急性脊柱创伤的影像学分析

目的 :探讨各种影像检查对急性脊柱创伤的诊断价值及限度。方法 :回顾性分析 2 5 2例急性脊柱创伤病例 ,均在伤后 48h内行X线平片、CT及MRI检查。结果 :共检出椎体骨折 2 78例 ,X线平片、CT及MRI检出率相同 ,三者对附件骨折的检出率分别为 9.1%、2 3 .4%、14 .3 %,差异有极显著性意义 (P <0 .0 1)。 15 2例MRI直接显示脊髓损伤。结论 :在急性脊柱创伤的影像诊断中 ,X线平片可作初检手段 ,CT对骨折检出率最高 ,MRI对脊髓损伤诊断最佳 ,三者结合可提高诊断水平。     

脊柱外伤的平片、CT和MRI诊断价值对比

目的 探讨平片、CT、MRI对脊柱外伤不同的诊断价值.方法 对比分析47例脊柱外伤的X线平片、CT、MRI图像,对椎体附件骨折检出率、脊柱曲度改变、碎骨片移位、椎管容积改变、椎间盘损伤、韧带损伤、脊髓损伤、神经根损伤、椎旁软组织损伤的诊断效果进行评价.结果 平片、CT、MRI检出压缩骨折椎体均为46个,分辨出椎体碎骨片分别是47、134、84块.MRI还检出12个单纯骨挫伤的椎体.CT、MRI显示34块碎骨片压迫脊髓、51个椎间盘形态改变.结论 对脊柱外伤,X线平片诊断价值有限;CT对骨折线、碎骨片移位显示最佳;MRI能显示骨折、骨挫伤、脊髓、椎间盘、神经根、韧带、软组织损伤.     

急性颈椎外伤的MRI诊断

目的 分析急性颈椎外伤的MRI征象,评价MRI在急性颈椎外伤诊断中的价值及限度。方法收集急性颈椎外伤150例,均有MRI检查和X线平片,15例有CT片,采用14个参数进行分析记录。结果150例中MRI检出骨折51个,小关节脱位30个,椎体脱位35个;外伤性椎间盘突出40个,硬膜外血肿2例;脊髓损伤69例;脊髓受压迫20例;前、后纵韧带损伤21例;棘间韧带和黄韧带损伤15例;椎前血肿或水肿30例;椎旁和背侧软组织损伤40例;X线平片发现椎体骨折55个,椎体脱位35个;小关节脱位35例,附件骨折25个,椎前软组织肿胀20例。15例CT均发现骨折,小关节脱位,椎管狭窄。结论MRI在显示脊髓、韧带、椎间盘和软组织损伤方面优于CT和X线平片。MRI能全面反映颈椎各种损伤的病理特征,为评估颈椎稳定性提供充分的依据;MRI和X线片的骨折检出率没有明显差异,CT应该用于复杂的颈椎骨折检查。     

CT与MRI诊断脊柱外伤的临床价值分析

目的探讨CT与MRI在脊柱外伤诊断中的应用价值。方法对收治的脊柱外伤患者分别采用CT和MRI检查,并与最终手术等治疗结果进行对比。结果 CT对92例脊椎外伤患者检查发现,89例患者表现出脊椎骨折,经CT检查发现101个骨折椎体,其中单发椎体85例,占95.51%,MRI对92例脊椎外伤患者检查发现,90例患者表现出脊椎骨折,经MRI检查发现103个骨折椎体,其中有38个椎体骨折线可以清晰辨别(占36.89%),可以清晰辨认出的椎体碎骨片113个,明显低于CT的辨认数量。这表明CT组对绝大多数的骨折线可以清晰辨别,对显示椎体碎骨片方面明显优于MRI。MRI对软组织损伤、脊髓损伤、神经根损伤、前纵韧带、后纵韧带等不同部位的损伤检出率明显高于CT组,且差异具有统计学意义。结论 MRI对脊柱外伤空间定位比较准确,并且也能很好地显示出外伤导致的脊髓病变和损伤,CT和MRI两种方法能够有效互相弥补彼此的不足。     

脊柱结核的影像学诊断

目的：评价X线平片、CT、MRI在脊柱结核的诊断价值。方法：回顾40例经手术病理或临床结果证实为脊柱结核病人的X线平片、CT、MRI影像表现。结果：X线平片可了解椎体破坏、塌陷、椎间隙变窄情况，及脊柱是否后凸畸形。40例CT均可较清楚显示椎体骨质破坏的数目（有21例分别两个椎体受累）、范围及病变是否进入椎管，其中19例形成寒性脓疡。9例行MRI均可显示椎体骨质破坏，周围软组织肿胀、寒性脓疡范围，及椎管、脊髓情况。结论：X线平片结合CT平扫可对脊柱结核进行较全面细致的观察并做出诊断。与肿瘤不易鉴别时需加CT增强扫描。若有神经症状时应补充MRI检查。     

55例外伤性脊髓损伤的MRI表现及诊断

外伤性脊髓损伤是一种非常严重的损伤，占全身损伤的0．2％-0．5％。传统的X线及CT均能够确认不稳定骨折或骨折脱位，但对脊柱挫伤和脊髓损伤的定位、损害范围及严重程度只能在MRI上很好地显示，特别对于无骨折或脱位的脊髓损伤尤显其诊断价值。我们收集了急慢性脊髓损伤55例，现分析MRI表现如下：     

