急性单纯骨髓挫伤的MRI表现特点

目的探讨急性单纯骨髓挫伤的MRI表现特点。方法对X线平片及多层螺旋CT检查均未见异常的63例骨髓挫伤的MRI表现进行回顾性分析,并总结其表现特点。结果本组MRI检查63例中,膝关节35例,脊柱28例;其MRI表现为T1WI呈低信号,T2WI呈高信号,在STIR及T2*WI上病灶与正常骨髓组织的对比度更高。在长骨灶病呈长斑片地图样,其长轴大体与应力骨小梁走行相一致;在脊柱椎体病灶表现为分布于椎体中央或近终板区的呈横形小片条带状,与椎体应力骨小梁排列垂直。结论MRI能清楚的显示急性单纯骨髓挫伤的病变部位、范围及严重程度,并且病变的形态特点及分布与局部骨髓的营养血管有关。     

CT和MR在颈椎椎体挫伤中的诊断价值

目的探讨CT和MR在颈椎椎体挫伤中的诊断价值。方法搜集39例颈椎椎体挫伤患者的CT及MRI影像资料,测量颈椎挫伤和正常椎体的CT值以及T1WI、T2WI和STIR的相对信号值。数据采用两独立样本t检验和ROC曲线进行统计分析。结果挫伤椎体的T1WI信号强度低于正常椎体,相对T1信号值在两者中的差异有统计学意义(P<0.001);挫伤与正常椎体在T2WI均表现为高信号,相对T2信号值在两者中的差异无统计学意义(P>0.05);挫伤椎体的STIR信号强度高于正常椎体,相对STIR信号值在两者中的差异有统计学意义(P<0.001);挫伤与正常椎体在CT图像上无明显密度差别,CT值在两者中的差异无统计学意义(P>0.05)。基于ROC曲线分析,相对T1信号值、相对STIR信号值和联合相对T1、STIR信号值鉴别两者的准确性分别为74.64%、84.62%和86.5%。结论MR是诊断颈椎椎体挫伤的重要检查,联合T1WI和STIR序列有助于颈椎椎体挫伤的诊断。     

APPLICATION VALUE OF MAGNETIC RESONANCE SEQUENCES IN DIAGNOSIS OF EARLY SPINAL METASTATIC TUMOR

MAGNETIC resonance imaging (MRI) habeen used for the evaluation of spinal in-volvement by metastases.Although in sominstances spinal involvementofmetastasis can be diagnosedclinically and by skeletal scintigraphy, much difficulty iencountered in the case …     

腰椎Modic改变与腰痛及其手术疗效关系的系统回顾分析

Modic changes(MC)are vertebral endplate and ad-jacent bone marrow changes visible in magnetic resonanceimaging(MRI).Bone marrow signal changes in the ver-tebral bodies were first reported by De Roos et al[1].Modic et al[2]classifiedMRI changes into three categories(Fig 1):typeⅠchanges show a low signal intensity(SI)in T1-weighted images(T1W I)and a high SI in T2-weighted images(T2W I),typeⅡchanges show a high SIboth in T1W     

非潜水性下肢骨梗死的影像学诊断

目的探讨骨梗死的影像学表现特征,提高影像学诊断水平。方法回顾性分析经临床随访和病理证实的8例骨梗死患者的DR、CT及MRI影像学资料,将骨梗死分为急性期、亚急性期和慢性期,并与病理相对照。结果骨梗死急性期DR、CT扫描仅表现为局部的骨质疏松,MR T1WI呈等或稍低信号,T2WI呈等或稍高信号,STIR呈不均匀斑片高信号;亚急性期骨梗死DR及CT表现为虫噬样骨质破坏及斑点状硬化,MR T1WI中央呈等或稍低信号,T2WI中央为等或高信号,边缘呈典型的地图样改变;慢性期DR及CT表现为髄腔内不规则蜿蜒状硬化斑块,伴结节状低密度区。结论 MRI是诊断急性期骨梗死最有价值检查方法,能够发现早期病变,DR、CT对亚急性期和慢性期骨梗死病变有帮助,并可见特征性的影像表现。     

