椎间盘源性下腰痛的MRI和椎间盘造影的相关性研究

目的 探讨椎间盘源性下腰痛患者的MRI和椎间盘造影表现与椎间盘造影一致性诱发痛的相关性.方法 93例慢性下腰痛患者腰椎MR检查和256个腰椎椎间盘造影.椎间盘造影按照Adams等分级标准进行,MRI髓核退变按Pearce等分级标准,终板退变按Medic标准分级,疼痛诱发评价分为一致性诱发痛和无痛或非一致性诱发痛.分析MRI椎间盘退变分级、椎间盘造影分级与一致性诱发痛的相关性.获得的数据采用X2检验进行统计分析.结果 93例256个椎间盘造影,116个出现一致性诱发痛.椎间盘造影:Ⅰ型椎间盘17个(6.6%),Ⅱ型椎间盘25个(9.8%),Ⅲ型椎间盘91个(35.5%),Ⅳ型椎间盘77个(30.1%),Ⅴ型椎间盘46个(18.0%).MRI椎间盘退变分级:Ⅰ级23个(9.0%),Ⅱ级34个(13.3%),Ⅲ级84个(32.8%),Ⅳ级85个(33.2%),Ⅴ级30个(11.7%).椎间盘造影与MRl分级密切相关(r=0.62,X2=160.87,P<0.01);椎间盘造影Ⅳ-Ⅴ型椎间盘123个,104个出现一致性诱发痛,与一致性诱发痛密切相关(r=0.60,X2=144.08,P<0.01);MRI椎间盘Ⅳ-Ⅴ级退变115个,99个出现一致性诱发痛,与一致性诱发痛密切相关(r=0.59,X2=137.11,P<0.01);椎间盘后缘高信号区60个,52个出现一致性诱发痛,两者具有密切相关性(r=0.41,X2=51.93,P<0.01);椎间盘终板异常58个,51个出现一致性诱发痛,两者具有密切相关性(r=0.41,X2=52.76,P<0.01).结论 MRI显示髓核中、重度退变、椎间盘后缘高信号区、椎体终板退变,以及椎间盘造影表现为外纤维环破裂、后纵韧带复合体破裂和出现一致性诱发痛时,可高度提示椎间盘源性下腰痛.椎间盘造影显示的椎间盘纤维环破裂伴随造影时的一致性诱发痛,是椎间盘源性下腰痛诊断的重要依据.     

Prospective evaluation of contrast-enhanced MR imaging after uncomplicated lumbar discography

Objective Postdiscography infection is an uncommon complication. Magnetic resonance (MR) imaging is often the modality of choice for evaluating spinal infection. Discography entails disc access and fluid injection that could alter the baseline MR imaging appearance of the spine and be confounded for infection. Our purpose was to describe the MR imaging findings of the lumbar spine subsequent to uncomplicated discography and to determine if this may mimic infection. Design and patients In a prospective cohort study of eight adults (age 22–64 years, mean 45 years) with 22 intradiscal injections, all subjects underwent routine unenhanced and contrast-enhanced MR imaging during the 2–3 week interval postdiscography. A subset of four returned for additional MR imaging during the 4–8 week interval postdiscography. MR images were reviewed for intradiscal, endplate, marrow, and epidural findings and then compared with prediscography examinations. Infection was excluded by clinical documentation. Results Postdiscography MR imaging showed that almost all levels were similar to baseline prediscography examinations. No levels developed new vertebral marrow edema, fluid-like intradiscal signal, endplate irregularity, or epidural abnormality. Two subjects simulated potential discitis, but these findings were unchanged from prediscography and were related to prior surgery. Conclusions Uncomplicated lumbar spine discography does not cause MR imaging changes that simulate discitis. This research was supported by the Air Force Surgeon General’s Office.     

