椎管内结核性蛛网膜炎的MR成像

目的评估ＭＲＩ对椎管内结核性蛛网膜炎的诊断价值。材料与方法对１６例椎管内结核性蛛网膜炎的ＭＲＩ表现、Ｇｄ－ＤＴＰＡ增强ＭＲＩ的作用和追踪ＭＲＩ的变化进行分析。结果ＭＲＩ显示脊膜炎１２例，表现为蛛网膜下腔狭窄和消失、脑脊液分房和神经根增厚。在增强ＭＲＩ上，受累的软脊膜和硬膜呈线形、弥漫性斑块状和结节状或环形显著增强。脊髓受累见于全部１６例，包括脊髓水肿９例；脊髓空洞７例。在全部１６例中，髓内结核瘤２例。结论ＭＲＩ可以直接显示脊膜、脊髓和神经根受累后的形态学和病理学改变，增强ＭＲＩ可以更清楚地显示出髓内和髓外病变的程度。因此，ＭＲＩ对椎管内结核性蛛网膜炎的诊断价值，无论是在急性期或慢性粘连期，均优于脊髓造影和ＣＴ脊髓造影     

后纵隔肿瘤向椎管内蔓延的MRI诊断

目的：评价ＭＲＩ对后纵隔肿瘤向椎管内蔓延的诊断价值。材料与方法：回顾性分析６例（男５例，女１例，年龄３～５２岁）经手术及病理证实的后纵隔肿瘤向椎管内蔓延的临床及ＭＲＩ表现。结果：ＭＲＩ显示肿瘤呈哑铃形５例，卵圆形１例；单个椎间孔开大５例，３个椎间孔开大１例；硬膜囊和脊髓受压移位５例，无受压移位１例；在Ｔ１ＷＩ和Ｔ２ＷＩ图像上，椎管内外肿瘤的信号强度一致。结论：不使用造影剂，ＭＲＩ可以准确的确定后纵隔肿瘤向椎管内蔓延的平面，清楚的显示椎管内病变是否压迫脊髓，了解其压迫程度和范围。结论认为，在确定后纵隔肿瘤向椎管内蔓延中，ＭＲＩ具有重要的临床应用价值     

原发性椎管内肿瘤的MRI诊断价值

目的：评价ＭＲＩ对原发性椎管内肿瘤的诊断价值。材料和方法：对６３例原发性椎管内肿瘤进行ＭＲＩ扫描，并与手术病理和临床随访结果对照分析。结果：检出神经纤维瘤及神经鞘瘤２７例，脊膜瘤１１例，髓内胶质瘤１４例，蛛网膜囊肿６例，皮样囊肿２例，淋巴瘤２例，脂肪瘤１例。与ＣＴ和脊髓造影等检查相比，ＭＲＩ对本病的检出率和诊断正确率明显提高。结论：ＭＲＩ是发现原发性椎管内肿瘤的首选方法，对本病的诊断与鉴别诊断具有重要价值。     

脊柱爆裂骨折的影像学评价

目的：阐述脊椎爆裂骨折的Ｘ线、ＣＴ、ＭＲＩ表现及其对治疗的指导作用。材料与方法：回顾性分析１２０例脊椎爆裂骨折的影像和临床资料,其中颈椎１４例,胸椎３４例,胸腰椎交界处５９例,腰椎１３例;男８９例,女３１例,平均年龄３３岁。伤后全部行Ｘ线正侧位片;９０例ＣＴ平扫,其中４１例行ＣＴ多平面重建;ＭＲＩ平扫６７例。结果：Ｘ线、ＣＴ表现为椎体高度减低,椎体纵或横形骨折崩解,终板骨折移位并突入椎管,椎管狭窄,椎板骨折,棘突间或椎弓间距增大;ＭＲＩ同时还显示了脊髓受压信号异常及后纵韧带、棘间韧带、椎间盘的撕裂。结论：平片诊断爆裂骨折需与单纯压缩骨折鉴别,明确诊断需ＣＴ证实;ＣＴ、ＭＲＩ能对爆裂骨折明确诊断;平片对指导治疗作用不大,ＣＴ有一定价值,爆裂骨折需行ＭＲＩ检查以帮助决定外科手术的方式     

