脊柱骨转移瘤MRI诊断价值

作者报告５５例脊椎转移瘤ＭＲＩ表现，并与Ｘ线平片、平扫及增强ＣＴ、椎管造影、椎管造影ＣＴ（ＣＴＭ）等方法相比较，在显示肿瘤的解剖关系，包括骨破坏、椎管内侵犯、椎旁软组织延伸、病理压缩性骨折等方面，ＭＲＩ明显优于Ｘ线平片，平扫及增强ＣＴ，至少等于脊髓造影和ＣＴＭ，但是ＭＲＩ诊断脊椎转移瘤，大多数病例不需要椎管内注射造影剂。ＭＲＩ作为一种新的可供选择的技术，对脊椎转移瘤的诊断有重要价值。在大多数病例中可以替代脊髓造影和ＣＴＭ     

<中国矫形外科杂志>1999年主要刊文综述

《中国矫形外科杂志》(以下简称本刊)1999年共发表论文662篇,重点刊出了脊柱四肢骨疾病、骨创伤、骨肿瘤、先后天性肢体畸形矫治及骨科领域基础研究等方面的论文,基本反映了我国矫形外科诊治和基础研究的现状与水平。1　骨肿瘤本刊1999年第1、8期重点报道了骨肿瘤诊断、治疗、基础研究及治疗进展。1.1　骨肿瘤诊断方面医学影像检查方法的选择及其结果的评价对早期诊断椎管内肿瘤十分重要,叶根茂等(8:568)将73例经手术治疗、病理证实的原发性椎管内肿瘤的资料进行分析,发现椎管造影、ＣＴＭ、ＭＲＩ确诊率高,Ｘ线平片和ＣＴ则较低,认为在神经…     

放射影像检查在腰椎退行性病变的应用

本文论述了脊柱影像检查的基本原则及Ｘ线平片，ＣＴ，椎间盘造影，椎管造影，ＭＲＩ等在急慢性下腰背痛，下肢痛，术后疾病方面的应用。     

MRI对胸腰椎爆裂性骨折的诊断价值

本文对５６例胸腰椎爆裂性骨折的ＭＲＩ检查结果进行回顾性分析,以探讨ＭＲＩ的诊断价值,重点观察骨折,韧带及椎间盘损伤、脊髓马尾损害及血肿情况。结果有５３例前、中柱骨折在ＭＲＩ图像上得到明确显示,其椎管狭窄及后凸畸形程度与Ｘ线平片或ＣＴ扫描结果成正相关,有非常显著的统计学意义（Ｐ＜０．０１）,而ＭＲＩ所示韧带损伤多数无法根据Ｘ线平片或ＣＴ扫描结果作出诊断。作者认为,ＭＲＩ对于胸腰椎爆裂性骨折的诊断具有重要价值,必要时应与ＣＴ扫描同时选用。     

椎管扩大成形术治疗腰椎椎管狭窄症30例

目的：椎管扩大成形术治疗腰椎椎管狭窄症。方法：临床治疗３０例,术前均作Ｘ线片,ＣＴ检查,部分病人还作ＭＲＩ检查,以明确诊断,准确定位。随诊０．５年～５年,平均２．２年。结果：临床症状缓解,椎管扩大满意,脊柱稳定性良好,优良率达９６．６％。     

四肢骨肿瘤的MRI与X线平片检查的比较

作者对１４例经组织学证实的四肢原发性骨肿瘤的ＭＲＩ和Ｘ线平片检查结果做了比较。结果表明ＭＲＩ对骨肿瘤范围的确定优于Ｘ线平片，特别在软组织内。９例恶性骨肿瘤中８例ＭＲＩ显示的病变范围大于乎片所见；６例根据ＭＲＩ表现做出组织学诊断，７例经Ｘ线平片做出诊断。５例良生骨肿瘤４例分别经ＭＲＩ和Ｘ线平片做出诊断。ＭＲＩ对肿瘤的范围能提供更多信息，有助于肿瘤的分期，但平片不仅最为经济，对组织学确定也最为可靠。有些病例ＭＲＩ较平片更为准确地反映大体病理改变。     