MRI和CT椎间盘造影对腰椎间盘破裂诊断的比较研究

目的 比较MRI、CT椎间盘造影（CTD）对腰椎间盘破裂的诊断价值。方法 选择有慢性下腰痛病史、无典型的神经根性症状和体征、CT平扫和MR检查无腰椎间盘突出征象的16例患者行MR和CTD配对检查；制定统一的CTD分型及阳性椎间盘的标准；观察诱发腰痛与椎间盘内注射对比剂剂量之间的关系。结果 16例（21个腰椎间盘）MR和CTD的配对检查，CTD显示12个腰椎间盘为2型、1个腰椎间盘为5型，合计13个为阳性椎间盘，MRI显示6个腰椎间盘纤维环后方可见高信号区，为椎间盘破裂的间接征象，7个腰椎间盘仅显示退行性改变。结论 CTD是显示椎间盘破裂直接征象的惟一方法；诱发腰痛与腰椎间盘破裂类型有关。常规MRI仅能显示部分腰椎间盘破裂的间接征象，要明确腰椎间盘破裂需行CTD。     

MR imaging and CT in osteoarthritis of the lumbar facet joints

Objective. To test the agreement between MR imaging and CT in the assessment of osteoarthritis of the lumbar facet joints, and thus to provide data about the need for an additional CT scan in the presence of an MR examination. Design and patients. Using a four-point scale, two musculoskeletal radiologists independently graded the severity of osteoarthritis of 308 lumbar facet joints on axial T2-weighted and on sagittal T1- and T2-weighted turbo-spin-echo images and separately on the corresponding axial CT scans. Kappa statistics and percentage agreement were calculated. Results. The weighted kappa coefficients for MR imaging versus CT were 0.61 and 0.49 for readers 1 and 2, respectively. The weighted kappa coefficients for interobserver agreement were 0.41 for MR imaging and 0.60 for CT, respectively. There was agreement within one grade between MR and CT images in 95% of cases for reader 1, and in 97% of cases for reader 2. Conclusion. With regard to osteoarthritis of the lumbar facet joints there is moderate to good agreement between MR imaging and CT. When differences of one grade are disregarded agreement is even excellent. Therefore, in the presence of an MR examination CT is not required for the assessment of facet joint degeneration. Received: 12 June 1998 Revision requested: 20 October 1998 Revision received: 29 December 1998 Accepted: 14 January 1999     

The role of discography in lumbar disc disease: a comparative study of magnetic resonance imaging and discography

This study reviews prospectively a series of 29 patients who were examined by magnetic resonance imaging (MRI) and discography for degenerative disc disease. All had persistent low-back pain and non-diagnostic initial investigations, including plain films, myelography and/or computed tomography (CT). The imaging characteristics for degenerative disc disease correlated in 65 out of 73 intervertebral levels. All symptomatic discs were degenerate on both MRI and discography. Features of degenerative disc disease on MRI were assessed retrospectively, with a view to identifying the symptomatic level as defined by discography. MRI could not reliably detect this level, particularly in those with multi-level degenerative disc disease. Positive reproduction of symptoms at discography was the criteria used for surgery. All 12 patients in this group had posterior spinal fusion performed. Nine improved and three were unchanged. Of the ancillary features associated with disc degeneration, only a bulging annulus fibrosis proved to be of any value on MRI. Nonetheless, MRI should be used as the primary investigation in this patient group as it can lead to a marked reduction in the number of disc levels requiring injection.     

Adrenoleukodystrophy: correlating MR imaging with CT

The effect on the brain of the sex-linked recessive form of adrenoleukodystrophy was studied in 40 boys, 4-18 years old. All underwent computed tomography (CT) scanning; six underwent magnetic resonance (MR) imaging. MR showed a high sensitivity in demonstrating white matter disease. Auditory pathway disease was characterized as involvement of the lateral lemniscus and medial geniculate body, and visual pathway disease was characterized by lateral geniculate body, Meyer loop, and optic radiation involvement. Contrast-enhanced CT still proved to have a greater capacity (at this time) to show the active, advancing form of the disease and concomitant calcifications. This large CT series also demonstrated the broad and variable expressions of adrenoleukodystrophy, which allowed the unification of previously described atypical forms of the disease.     