脊髓型颈椎病的早期诊断──附临床62例分析

对６２例脊髓型颈椎病患者进行的临床观察发现：１．四肢沉重、乏力、步态不稳并不一定就是患者的最初主诉，当眩晕为最初主诉时，要注意体征的检查。２．霍夫曼改良测试试验阳性或弱阳性与下肢肌张力的增高是脊髓型颈椎病早期的重要征象。３．Ｘ线平片虽为最基本的检查方法，但无椎管狭窄时并不意味着致压物就不存在。４．ＣＴ检查在脊髓型颈椎病的诊断中作用虽大，但ＣＴ片为阴性结果时并不能完全排除脊髓型颈椎病的存在。ＣＴ片上显示为硬脊膜受压、变形，病变并非只局限如此。５．ＭＲＩ检查在显示颈椎间盘突出方面优于ＣＴ检查。６．ＳＥＰ在脊髓型颈椎病中的应用可能提高诊断的精确性。为此，作者提出了一种新的早期诊断标准，即：１．临床所见与Ｘ线片所见符合颈椎病。２．霍夫曼改良测试试验阳性或弱阳性，伴有或不伴有下肢肌张力的增高。３．ＣＴ片或ＭＲＩ显示硬脊膜、脊髓受压、变形。４．除外肌萎缩型侧索硬化症、脊髓肿瘤、脊髓损伤，多发性末梢神经炎等症。该标准与过去以症状、体征及Ｘ线片诊断脊髓型颈椎病相比，不仅检出率高，症状轻时亦能早期作出明确诊断。     

甲状腺癌的CT和MRI诊断

评价ＣＴ和ＭＲＩ对甲状腺癌的诊断价值。材料和方法：回顾分析临床、病理证实的５０例甲状腺癌：３８例进行ＣＴ扫描,２８例作ＭＲＩ检查,其中１６例兼作ＣＴ和ＭＲＩ检查。结果：肿瘤内出血６例（１２％）、相邻结构受侵１１例（２２％）、颈部淋巴结转移１５例（３０％）、甲状腺内囊变２６例（５２％）和钙化２４例（４８％）,对甲状腺的定性诊断有重要价值。ＣＴ对甲状腺癌内钙化的发现明显优于ＭＲＩ,对肿瘤侵犯相邻结构的显示与ＭＲＩ相仿。ＭＲＩ对肿瘤内囊变,出血和颈部淋巴结转移的发现优于ＣＴ。结论：在甲状腺癌的定性诊断上,ＭＲＩ优于ＣＴ,但若能将两者相结合,能更准确地作出甲状腺癌的诊断。     

后纵隔肿瘤向维管内蔓延的MRI诊断

目的：评价ＭＲＩ对后纵隔肿瘤向椎管内蔓延的诊断价值。材料与方法：回顾性分析６例（男５例，女１例，年龄３￣５２岁）经手术及病理证实的后纵隔肿瘤向椎管内蔓延的临床及ＭＲＩ表现。结果：ＭＲＩ显示肿瘤呈哑铃形５例，卵圆形１例；单个椎间孔开大５例，３个椎间孔开大１例；硬膜囊和脊髓受压移位５例，无受压移位１例；在Ｔ１ＷＩ和Ｔ２ＷＩ图像上，椎管内外肿瘤的信号强度一致。结论：不使用造影剂，ＭＲＩ可以准确的确定后纵     

垂体瘤的CT和MRI增强

目的：分析垂体瘤的ＣＴ和ＭＲＩ增强表现，探讨增强后ＣＴ和ＭＲＩ对诊断垂体瘤的价值。材料和方法：对手术和病理证实的２４２例垂体瘤，回顾性分析ＣＴ和ＭＲＩ增强前后表现。结果：２４２例中微腺瘤（≤１０ｍｍ）８１例，大腺瘤（＞１０ｍｍ）１６１例。微腺瘤直接征象为垂体内的ＣＴ低密度或ＭＲＩ（Ｔ１ＷＩ）低信号。增强后ＣＴ和ＭＲＩ显著提高低密度或低信号的显示率（Ｐ＜０．０１）。大腺瘤增强后扫描肿瘤均有不同程度的强化。ＣＴ和ＭＲＩ增强对于显示肿瘤的部位、大小、范围、鞍旁结构如海绵窦和颈内动脉的受侵情况以及显示残存正常垂体均有很高的价值。介绍了一种新的ＭＲＩ垂体瘤分级方法－ＳＩＰＡＰ分级系统。结论：ＣＴ和ＭＲＩ增强对垂体瘤的定位、定性、定量和定级诊断均具有至关重要的作用。     

颈椎病椎动脉血流的MR测量研究

颈椎病椎动脉血流的ＭＲ测量研究陈彦徐家兴李恩中张光武颈椎病是临床常见病。颈椎常规ＭＲＩ可精确地显示椎间盘变性突出、椎间孔和椎管狭窄、脊髓受压及髓内异常信号，对神经根型、脊髓型颈椎病的诊断具有较高参考价值，但对椎动脉型颈椎病尚较难提供可靠的诊断依据。Ｍ...     

