but the lack of a pathoanatomic gold standard obviates any definitive conclusions. The imaging natural history of disc herniation is resolution. There is very poor correlation between imaging findings of disc herniation and the clinical presentation or course. Psychosocial factors predict functional disability due to disc herniation better than imaging. Imaging with MRI, computed tomography (CT), or CT myelography can readily identify central canal, lateral recess, or foraminal compromise. Only when an imaging finding is concordant with the patient's pain pattern or neurologic deficit can causation be considered. The zygapophysial (facet) and sacroiliac joint are thought to be responsible for axial back pain, although with less frequency than the disc. Imaging findings of the structural changes of osteoarthritis do not correlate with pain production. Physiologic imaging, either with single-photon emission CT bone scan, heavily T2-weighted MRI sequences (short-tau inversion recovery), or gadolinium enhancement, can detect inflammation and are more predictive of an axial pain generator.     

Radiologic evaluation of chronic neck pain

For many years, there were no guidelines for evaluating patients with chronic neck pain. However, in the past 15 years, considerable research has led to recommendations regarding whiplash-associated disorders. This article summarizes the American College of Radiology Appropriateness Criteria for chronic neck pain. Imaging plays an important role in evaluating patients with chronic neck pain. Five radiographic views (anteroposterior, lateral, open-mouth, and both oblique views) are recommended for all patients with chronic neck pain with or without a history of trauma. Magnetic resonance imaging should be performed in patients with chronic neurologic signs or symptoms, regardless of radiographic findings. The role of magnetic resonance imaging in evaluating ligamentous and membranous abnormalities in persons with whiplash-associated disorders is controversial. If there is a contraindication to magnetic resonance imaging, computed tomography myelography is recommended. Patients with normal radiographic findings and no neurologic signs or symptoms, or patients with radiographic evidence of spondylosis and no neurologic findings, need no further imaging studies.     

多体位颈椎MRI诊断颈椎病

目的 探讨多体位颈椎MRI对颈椎病的诊断价值。方法 对30例临床诊断为颈椎病的患者进行颈椎中立位、过屈位、过伸位MR检查,比较三种体位下颈椎椎间盘突出矢状径指数(SI)的差异。结果 30例中共发现颈椎椎间盘突出92个,两两组间比较,三种体位下SI差异均有统计学意义(P<0.05);过屈位椎间盘突出程度最轻,过伸位椎间盘突出程度最重。结论 不同体位下颈椎MR检查显示椎间盘突出程度有所差异。多体位颈椎MRI对于临床选择颈椎病治疗方案有着重要意义,也为研究颈椎病发病机制提供了新的方法。     

Diagnostic capabilities of magnetic resonance imaging and computed tomography in acute cervical spinal column injury

The present study was conducted to evaluate the imaging capabilities of magnetic resonance imaging (MRI) in evaluating acute cervical spinal column injury and compare these results to that of computed tomographic (CT) imaging. Forty-nine patients undergoing MRI at a Level I and regional spinal cord trauma center to evaluate cervical spinal column injury were studied. Seventy-one injuries were identified by MRI. These injuries were classified as osseous (fracture/dislocation) (n = 21), disc herniation (n = 29), and spinal cord injury (edema/contusion/transection) (n = 21). Diagnostic imaging results in 33 of the 49 patients undergoing both MRI and CT were compared. CT demonstrated 22 fracture/dislocations compared to 10 on MRI. MRI demonstrated 19 disc protrusions compared to 7 on CT. Additionally, MR imaged 13 cord injuries as compared to 0 by CT. MR imaging proved superior in demonstrating spinal cord pathology and intervertebral disc herniation. CT was superior to MRI in demonstrating osseous injury. CT and MRI may be useful together in determining presence and extent of spinal column injury.     

颈椎病的影像诊断并附460例分析

目的:通过分析临床诊断的460例颈椎病患者的影像表现,总结其各分型的影像学特点,提高其诊断水平。材料与方法:对460例诊断为颈椎病患者的平片和CT检查颈椎骨质、椎间隙、椎间孔及椎间盘改变的影像表现,进行分类统计。结果:颈椎病患者中,X线表现中以椎间隙变窄多见,好发部位以颈5/6为主,CT表现中以颈椎间盘突出常见,以颈5/6椎间盘好发,神经根型颈椎病较多。结论:X线平片和CT检查的影像表现结合临床表现即可诊断颈椎病并分型。     

Dynamic weight-bearing cervical magnetic resonance imaging: technical review and preliminary results