Benign lumbar arachnoiditis: MR imaging with gadopentetate dimeglumine

MR imaging was performed in 13 patients with benign lumbar arachnoiditis both before and after IV injection of gadopentetate dimeglumine. The arachnoiditis was proved by previous myelography in 12 patients and by noncontrast MR imaging in one patient. The disease was presumably the result of previous myelography and/or surgery. It was characterized as mild in two patients, moderate in two patients, and severe in nine patients. Imaging was performed on a 1.5-T unit, and both short and long TR images were obtained before and after contrast administration. Noncontrast MR images demonstrated changes consistent with arachnoiditis in all patients. After contrast, three patients had no enhancement, three patients had minimal enhancement, three patients had mild enhancement, and four patients had moderate enhancement. In no case did contrast enhancement alter the diagnosis or reveal additional findings that could not be seen on the noncontrast images. Gadopentetate dimeglumine enhancement plays little role in the diagnosis of lumbar arachnoiditis. If used for another reason, however, short TR scans may show enhancement of adherent roots in some cases. In addition, administration of gadopentetate dimeglumine will not cause sufficient enhancement to hinder the detection of arachnoiditis on long TR images and may aid in recognition of adherent roots on short TR images.     

Benign lumbar arachnoiditis: MR imaging with gadopentetate dimeglumine

MR imaging was performed in 13 patients with benign lumbar arachnoiditis both before and after IV injection of gadopentetate dimeglumine. The arachnoiditis was proved by previous myelography in 12 patients and by noncontrast MR imaging in one patient. The disease was presumably the result of previous myelography and/or surgery. It was characterized as mild in two patients, moderate in two patients, and severe in nine patients. Imaging was performed on a 1.5-T unit, and both short and long TR images were obtained before and after contrast administration. Noncontrast MR images demonstrated changes consistent with arachnoiditis in all patients. After contrast, three patients had no enhancement, three patients had minimal enhancement, three patients had mild enhancement, and four patients had moderate enhancement. In no case did contrast enhancement alter the diagnosis or reveal additional findings that could not be seen on the noncontrast images. Gadopentetate dimeglumine enhancement plays little role in the diagnosis of lumbar arachnoiditis. If used for another reason, however, short TR scans may show enhancement of adherent roots in some cases. In addition, administration of gadopentetate dimeglumine will not cause sufficient enhancement to hinder the detection of arachnoiditis on long TR images and may aid in recognition of adherent roots on short TR images.     

Sports-related groin pain: evaluation with MR imaging

Our purpose was to assess the role of MRI in evaluating themusculoskeletal system in athletes with chronic pain laterally in the groin of unknown etiology. Magnetic resonance imaging (MRI) of the pubic ring was performed in 11 young athletes (soc cer players) with long-standing groin n pain. MR findings were: compared with plain films and isotope examination (bone scan Tc 99M). Abnormal MRI findings included a broadend andirregular symphysis witha characteristics pattern of low signal intensity on T1W and high signal intensity on T2W images localized in the superior pubic ramus at a distance from the symphasis. Positive findings wer also observed on plain films and on nuclear medicine studies. However, the imaging findings in the superior pubic ramus of the symphysis was located considerably more laterally on MRI. MRI is :a valuable method for evaluating discrete and ambiguous pelvic pain in athletes. particularly for identifying concomitant changes in the superior ramus, which may give rise to long-standing localized laterally in the groin.     

Vagal neuropathy: evaluation with CT and MR imaging

The vagus nerve, as a result of its protracted course from the brain stem to the abdomen, can present a difficult imaging problem when it is compromised by a clinically occult lesion. The clinical and radiologic records of 48 patients with suspected vagus nerve dysfunction were reviewed to derive an efficient and effective approach to imaging this patient population. An imaging algorithm is proposed in which vagal neuropathies are divided both clinically and radiologically into proximal and distal categories. Proximal vagal lesions are part of a cranial neuropathy complex and have associated oropharyngeal signs and symptoms (e.g., abnormal gag reflex, uvular deviation). Distal vagal lesions occur as an isolated paralysis of the vagus nerve with no symptoms or signs referable to the oropharynx. Either computed tomography (CT) or magnetic resonance imaging can be used to diagnose proximal or distal lesions. However, CT will be insensitive in the detection of the more cephalic proximal lesions, especially those in the brain stem, basal cisterns, and skull base.     