鼻咽癌颅内侵犯的MRI诊断

目的：评价Ｇｄ－ＤＴＰＡ增强后ＭＲＩ对鼻咽癌放疗后复发及颅内侵犯的诊断价值。材料和方法：对颅内侵犯的２０例放疗后复发和７例初发鼻咽癌患者比较ＣＴ及ＭＲＩ增强前后检查结果。结果：２７例鼻咽癌侵犯颅内者几乎均有颅底骨质破坏,比较ＣＴ和ＭＲＩ检查,增强ＣＴ显示颅内侵犯确定、可疑和不明确者各占１／３,增强ＭＲＩ都可显示清楚,且较好确定肿瘤的复发。结论：增强ＭＲＩ可作为鼻咽癌复发和颅内侵犯的主要诊断方法。     

颈椎病动态MRI扫描揭示椎管狭窄及脊髓受压因素的价值

颈椎动态MRI扫描直观地显示屈伸状态下导致椎管狭窄及脊髓受压的动态因素,为临床提供了中立位扫描所不能揭示的致病机制,以后伸位为著。后伸位颈椎功能性受压与颈椎退变阶段及椎管矢径密切相关,当中立位MRI显示黄韧带肥厚,或椎关节僵硬伴发椎管矢径≤10.0mm时,建议行动态MRI扫描。前屈位虽然可以减轻脊髓受压,但持久前屈会促使或加重颈椎病的发生。     

Identifiable causes for poor outcome in surgery for cervical spondylosis

Summary Outcome from surgery for cervical spondylosis is often disappointing. To identify possible causes of poor outcome 56 such patients referred for post-operative computed myelography or MRI were evaluated, 22 of which eventually had further surgery. Alternative diagnoses to cervical spondylosis were eventually established in 14.3 %; 26.8% had spinal cord atrophy 15.6% of which also had myelomalacia; 28.6% had diffuse spinal canal stenosis; and in 57.1% surgery had failed to decompress the spinal canal. These findings can be partly explained by patient selection criteria; nevertheless they do serve to emphasises the point often ignored in discussions of the efficacy of surgery in cervical spondylosis, that operations significantly often fail to achieve adequate decompression. Furthermore there was no evidence in this material that osteophytes regress after spinal fusion.     

颈椎病的CT诊断

作者分析了２６０例颈椎病的ＣＴ表现，特征性的ＣＴ表现对提供正确的诊断有帮助，其主要征像为：１．椎间盘突出及部分钙化；２．钩突增生肥大；３．椎体后缘及前周缘骨质增生；４．椎管、侧隐窝及椎间孔受压变窄；５．黄韧带肥厚；６．椎间盘“真空征”。本文对颈椎病ＣＴ检查的优点和限度作了简短的讨论。     

颈椎管狭窄症的磁共振成像研究

目的：比较分析手术证实颈椎管狭窄症的MRI及X线和临床资料，明确颈椎管狭窄症的MRI概念及分型．材料和方法：对一组47例MRI进行各节段颈髓腹侧代偿间隙、颈髓和颈髓背侧代偿间隙矢状径测量;X线片上测量椎体、椎臂矢状径并计算Torg指数；采用JOA十七分法作临床评分。对MRI及X线和临床资料进行相关分析．结果：MRI示颈椎管狭窄患者的颈髓腹背侧代偿间隙、颈髓矢状径均减小，以病变节段最明显。MRI对临床表理的预示能力优于X线。MRI可以就狭窄范围、狭窄方向、狭窄程度和髓内信号改变行详尽分型．结论：颈椎管狭窄的MRI特征变化为正中矢状面上蛛网膜下腔减少或消失．和／或伴有脊髓的压迫变形，髓内信号异常．分类更准确地反映病理解剖及病理生理改变,密切地联系了临床，对颈椎管狭窄症的准确诊断和治疗选择有指导意义．     

Evaluation of spinal trauma by multi detector computed tomography and magnetic resonance imaging

Aim of work

The aim of this work is to assess the role of multi-detector computed tomography (MDCT) and magnetic resonance imaging (MRI) in evaluation of spinal trauma.