颈椎损伤的影像学检查

颈椎损伤患者的急救与治疗关键在于早期即作出正确的诊断,影像学检查在颈椎损伤的早期诊断手段中占有十分重要的地位。尽管近年来ＣＴ、ＭＲＩ等影像学先进技术在颈椎损伤诊断中逐步得到应用和普及,传统的放射学检查方法仍具有不可替代的作用。本文重点讨论颈椎损伤的Ｘ线平片诊断要点及研究进展,并对ＣＴ和ＭＲＩ检查的特点与适应证选择作一简要介绍。1　Ｘ线检查的适应证1.1　无症状患者　一些作者主张所有严重创伤病例不论有无相关症状或体征均应视为高危患者而行颈椎Ｘ线检查,美国外科学会曾建议对严重创伤患者应常规行颈椎Ｘ线检查,但…     

腰椎间盘突出症的定位诊断及影像学对比研究

方法：回顾性分析３８０例腰椎间盘突出症术前临床定位诊断、术前脊髓造影、ＣＴ扫描和ＭＲＩ成像等四组术前诊断的手术诊断符合率，探讨临床定位诊断和三种影像学诊断在腰椎间盘突出诊断中的价值。结果：经Ｘ检验，三种影像检查对单纯间盘突出诊断的手术符合率与临床定位诊断的手术符合率有非常显著差别。对于间盘突出合并侧隐窝狭窄的手术诊断符合率分别是ＣＴ９２１％，ＭＲＩ２８６％，脊髓造影２６３％。结论：在定位诊断中要明确是否合并侧隐窝狭窄，高分辩率的ＣＴ扫描应列为首选检查方法。     

四肢长骨骨肿瘤的X线片评价

随着肌肉骨骼系统影像诊断技术的不断进步,ＣＴ、ＭＲＩ、ＥＣＴ等越来越多地应用到了骨肿瘤的诊断和评价中来。然而,Ｘ线平片仍是其最先接受的辅诊检查。Ｘ线平片的主要目的是确定病变的存在、判断病变的性质,从而决定是否需行进一步的影像学检查甚至病理活检。由于骨...     

骶神经根囊肿的影像学诊断和治疗方法的探讨

目的：探讨骶神经根囊肿的临床及影像学特点、病因和治疗方法。方法：总结分析了６８例骶神经根囊肿的ＭＲ（３５例）、ＣＴ（１６例）、脊髓造影（２９例）、Ｘ线平片等影像学特点和临床表现。结果：本病的临床特点是腰骶部疼痛伴骶神经压迫症状;ＣＴ扫描和Ｘ线侧位平片有的可见椎体后缘凹陷性压迹、骶骨椎板变薄、骶管扩大。ＭＲＩ在Ｔ１加权像囊肿呈低信号,Ｔ２加权像囊肿呈高信号,表现为长Ｔ１和长Ｔ２信号。脊髓造影显示骶神经根有造影剂囊状充盈。其影像学表现与其手术所见一致。椎板减压、囊肿切除疗效显著。结论：脊髓造影和ＭＲＩ对本病诊断和鉴别诊断具有重要的临床价值;ＣＴ扫描对骶骨侵蚀性改变显示较清楚,但由于受扫描范围的限制和囊肿大小的影响易发生漏诊。对保守治疗无效者,应行椎板开窗减压和囊肿摘除术。如有条件可在ＣＴ引导下定位穿刺,囊肿内注入医用人血纤维蛋白胶行栓塞和粘贴术。     

磁共振成像对椎管内肿瘤与肿瘤样病变的诊断价值

目的：分析椎管内肿瘤的MRI表现特征，探讨MRI对椎管内肿瘤与肿瘤样病变的诊断价值。方法：33例经手术和病理证实的椎管内肿瘤与肿瘤样病变患者，术前均行MRI平扫与增强扫描，分析其MRI影像特征。结果：髓内肿瘤3例；髓外硬膜下肿瘤20例；其它椎管内病变10例。髓外硬膜下肿瘤中脊膜瘤与神经类肿瘤的发生部位与信号有一定的特异性。脊膜瘤好发于上胸及下颈段，神经类肿瘤则以上颈及下胸段居多。脊膜瘤信号多均匀，而神经类肿瘤多不均匀，易发生囊变是较为特征性的表现，有囊变病灶中又以神经鞘瘤居多。结论：MRI检查可以对椎管内肿瘤进行明确的髓内与髓外定位诊断，在此定位诊断的基础上，结合肿瘤的好发部位，信号是否均匀、增强扫描上所见有助于其术前定性诊断。     