脊柱转移瘤的低场MRI诊断

目的:探讨脊柱转移瘤的低场MRI诊断价值。方法:分析经临床或病理证实的脊柱转移瘤的MRI表现。结果:38例转移瘤共涉及166个椎体,单发转移5例,多发转移33例,其中呈跳跃式分布22例。134个受累椎体呈长T1长T2信号,27个呈长T1短T2信号,5个椎体T1WI为低信号,T2WI上为混杂信号,STIR上139个受累椎体见高信号。合并压缩性骨折椎体数21个,合并椎旁软组织肿块15例,合并附件转移14例,无一例出现椎间盘受累征像。18例行增强扫描时,受累椎体、附件及相邻的软组织肿块均见轻—中度强化。结论:在低场强磁共振上脊柱转移瘤具有特征性表现,能有助于早期诊断与鉴别诊断。     

MRI在骨肉瘤诊断中的应用价值

目的:探讨MR常规序列及STIR序列在骨肉瘤诊断中的应用价值。方法:对16例经手术或穿刺病理证实的骨肉瘤患者MRI影像资料进行对比分析。结果:16例患者在MRI常规序列(SE)检查中,6例T1WI/T2WI表现为低信号;2例表现为T1WI低信号,T2WI高信号;其余均表现为T1WI不规则低信号,T2WI为不规则高信号。SE与STIR均能显示肿瘤的形态、部位,STIR序列显示为病变区及周边呈片状高信号,且范围比SE序列显示更大。结论:MRI常规序列可以显示肿瘤的形态、部位,STIR序列在显示肿瘤的侵蚀范围上,显示比较明显、准确,更具有明显优势。     

Avascular necrosis of the femoral head: MR imaging with radiological and histological correlation

OBJECTIVE: To assess the value of MR in the diagnosis of avascular necrosis (AVN) of the femoral head. METHODS: MR images in 34 consecutive patients (26 men and 8 women) with AVN (57 hips) were reviewed. All lesions were confirmed by radiographic, radionuclide, computed tomographic, and/or histologic examination. Eleven specimens were obtained after total replacement of the hip. Four hips underwent biopsy. All MR images were obtained using a 0.35 T superconductive imaging unit with SE sequence. Specimens were cut coronally into 5 mm thick section and radiographs were obtained. RESULTS: There were four types of MR patterns of AVN. Type one appeared liner or patchy low signal area in the superoanterior portion of the femoral head. In type two, a band or ring of low signal intensity was found surrounding a central area of high signal intensity on T1WI and intermediate signal intensity on T2WI. The low signal band or ring consisted of thickened trabecular bone, mesenchymal and fibrous tissue, and amorphous acidophilic cellular debris. The central zones within the ring were composed of necrotic bone and marrow that had not been reached by the repair process. In type three, the focal subchondral region showed intermediate signal intensity on T1WI and high signal on T2WI surrounded by a low signal ring. The low signal ring consisted of thickened trabecular bone and little mesenchymal tissue. The central area was composed of mesenchymal tissue rich in capillaries and cystic necrotic zones. In type four, the signal intensity of femoral head was inhomogeneous on both T1WI and T2WI. There were low signal bands in the femoral neck surrounding the necrotic zone. Only limited areas of some lesions had signal intensity isointense with fat on T1WI and T2WI. The inhomogeneous area of low signal intensity consisted of a mixture of necrotic bone and marrow, amorphous cellular debris. The first type of MR pattern corresponded to the early stage of radiograph, and the third type of MR pattern to stage 5. The second and fourth type of MR patterns correlated less with the radiographic stage. CONCLUSIONS: MR imaging plays an important role in the diagnosis of AVN of femoral head especially in the early detection of AVN. The MR patterns of AVN is not correlated with radiographic stages exactly.     

