CT和MRI在椎体缺血性坏死病诊断中的价值

目的：探讨椎体缺血性坏死（avascular necrosis of the vertebral body,ANV）诊断中CT和MRI的价值。方法：对2005年至2009年诊治的12例ANV的病史、临床表现、CT和MRI扫描结果进行分析。12例ANV椎体均行经皮椎体成形术（percutaneous vertebroplasty,PVP）治疗,治疗前后疼痛状况采用视觉模拟评分法（visual analogue scale,VAS）进行评估。结果：本组ANV均发生在胸腰段脊柱。CT和MRI检查发现椎体内有真空区,内部可积气或积液,早期ANV真空区内积液时MRI在T1加权像上为低信号且T2加权像上则为高信号,晚期ANV的CT扫描可见真空区边缘硬化带。VAS评分从术前的平均（9.08±0.76）分降为术后的平均（2.33±1.43）分。结论：骨质疏松椎体压缩骨折后内出现真空区时应警惕本病,CT和MRI在椎体缺血性坏死的诊断中有重要价值,PVP是一种治疗ANV的有效方法,具有良好的止痛效果。

CT and MRI in diagnosis of avascular necrosis of the vertebral body

Objective: To evaluate the value of CT and MRI in the diagnosis of avascular necrosis of the vertebral body(ANV). Methods: Twelve ANV patients were retrospectively analysed by their medical history,clinic manifestation,CT and MRI. Twelve AVN patients were treated with percutaneous vertebroplasty(PVP). The pain level of each patient was assessed,both before and after the procedure,using a visual analogue scale(VAS). Results: All the patients had ANV in the thoracolumbar spine. The intravertebral vaccum phenomenon(VP),with gas or fluid-like collection,was seen on computed tomographic(CT) images and magnetic resonance images(MRI). In the early stages,the VP zone was characterized by fluid-like collection,and was low intensity on T1,high intensity on T2. In the latter stages,the margin of VP zone had sclerotic change on CT scan. VAS score decreased from preoperative(9.08±0.76)to(2.33±1.43)at 3 days after PVP. Conclusion: ANV must be considered as a possible diagnosis of VP secondary to osteoporotic vertebral fractures. Both CT and MRI could provide reliable diagnostic proof for ANV. PVP is proved to be an effective and safe procedure for the treatment of ANV,and could provid quick pain relief.