BACKGROUND: Conventional magnetic resonance imaging (MRI) of complex cervical spine disorders may underestimate the magnitude of structural disease because imaging is performed in a nondynamic non-weight-bearing manner. Myelography provides additional information but requires an invasive procedure. METHODS: This was a prospective review of the first 20 upright weight-bearing cervical MRI procedures with patients in the flexed, neutral, and extended positions conducted in an open-configuration MRI unit. RESULTS: This technique clearly illustrated the changes in spinal cord compression, angulation, and spinal column alignment that occur during physiologic movements with corresponding changes in midsagittal spinal canal diameter (P < 0.05). Image quality was excellent or good in 90% of the cases. CONCLUSIONS: Dynamic weight-bearing MRI provides an innovative method for imaging complex cervical spine disorders. This technique is noninvasive and has adequate image quality that may make it a good alternative to cervical myelography.     

Magnetic resonance imaging study of the morphometry of cervical extensor muscles in chronic tension-type headache

This study analyses the differences in the relative cross-sectional area (rCSA) of several cervical extensor muscles, assessed by magnetic resonance imaging (MRI), between patients with chronic tension-type headache (CTTH) and healthy controls. MRI of the cervical spine was performed on 15 CTTH females and 15 matched controls. The rCSA values for the rectus capitis posterior minor (RCPmin), rectus capitis posterior major (RCPmaj), semispinalis capitis and splenius capitis muscles were measured from axial T1-weighted images using axial MR slices aligned parallel to the C2/3 intervertebral disc. A headache diary was kept for 4 weeks in order to substantiate the diagnosis and record the pain history. CTTH patients showed reduced rCSA for both RCPmin and RCPmaj muscles (P < 0.01), but not for semispinalis and splenius capitis muscles, compared with controls. Headache intensity, duration or frequency and rCSA in both RCPmin and RCPmaj muscles were negatively correlated (P < 0.05): the greater the headache intensity, duration or frequency, the smaller the rCSA in the RCPmin and RCPmaj muscles. CTTH patients demonstrate muscle atrophy of the rectus capitis posterior muscles. Whether this selective muscle atrophy is a primary or secondary phenomenon remains unclear. In any case, muscle atrophy could possibly account for a reduction of proprioceptive output from these muscles, and thus contribute to the perpetuation of pain.     

Stance ataxia and delayed leg muscle responses to postural perturbations in cervical spondylotic myelopathy

OBJECTIVE: We studied balance control in patients with cervical spondylosis, on the hypothesis that ataxia and changes in postural responses occur concurrently as a consequence of structural problems in the cervical cord. Subjects and patients: Seventeen patients and 17 healthy subjects were recruited. Based on magnetic resonance imaging, the patients were divided into 2 groups, with (n=9) and without (n=8) signs of myelopathy. METHODS: Body sway was recorded under quiet stance on a force platform. Postural perturbations evoked early and late responses in soleus and tibialis anterior. RESULTS: Most patients showed increased body sway during stance, which was larger in cervical spondylosis with myelopathy than cervical spondylosis. Early postural responses in the soleus were not affected. Late responses in soleus and tibialis anterior were delayed in cervical spondylosis with myelopathy. Across all patients, latency of tibialis anterior late response was correlated with lower limb sensory impairment and amplitude of body sway. CONCLUSION: Abnormal transmission through the cervical cord of proprioceptive input to supraspinal centres and of descending commands to caudal cord levels are accountable for ataxia in cervical spondylosis with myelopathy. Stabilometry may be an economic and easy way in a clinical and rehabilitative setting to distinguish severe from mild forms of cervical spondylosis prior to physical treatment and to help the differential diagnosis from other diseases featuring similar signs.     

影像学在诊断颈椎病中的应用

目的通过对85例颈椎病影像学资料进行分析,探讨颈椎病的影像学特征及其X线片、CT、MRI及MRA检查方法的选择原则,以便临床上对不同类型以及不同程度的颈椎病选择合适的诊断技术。方法 2005年6月2009年7月,85例均行颈椎标准X线片、CT、MRI及MRA检查,对其影像学资料进行分析。结果颈椎病以椎体及小关节增生、生理曲度改变、椎间隙变窄和局部失稳为常见X线表现,X线片、CT、MRI及MRA对颈椎病的诊断有不同的优点及限度。结论 X线片为首选检查方法 ,绝大部分可明确诊断,特殊情况加做CT、MRI或MRA检查。