急性硬脊膜外血肿的MRI诊断

目的探讨急性硬脊膜外血肿的MRI特征。方法回顾性分析28例经手术或临床随访证实的急性硬脊膜外血肿的MRI表现。结果28例中12例位于颈段,5例位于胸段,11例位于腰段。血肿累及1～11个椎体高度,平均3.5个椎体高度。血肿呈短T、短T2或短长混杂T2信号1者8例,呈等T1、短T2或短长混杂T2信号者16例,呈等短混杂T1、短T或短长混杂T信号者422例。血肿在T1WI上均与脊髓间有低信号线相隔,T2WI上与蛛网膜下腔间有低信号线相隔者12例,不明显者16例。结论MRI对急性硬脊膜外血肿的显示,明确范围及对脊髓受压损伤程度等有明显优势,是目前评价急性硬脊膜外血肿的最佳方法。     

脊柱结核的MRI表现

目的探讨脊柱结核的MRj表现,分析其特征。方法回顾分析44例经手术病理证实的脊柱结核MRI征象,观察榷体、终板、椎间盘、冷脓疡的信号变化和增强后改变。结果（1）44例共有110个椎体受累,单椎体2例,2个椎体30例,3个及以上椎体12例;椎体破坏于T1WI呈片状均匀低信号、混杂信号,T2WI及T2脂肪抑制序列呈均匀高信号、混杂信号;终板局限破坏,见囊状小脓肿形成,呈无结构长T1、长T2信号。（2）39例为单个椎间盘受累,其中轻度变窄20例,中至重度变窄19例,T2WI呈低信号,T2wI及T2＋STIR呈不均匀高信号,椎间盘正常者5例。（3）44例椎旁软组织肿胀,椎前或椎旁脓肿39例,其中,10例伴腰大肌脓肿,4例伴椎管内脓肿。脓肿呈T2WI稍低、T2WI及T2＋STIR明显高信号。增强扫描,脓肿壁呈不均匀条带状或环形强化。（4）15例患者21个椎弓根受累,18例脊髓受压。结论椎体及椎间盘破坏、椎体破坏伴椎旁脓肿为脊柱结核特征,MRj能发现脊柱结核早期征象,反映其病理变化。     

膝关节骨挫伤的MRI研究

目的探讨磁共振成像（MRI）对骨挫伤的诊断价值和意义，评价X线、CT、MRI诊断膝关节骨挫伤的效果。方法选取近年X线平片未见膝关节骨折，而MRI检查显示膝关节骨髓有异常改变的56个外伤病例，进行影像表现分析研究。结果56例X线平片均未见明确骨折征象，而MRI检查显示有骨挫伤，表现为T1WI短TI反转恢复序列（short TI inversion recovery，STIR）病变区呈高信号，T1W1呈稍低信号，有膝关节骨挫伤的部分病例还伴有前后交叉韧带、内外侧副韧带、内外侧半月板损伤及创伤性滑膜炎等表现。结论MRI能早期显示骨挫伤及隐性骨折，如患者外伤后X线平片或CT未见骨折，外伤部位持续疼痛并伴有软组织肿胀，不能承受重力，应做MRI检查；脂肪抑制技术STIR及化学位移脂肪成像（Chem—Sat）对显示骨挫伤的敏感性较高，能显示细微的骨髓水肿、充血及骨小梁的微骨折，对发现骨外伤的隐性损伤具有较高的诊断价值。     

原发性骨髓纤维化转化为急性巨核细胞白血病1例及文献复习

目的报道1例由原发性骨髓纤维化转化的急性巨核细胞白血病（M7），并讨论转化前后骨髓MRI表现的改变。方法对我院1例由原发性骨髓纤维化转化为急性巨核细胞白血病的患者在转变前后进行骨髓细胞形态学、细胞遗传学检测，并同步进行髂骨骨髓的MRI检查；使用标准IDA、HA、MA、ACLA等方案序贯治疗，并随访至今。结果在患者处于原发性骨髓纤维化阶段时，髂骨骨髓在MRI上表现为T1WI及T2WI上的片状低信号；而在转化后相同部位骨髓在MRI上表现为T1WI片状低信号，T2WI上散在高信号。该患者（染色体检测提示核型正常）经序贯化疗后达到完全缓解至今。结论原发性骨髓纤维化与急性巨核细胞性白血病在MRI上骨髓表现有明显的改变；核型正常的由骨髓纤维化转变的M7经合理序贯化疗后仍能达到完全缓解。     