Magnetic resonance imaging: lumbosacral lipoma

To evaluate the clinical efficacy of magnetic resonance imaging (MRI) of lumbosacral lipomas, the magnetic resonance images of nine patients were reviewed. T1- and T2-weighted spin echo sequences were used with a 0.5-T magnetic resonance system. The tethered or low-positioned conus medullaris, the lipoma itself, the lipoma--cord interface, the subarachnoid space, and hydromyelia were clearly disclosed. The nerve rootlets were not as clear. These results indicate the possible discontinuance of myelography and metrizamide computed tomography (CT) cisternography for such imaging. The diagnostic modalities of choice for lumbosacral lipoma imaging are plain spine films, plain CT scan, and MRI.     

A new cervical spine clearance protocol using computed tomography

OBJECTIVE: The purpose of this study was to assess a cervical spine clearance protocol for blunt trauma patients using helical computed tomographic (CT) scan of the cervical spine (C-spine). METHODS: A protocol using CT scan of the C-spine was implemented and the first 6 months of use reviewed. Patients requiring a CT scan of the head had the C-spine evaluated by lateral C-spine radiography and a helical CT scan. Patients without indication for CT scan of the head had the C-spine evaluated by three-view radiography (anteroposterior, lateral, and odontoid) with selective CT scan of the C-spine for imaging areas not well visualized or those with abnormalities identified by radiography or by clinical examination alone. RESULTS: Three hundred twenty-four patients were admitted to the trauma center after blunt trauma during the first 6 months of protocol implementation. Head CT scans were obtained in 158 patients and lateral cervical spine radiography in conjunction with helical CT scanning evaluated the C-spine. The other 166 patients had the cervical spine cleared by three-view radiography series or by clinical examination alone. For patients in whom a head CT scan was not indicated, CT scanning was used only when plain radiographs failed to adequately visualize the entire C-spine. A total of 15 injuries (4.6% of the group) were detected. Seven injuries were suspected or detected by lateral plain radiographs and confirmed by CT scan. Six patients had an injury not detected by radiography but diagnosed by CT scan, and one patient had a false-positive radiograph. Of the remaining two injuries, one was diagnosed by magnetic resonance imaging and the other by CT scan outside of the protocol. Lateral plain radiographs alone failed to detect 46% (n = 6) of all injuries. CONCLUSION: In our series, the selective use of helical CT scanning with plain radiography increased the accuracy with which cervical spine injury was detected from 54% to 100%. The protocol allowed for more rapid evaluation in many patients as well. We recommend that practice guidelines include the use of helical CT scan of the entire C-spine as the diagnostic procedure for those blunt trauma patients undergoing CT scanning of the head.     

Imaging modalities and tests for cervical myelopathy

Cervical spondylotic myelopathy (CSM) is a progressively degenerative disease of the spine that results from compression of the spinal cord. Diagnostic imaging, in addition to a history and physical examination, is essential to diagnose CSM, to guide surgical decision making, and to identify prognostic indicators to surgical success. We discuss the modalities of imaging in common practice and examine the use of radiographs, magnetic resonance imaging (MRI), CT/CT myelography, diffusion tensor imaging (DTI), and magnetization transfer imaging (MT) in the diagnostic evaluation of patients with CSM.     

Diagnosis of developmental pathology of the neuraxis by magnetic resonance imaging

We have used magnetic resonance imaging (MRI) to evaluate 22 patients with various clinical and/or radiographic findings potentially associated with intraspinal pathology whose evaluation would have necessitated myelography or computed tomography scanning in the past. Ten of these 22 children were diagnosed by MRI to have significant intraspinal lesions: diastematomyelia in four, syringomyelia in four, tethered spinal cord in three, intraspinal lipoma in two, and spinal cord tumor in one. MRI is noninvasive, requires no exposure to ionizing radiation, and provides multiplanar images and three-dimensional reconstruction potential, all with superior soft tissue imaging. In our patient population, it has proven to be a useful diagnostic adjunct.     