Bladder cancer: staging with CT and MR imaging

Magnetic resonance (MR) imaging and computed tomography (CT) were compared in 30 patients with histologically proved bladder cancer. MR imaging was accurate in depicting the presence or absence of extravesical spread in 22 patients (accuracy, 73%; sensitivity, 82%; specificity, 62%), and CT was accurate in 24 patients (accuracy, 80%; sensitivity, 94%; specificity, 62%). The MR examinations of two patients were of undiagnostic quality and therefore considered to be technical failures. Each technique resulted in five false-positive and one false-negative examination for the diagnosis of extravesical tumor spread. In 28 patients the integrity of the bladder wall was assessed with MR imaging. In 22 patients the bladder wall was disrupted, and 18 of these patients had deep muscle invasion. In six patients the bladder wall was intact, and none of these patients had evidence of deep muscle invasion at pathologic examination. In this study MR imaging was slightly inferior to CT in the delineation of invasive tumors beyond the bladder wall. However, if one excludes from analysis the two patients with undiagnostic studies, there is no significant difference in accuracy between the two techniques.     

CT/MRI在随访嗅神经母细胞瘤的价值(附5例报告)

目的 评价影像学检查在随访嗅神经母细胞瘤的价值.方法 分析5例嗅神经母细胞瘤随访过程中的CT、MRI表现.结果 2例病人的存活时间超过5年. 2例就诊时病变局限于鼻腔,在随访过程中, 1例表现为右侧眼眶区硬膜外软组织肿块,同时左侧鼻腔内亦可见软组织肿块影,CT、MRI显示病变强化均匀,1个月后左侧鼻腔病变显著增大,且破坏了邻近硬腭.另1例病变则呈浸润性生长,CT显示颅底骨质广泛破坏,翼腭窝、颈动脉管、圆孔、卵圆孔均受累.MRI显示病变侵及颅内海绵窦、颈内动脉以及鞍区结构.另3例就诊时已为T4期,病变以鼻腔顶壁、筛窦为中心,侵犯颅内海绵窦以及鞍区结构,颅底骨质破坏.结论 CT/MRI可清晰地显示病变的侵袭范围,对评价病变的生物学生长行为提供了客观依据.     

Fungal sinusitis: diagnosis with CT and MR imaging

Of 293 patients who underwent computed tomography (CT), surgery, and pathologic examination for chronic sinusitis, 25 had a diagnosis of fungal sinusitis at pathologic examination. Of these, 22 had foci of increased attenuation at CT (in four patients the mean representative CT number [Hounsfied unit] was 122.2 HU [SD, 8.2 HU]), and three did not. Of the 22, 19 patients (76%) met the CT criterion of this study (there was a 12% false-positive and a 12% false-negative diagnostic rate). Six of the 19 patients and one additional patient underwent magnetic resonance (MR) imaging, and all demonstrated remarkably hypointense signal characteristics on T2-weighted images. The findings at MR imaging therefore appear more characteristic of fungal sinusitis than the findings at CT. Furnace atomic absorption spectrometry showed increased concentrations of iron and manganese in mycetoma compared with their concentrations in bacterially infected mucus. This finding and the presence of calcium in the fungal concretion may explain the hypointense T2-weighted signal on MR images.     

Sphenochoanal polyps: evaluation with CT and MR imaging

A sphenochoanal polyp is a solitary mass of low attenuation on computed tomographic (CT) scans that arises from the sphenoid sinus and extends through the sphenoid ostium, across the sphenoethmoid recess, and into the choana (the boundary between the nasal cavity and nasopharynx). More often, however, a choanal polyp is an antrochoanal polyp, which arises from the maxillary antrum, protrudes through the middle meatus, extends into the nasal cavity, and continues back to the choana. Contiguous axial or coronal magnetic resonance and CT images help clearly differentiate the rare sphenochoanal polyp from the more common antrochoanal polyp. The sinus of origin is important to identify, as the surgical approach depends on the target sinus.     