淋巴细胞性及髓细胞白血病脊椎骨髓的MRI表现

【目的】比较淋巴细胞性白血病(LL)及髓细胞白血病(ML)脊椎骨髓MRI表现的异同。【方法】对初诊的20例LL,10例ML进行脊椎骨髓磁共振成像(MRI)检查,全部白血病的诊断均经骨髓细胞学检查证实。MRI检查使用0.5T超导磁共振成像系统,自旋回波(SE)序列T_1加权像(T_1WI)及快速自旋回波(TSE)序列T_2加权像(T_2WI)。在T_1WI上将骨髓浸润分为局灶型、弥漫型、斑驳型3种类型。观察LL及ML脊椎骨髓MRI的信号强度、骨髓浸润方式、椎体形态及周围组织改变。【结果】T_1WI上,85％的LL及80％的ML椎体骨髓表现为低信号;T_2WI上,80％的LL及70％的ML为高信号。LL与ML在T_1WI及T_2WI上的信号表现无统计学差异(P>0.05)。75％的LL及80％的ML椎体骨髓为弥漫型浸润。【结论】LL与ML脊椎骨髓MRI表现极其相似,但伴有的椎体形态学特征上可能存在一定的差异。     

STIR对诊断乳腺肿块的临床应用研究

目的 探讨低场强MR机STIR对诊断乳腺肿块的临床应用价值。方法 对25例共26个临床可扪及的乳腺肿块患者行T1WI和STIR横断及矢状面扫描，逐个记录肿块的MRI形态和信号特征，重点观察肿块的形态、边缘、纵横比、内部信号、周围腺体及皮肤改变、腋窝淋巴结肿大等表现，密切结合临床和MRI特点对乳腺肿块性质进行判断。结果 乳腺囊肿于T1WI信号特异，乳腺实性肿块于T1WI信号无特征性，但可以显示肿块形态及与腺体下脂肪垫的关系。STIR可清晰显示乳腺肿块的形态和信号特征，并可同时显示肿块同腺体、皮肤及腋窝淋巴结肿大的关系。良恶性肿块间在形态、边缘、纵横比及内部信号特征方面具有显著性差异。结合STIR所显示的乳腺肿块的形态和信号特点及临床触诊，MRI诊断乳腺肿块的灵敏度为92．3％,符合率为81％。结论 低场强MR机STIR是显示乳腺肿块的理想序列，对诊断乳腺囊肿、乳腺炎和典型的浸润性导管癌及乳腺纤维腺瘤效果明显。     

Age-related Marrow Conversion and Developing Epiphysis in the Proximal Femur： Evaluation with STIR MR Imaging

In order to observe the feature of age-related marrow conversion and maturation of epiphyseal cartilage and analyze the distribution of red and yellow marrow in the proximal femur at STIR MR imaging,STIR and T1 weighted MR imaging of the proximal femur in 52 subjects,aged 4 months to 25 years old,were retrospectively analyzed for the distribution and appearance of red and yellow marrow.The subjects with no known bone marrow abnormalities were divided into 6 age groups.The signal intensity of the marrow in the proximal epiphysis,proximal metaphysis,proximal diaphysis,distal diaphysis and greater trochanter was compared with the signal intensity and homogeneity of surrounding muscle and fat and graded by two observers.The results showed that the conversion of hematopoietic marrow in the proximal femur followed a well-defined sequence,occurring first in the proximal epiphysis,followed by the distal diaphysis,and then greater trochanter and metaphysis.STIR in combination with T1-weighted imaging could display clearly the origin of ossification center and the course of conversion from red to yellow marrow in proximal epiphysis and greater trochanter.STIR imaging showed that the marrow conversion in proximal metaphysic began below epiphyseal plate and intertrochanter.The site of red yellow was distributed in weight-bearing axis by 20 years of age.The marrow conversion of diaphysis was from distal end to proximal end,and the consequence of conversion was that distal diaphysis contained yellow marrow but proximal diaphysis partly red marrow connected with the red marrow of metaphysic.The epiphyseal cartilage had different characters of signal-intensity with age in STIR sequence.The distribution of red marrow in STIR imaging was more close to that of anatomy than T1-weighted imaging.It was concluded that STIR could dynamically display the feature of morrow conversion and the development of epiphyseal cartilage and accurately reveal the age-related distribution of red and yellow marrow on STIR imaging in the proximal femur.     