Lumbar spinal stenosis: Imaging and non-operative management

Lumbar spinal stenosis (LSS) is a common disorder of the spine. It may be classified etiologically, anatomically, and by severity. Radiographic imaging is an integral adjunct to history and physical examination in the successful diagnosis and treatment of the disorder. MRI is the study of choice; however, patient comorbidities and other factors may necessitate use of other imaging modalities, such as CT scan, myelography, radiographs, and dynamic CT or MRI. There are no generally accepted diagnostic criteria on radiologic studies for LSS, but specific measurement criteria commonly used to diagnose the disorder are reviewed. Common findings associated with LSS on each of the imaging modalities are also reviewed. The natural history of LSS demonstrates that roughly 1/3 of patients will improve, 1/3 of patients will experience no significant changes in symptoms type or severity, and 1/3 of patients will experience exacerbation of symptoms requiring surgical treatment. Several non-operative modalities are reviewed including the following: pharmacologic, epidural steroid injections, physical therapy programs, bracing, and chiropractic. Non-operative modalities by and large are unsuccessful in altering the natural history; however, a 3–6 month course of non-operative treatment is recommended prior to proceeding to surgical management. Careful patient selection is critical for both operatively and non-operatively managed patients.     

Occult intraspinal anomalies in congenital scoliosis

Thirty consecutive patients with congenital spinal deformity underwent magnetic resonance imaging (MRI) to determine the incidence of occult intraspinal anomaly. These congenital spinal deformities included 29 cases of congenital scoliosis and one case of congenital kyphosis. Physical examination findings and plain radiographs were reviewed in an attempt to correlate these findings with subsequent intraspinal pathology. Nine patients had intraspinal anomalies identified on MRI consisting of five with tethered cord, four with syringomyelia, three with lipoma, and one with diastematomyelia. One patient required surgery for diastematomyelia; another underwent release of his tethered cord. Only one patient, with diastematomyelia associated with a syrinx and bifocal tethering, had his anomaly suggested by physical examination and plain radiographs. Two other patients had findings on plain radiographs previously associated with high prevalence of occult intraspinal anomalies; one patient with congenital kyphosis had a tethered cord, and one patient with a unilateral hemivertebrae associated with a contralateral bar had a tethered cord. Two of nine patients with occult intraspinal anomalies required surgery for their anomaly. In patients with a congenital spinal deformity, we found nine (30%) of 30 to have an associated anomaly within the spinal canal. Only three of these nine had plain radiographs and physical examination findings suggestive of their subsequent MRI findings. Given the poor correlation between findings on physical examination, plain radiographs, and subsequent occult intraspinal anomalies on MRI, we believe that MRI is helpful in evaluating patients with congenital spinal anomalies.     

Impact of MRI on treatment plan and fracture classification of tibial plateau fractures

OBJECTIVE: To evaluate the interobserver agreement for both treatment plan and fracture classification of tibial plateau fractures using plain radiographs, computed tomography (CT) scan, and magnetic resonance imaging (MRI). DESIGN: Prospective study to assess the impact of an advanced radiographic study on the agreement of treatment plan and fracture classification of tibial plateau fractures among three orthopaedic surgeons. SETTING/PARTICIPANTS: Patients presenting with tibial plateau fractures to a level I trauma center were evaluated with plain knee radiographs (anteroposterior, lateral, two oblique views), CT scan, and MRI. Three experienced attending orthopaedic trauma surgeons were randomly presented three sets of studies for each injury: radiographs alone, radiographs with CT, and radiographs with MRI (including soft tissue injuries documented by an experienced MRI radiologist). The surgeons were asked to render fracture classification and treatment plan based upon the blind reading of each individual radiographic set. MAIN OUTCOME MEASURES: Agreement among the three surgeons was measured using kappa coefficients. RESULTS: For fracture classification, radiographs alone yielded a mean kappa coefficient of 0.68, which increased to 0.73 for radiographs with CT scan and 0.85 for radiographs with MRI. Fracture classification (Schatzker) was changed an average of 6% with the addition of the CT scan and 21% based on radiographs with MRI. For the fracture management plan, the mean interobserver kappa coefficient for radiographs alone was 0.72, which increased to 0.77 for radiographs with CT scan and 0.86 for radiographs with MRI. MRI changed treatment plan in 23% of the cases. CONCLUSION: Magnetic resonance imaging increases the interobserver agreement on fracture classification and operative management of tibial plateau fractures.     