Patients and methods

Between January 2013 and April 2014, 98 patients (78 males and 20 females) with spinal injuries were investigated by MDCT and MRI. Assessment of the radiological findings of spinal injury was performed and the following were investigated: vertebral compression fractures, bursts and dislocations, posterior element fractures, C1 and C2 lesions, vertebral listhesis, bone marrow edema, spinal canal compression, disk herniation, extradural hematoma, spinal cord contusions, spinal cord swelling and posterior ligamentous complex injuries.

Result

A total of 271 lesions were diagnosed as follows: 217 lesions were diagnosed using MRI alone, 1 54 lesions were diagnosed using MDCT alone and 100 lesions were diagnosed using MRI and MDCT conjointly. By using MRI 117 more lesions were detected than using MDCT. MRI was significantly superior to MDCT in the diagnosis of bone marrow edema, posterior ligamentous complex injuries, disk herniations, spinal canal compressions, and spinal cord contusions and edema. In cervical spine injuries, MRI was useful for the evaluation of the supporting ligaments and the spinal cord after the patient has been stabilized. The average times required to perform CT and MRI were 1.38 ± 19.83 and 2.00 ± 19.58 days, respectively; this difference was significant (p?0.05) according to the Mann–Whitney test.

Conclusion

MRI was significantly superior to MDCT in the diagnosis of bone marrow edema, posterior ligamentous complex injuries, disk herniations, spinal canal compressions, and spinal cord contusions and edema. In cervical spine injuries, MRI was useful for the evaluation of the supporting ligaments and the spinal cord after the patient has been stabilized.MDCT and MRI are complementary to each other in evaluation of spine injuries.     

Comparison of MR and CT myelography in imaging the cervical and thoracic spine

MR imaging and CT myelography were compared in a retrospective study of 38 patients with suspected lesions of the cervical and thoracic spinal canal and cord. Twenty-eight abnormal cases were found, including spondylosis (9), tumors (8), intramedullary cavities (3), arachnoiditis (3), disk-space-centered infection or osteomyelitis (2), nonneoplastic cord swelling (2), and CSF-borne metastasis (1). MR was equal or superior to CT myelography in depicting cases of cord enlargement, cord compression, and cord atrophy, providing better tissue characterization, no shoulder artifact, and no limitation caused by CSF block. CT myelography was superior to MR in depicting cases of spondylosis and arachnoiditis. It showed superior spatial resolution, which was most pronounced when comparing axial images and hence particularly superior in detecting the lateral extent of disk herniation. Use of surface coils and thin imaging sections is essential for accurate and complete MR evaluation of the cervical and thoracic spine.     

椎动脉型颈椎病的CT和MR成像

目的:探讨多层螺旋CT和磁共振成像对椎动脉型颈椎病的诊断价值。方法:随机抽取CT检查和MRI检查显示异常患者各30例,30例全部行颈部MRI和MRA检查;30例行CTA检查。结果:MRA及CTA均显示椎动脉变细、扭曲、局限性狭窄、闭塞或走行失常等改变;但显示骨质结构CT优于MRI检查;MRI无射线损伤。结论:MRA与MRI联合应用及多层螺旋CTA检查均是诊断椎动脉型颈椎病较为理想的检查手段。     

高G载荷下飞行员颈椎病54例分析

目的探讨高G载荷下飞行员颈椎病的类型及发病与机种的关系。方法对54例颈椎病飞行员的颈椎正、侧、双斜位X片或(和)CT,MRI检查结果进行分析。结果54例中46·3%为局部型,交感神经型与脊髓型最少,两者均为3·7%。在各种机种中,强击机飞行员患颈椎病的比例最高为29·6%,直升机飞行员比例最低,为9·3%。颈椎生理曲度异常率强击机和歼击机组明显高于直升机组(P<0·01),而强击机与歼击机之间无显著差异(P>0·05)。结论强击机、歼击机等高性能战斗机的飞行员容易引起颈椎生理曲度异常和颈椎病,颈椎病中以局部型为主。