脊柱转移瘤的影像诊断

目的探讨脊柱转移瘤的X线、CT及MRI征象,以提高脊柱转移瘤的早期诊断率。方法结合临床资料回顾分析68例脊柱转移瘤的X线、CT及MRI影像特征。结果68例脊柱转移瘤共发现157个椎体异常,累及椎弓根23例59根,棘突及横突18处,椎体病理骨折38个,椎旁软组织肿块21例77处。X线和CT表现为椎体及其部分附件骨质破坏或片状高密度硬化影。MRI表现为T1WI低信号,T2WI高信号,脂肪抑制T2表现为高信号。结论脊柱转移瘤的X线、CT及MRI影像均有特征性表现,MRI在发现病灶、鉴别诊断方面优于X线、CT检查。     

X线平片阴性的脊柱外伤MR检查的价值研究

目的探讨MR对X线平片检查阴性的脊柱外伤的诊断价值。方法对103例经X线平片检查结果提示阴性的脊柱外伤病人行脊柱MRI检查,观察椎体附件、椎间盘、韧带、脊髓、神经根、肌肉软组织的形态、信号改变。结果 103例患者MRI检查发现异常31例,阳性率30%,表现为：椎体信号异常45个椎体,T1WI信号减低、T2WI信号增高、STIR序列信号更高;椎间盘损伤9个;前纵韧带损伤6处;后纵韧带损伤8处;发现脊髓损伤5例;一侧神经根损伤1例;椎旁软组织损伤17例。追踪观察7例,MRI提示椎体骨挫伤但无压缩、且未经治疗的患者,复查提示5例搓伤椎体压缩。结论 MRI能显示平片不能观察到的骨挫伤、椎间盘、脊髓、神经根、韧带、软组织损伤,对于X线平片阴性的脊柱外伤患者,应进一步行MRI检查。     

化脓性肌炎8例的MR诊断

目的分析化脓性肌炎的MR表现特点,探讨MR对化脓性肌炎的诊断价值。方法回顾分析经手术及病理证实的8例化脓性肌炎的MR表现并进行总结。结果 8例MR显示受累肌肉弥漫性肿大,T2WI上表现为较明显不均匀高信号,STIR上为明显高信号;而TlWI上呈与邻近肌肉等、略低或略高信号改变,邻近肌间隙水肿。4例病灶中见单个或多个TlWI低信号、T2WI高信号脓肿形成,周围脓肿壁在T1WI上为相对高信号。增强扫描受累肌肉呈明显弥漫性强化2例,2例脓肿形成者呈环状强化,脓腔及小的炎性坏死区无强化。结论 MR可清晰显示化脓性肌炎病变部位、特点及范围,具有重要的诊断价值。     

MRI诊断脊柱结核11例

目的：探讨MRI诊断脊柱结核的价值。方法：回顾性分析经手术病理检查或穿刺活检证实的11例脊柱结核患者的MRI影像资料,观察脊柱结核的MRI信号改变。结果：单椎体受累2例,2个椎体受累4例,3个及3个以上椎体受累5例。11例均见椎体骨质破坏,表现为“虫蚀状”,其中6例出现跳跃病灶,T1加权像（T1WI）均呈低信号,T2WI呈高信号;椎间盘破坏3例,表现为椎间盘变形,失去正常结构,在T1WI均呈低信号,T2WI呈不均匀高信号,受累椎间隙狭窄。寒性脓肿4例,T1WI多呈低信号,T2WI均表现为明显高信号,增强扫描为不规则及环形强化。结论：MRI对脊柱结核具有较高的诊断价值,尤其利于发现多部位脊柱结核。     

髋关节一过性骨髓水肿综合征的MRI诊断及鉴别诊断

目的 探讨髋关节一过性骨髓水肿综合征MRI表现 ,提高其诊断及鉴别诊断水平.方法 结合文献对13例髋关节一过性骨髓水肿综合征的MRI表现进行回顾性分析.结果 双侧髋关节同时受累4例,单侧9例(左侧6例,右侧3例);病变累及股骨头、股骨颈13侧,累及股骨头、股骨颈及股骨粗隆4侧.病变在T1WI呈等或略低信号13例;T2WI呈高信号或略高信号11例,等信号2例;T2WI脂肪抑制病变均呈高信号.合并关节积液8例,呈长 T1、长T2信号.股骨头形态均无异常.结论 正确认识髋关节一过性骨髓水肿综合征的 MRI表现,有利于正确诊断,减少误诊.