胸椎黄韧带骨化症的影像诊断

目的:探讨胸椎黄韧带骨化症的诊断及影像学特点。方法:分析90例胸椎黄韧带骨化症患者的CT和/或MRI资料,并根据影像学特征进行分类。按照MRIT2WI轴位脊髓及硬膜囊的受压迫程度分为轻度、中度、重度。9例获CT或/和MRI检查2年以上随访的患者,选择扫描条件、部位一致的骨化节段对比研究其变化情况。结果:MRI扫描的73例患者共发现黄韧带骨化节段421个。骨化节段呈跳跃性分布35例(46.58%)。多节段发生68例(93.15%)。T2WI轴位扫描的365个节段呈现有压迫:轻度193个节段,中度80个节段,重度92个节段。9例2年以上影像随访患者,随访前CT示均匀性骨化的9个节段,随访时骨化块大小密度无变化;随访前不均匀性骨化6个节段,随访时骨化块增大、密度改变。随访前MRI示骨化为无信号9个节段,随访时骨化块的形态、内部信号、对脊髓的压迫程度均无改变;随访前低信号18个节段,随访时15个节段有不同程度的生长,即对脊髓和硬膜囊的压迫程度加重,骨化块形态改变,3个节段只有骨化块信号的改变,脊髓的受压程度无明显变化。结论:胸椎黄韧带骨化多数病例为多节段,分布无明显规律性。骨化程度与对脊髓的压迫程度并不一致。CT和MRI检查可以作为判断胸椎黄韧带骨化是否成熟的手段。     

Assessment of injury to the thoracolumbar posterior ligamentous complex in the setting of normal-appearing plain radiography.

BACKGROUND CONTEXT: The posterior ligamentous complex (PLC) is thought to contribute significantly to the stability of thoracolumbar spine. Obvious translation or dislocation of an interspace clearly denotes injury to the PLC. A recent survey of the Spine Trauma Study Group indicated that plain radiographic findings, if present, are most helpful in determining PLC injury. However, confusion exists when plain radiography shows injury to the anterior spinal column without significant kyphosis or widening of the posterior interspinous space. PURPOSE: The objective of this study is to identify imaging parameters that may suggest a disruption of the posterior ligamentous complex of the thoracolumbar spine in the setting of normal-appearing plain radiographs. This study was performed, in part, as a pilot study to determine critical imaging parameters to be included in a future prospective, randomized, multicenter study. STUDY DESIGN/SETTING: Survey analysis of the Spine Trauma Study Group. PATIENT SAMPLE: None. OUTCOME MEASURES: Compilation and statistical analysis of survey results. METHODS: Based on a systematic review of the English literature from 1949 to present, we identified a series of traits not found on plain X-rays that were consistent with PLC injury. This included five imaging findings on either computed tomography (CT) scans or magnetic resonance imaging (MRI) and several physical examination features. These items were placed on a survey and sent to the members of the Spine Trauma Study Group. They were asked to rank the items from most important to least important in representing an injury to the PLC in the setting of normal-appearing plain radiographs. RESULTS: Thirty-three of 47 surveys were returned for final analysis. Thirty-nine percent (13/33) of the members ranked "disrupted PLC components (i.e., interspinous ligament, supraspinous ligament, ligamentum flavum) on T1 sagittal MRI" as the most important factor in determining disruption of PLC. When analyzed with a point-weighted system, "diastasis of the facet joints on CT" received the most points, indicating that this category was ranked high by the majority of the members of the group. The members were also given freedom to add other criteria that they believed were important in determining PLC integrity in the setting of normal-appearing plain radiograph. Of the other criteria suggested, one included a physical finding and the other a variant of MR sequencing. CONCLUSIONS: In a setting of normal-appearing plain radiographs, PLC injury as displayed on T1-weighted MRI and diastasis of the facet joints on CT scan seem to be the most popular determinants of probable PLC injury among members of the Spine Trauma Study Group. Between MRI and CT scan, most members feel that various characteristics on MRI studies were more helpful.