Mycetoma: comparison of MR imaging with CT

Magnetic resonance (MR) images obtained in 18 patients with pathologically confirmed mycetoma in the body (n = 4) or lower extremity (n = 14) were retrospectively reviewed and compared with computed tomographic (CT) scans in 15 patients and surgical findings in 10. T1-weighted images showed an infiltrating mass (same signal intensity as muscle) involving skin, subcutaneous fat, muscles, tendons, and other tissues. On T2-weighted images, the mass and affected structures showed moderately increased signal intensity. Bone marrow involvement was detected in seven patients and was best visualized on T1-weighted images. CT showed moderate enhancement of the infiltrative process in all patients. Bone changes, seen in nine, included coarse trabeculation, periosteal reaction, endosteal proliferation, and patchy destruction. MR imaging and CT were comparable and correlated well with surgery in showing the extent of soft-tissue involvement. Early bone changes (important for therapy planning for pedal mycetoma) were seen only at CT. The study showed that MR imaging is sensitive for assessing the extent of mycetoma in the soft tissues. CT should be the method of choice for staging pedal lesions because it can be used to detect early bone involvement.     

MR portography: Preliminary comparison with CT portography and conventional MR imaging

Magnetic resonance (MR) imaging with arterial portography (MRAP) was compared with computed tomography with arterial portography (CTAP) and conventional MR imaging for preoperative evaluation of hepatic masses in eight patients (nine studies). Twenty contiguous, 10-mm-thick-section CTAP images were obtained. MR imaging included T1- and T2-weighted spin-echo and fast multiplanar SPGR (spoiled gradient-recalled acquisition in the steady state) techniques. For MRAP, 0.1 mmol/kg gadopentetate dimeglumine was injected into the superior mesenteric artery. Portographic-phase, 8-mm-thick-section, axial SPGR images were first obtained, followed by “systemic phase” SPGR images. Lesions were seen best on the portographic-phase MRAP images and were less conspicuous on the systemic-phase MRAP, CTAP and conventional MR images. Of 19 visualized lesions, 18 were seen with MRAP; however; five subcentimeter lesions seen with MRAP were not seen with conventional MR imaging or CTAP. Systemic recirculation of iodinated contrast material from the bolus and from previous angiography is a potential limitation of CTAP. For both CTAP and MRAP, optimal results are expected if all images are obtained during a single breath hold, within seconds of the onset of contrast agent administration.     

Neural foraminal ligaments of the lumbar spine: appearance at CT and MR imaging.

Axial and parasagittal computed tomographic (CT) scans and magnetic resonance (MR) images and exactly corresponding sections obtained with the freezing microtome in 18 human cadavers were examined to characterize the radiologic appearance of the lumbar neural forminal ligaments, which have been thought to contribute to nerve root compression. In the CT component of this study, 114 neural foramina at 57 spinal levels were studied; in the MR component, 27 neural foramina were studied. The ligaments originated from the posterolateral margin of the intervertebral disk and attached to the inferior pedicle, superior articular process, transverse process, or ligamentum flavum. On CT scans, they appeared as linear structures with higher attenuation coefficients than those of the adjacent fat and areolar tissue; on MR images, as linear structures with lower signal intensities than those of the adjacent fat and areolar tissue in the neural foramina. It is concluded that the ligaments in the neural foramen can be effectively depicted with CT or MR imaging.     

Castleman disease: CT and MR imaging features of a retroperitoneal location in association with paraneoplastic pemphigus

We describe the CT and MRI features of a case of Castleman disease which was unusual by both its retroperitoneal location and its association with paraneoplastic pemphigus. Received: 9 July 1998; Revision received: 16 November 1998; Accepted: 12 January 1999