急性胸腰段脊柱脊髓损伤诊断中多种影像的互补作用

目的　讨论各种影像方法在诊断急性胸腰段脊柱和脊髓损伤的优缺点及其互补作用。方法　收集了 12 9例急性胸腰段脊椎损伤病例 ,均有X线和CT材料 ,其中 2 7例有磁共振成像 ,进行比较分析。结果　本组 12 9例 ,14 4个椎体骨折共 15 6个骨折部位 ,其中 84例椎管损伤 ,72例椎管狭窄 ,MRI检查的 2 7个病例均有脊髓损伤。结论　在急性脊柱损伤的诊断中 ,X线平片是基础 ,CT检查可作为补充 ,而MR对脊髓损伤诊断最佳。     

脊柱创伤的CT与MRI表现的对比研究

脊柱创伤往往是累及椎体并常伴有脊髓及周围软组织损伤的联合性损伤，最主要的是对脊髓的损伤，CT是评价椎体骨折的强有力工具，但对脊髓及周围软组织损伤的敏感性不高，随着MRI被广泛的应用于脊柱创伤的诊断，大大提高了对脊柱创伤诊断的全面性和准确性。我们将26例脊柱创伤的CT和MRI进行对照分析，现报告如下。     

脊柱结核的影像学分析

目的　评价X线平片、CT、MRI在脊柱结核的诊断价值。方法　回顾 180例被手术或临床证实为脊柱结核病人的X线平片、CT、MRI ,根据影像学表现和临床分为A(X线平片正常 ,CT或MRI异常 ) ,B(X线平片、CT和MRI均异常 ) ,C(临床有神经症状 ) 3类。结果　依据分类 ,A类 40例 (4 0 / 180 ) ,病史短 ,<4月 ,累及椎体数目少 ,均为 1个。CT可清晰显示骨破坏。B类 70例 (70 / 180 ) ,病史较长 (5～ 12月 ) ,累及椎体数目多 (2～ 3个 )。CT可清晰显示椎体骨破坏的数目、范围及碎骨片在椎管内情况。MRI可显示椎体软组织肿胀及寒性脓肿的范围。C类 70例 (70 / 180 ) ,病史长 ,病史短者 ,破坏位于椎体后部。CT可清晰显示椎体骨破坏的数目、范围及碎骨片在椎管内情况。MRI可显示硬膜外脓肿及脊柱后凸对脊髓的压迫 ,脊髓变性情况 ,寒性肿胀的范围。结论　X线平片结合CT扫描可对脊柱结核进行全面细致的观察 ,对于有神经症状的病人应用MRI作为补充。     

成人早期股骨头缺血性坏死的X线、CT及MRI诊断价值

目的 探讨成人早期股骨头缺血性坏死(ANFH)的X线、CT及MRI诊断价值.方法 回顾性分析经临床确诊的63例75个早期股骨头缺血性坏死的X线平片、CT及MRI的诊断结果.结果 75个早期ANFH中, Ⅰ期30髋;Ⅱ期45髋;早期(Ⅰ～Ⅱ期)股骨头坏死的X线平片、CT及MRI的确诊率分别是25.3%, 64%及100%.结论 MRI在早期诊断ANFH的敏感性和准确率方面优于CT和X线平片.     

经皮穿刺椎间盘切割抽吸术治疗颈椎间盘突出症(附101例分析)

目的 探索经皮穿刺颈椎间盘切割抽吸术（ＰＣＤ）的疗效及安全性。方法 对１０１例经临床和ＭＲＩ确诊为椎间盘突出症病人施行ＰＣＤ,观察术后并发症、临床症状缓解程度和突出髓核还纳程度、椎体的稳定性。结果 ＰＣＤ术后６个月及１、２、３、４年优良率分别为８３．２％,８６．１％,８６．０％,８５．７％,６６．７％．３６例合并失稳者随访３个月至１．５年无一例失稳加剧。并发椎间盘炎１例,穿刺点小血肿３例,脊髓一过     

胸腰椎外伤后脊髓损伤CT平扫的局限性

目的：探讨CT平扫诊断胸腰椎外伤后脊髓损伤的局限性。方法：收集近7a来48例胸腰椎外伤的CT平扫结果、X线片结果及临床资料，并进行对比分析。结果：48例胸腰椎外伤病人中椎体骨折73个，单发59个，多发14个，其中CT示碎骨入椎管内的有25处，血肿1处，附件骨折36处，X线片漏报附件骨折16处(44％)瘫痪病人11例，均经手术治疗，术中发现椎管内碎骨15处，血肿2处，脊髓挫伤或断裂10处。结论：CT平扫对椎体、附件骨折、椎管形态改变和碎骨片移位及明显的椎管内血肿的诊断，优于X线平片，但是对脊髓损伤的显示有局限性，建议胸腰椎外伤后瘫痪病人做脊髓造影(CTM)或磁共振成像(MRI)。     

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.     

Spine trauma

Spinal fractures represent 3% to 6% of all skeletal injuries. Spine trauma is a complex diagnostic area in which the radiological assessment is crucial. Plain radiography is often used as the initial diagnostic modality. However, stabilization of the acutely injured spine is a primary concern. In this respect, computed tomography (CT) is vastly superior to plain film in terms of speed and accuracy. In many trauma centers, CT has replaced plain film as the primary modality for evaluation of spinal trauma. Magnetic resonance imaging is not indicated for all cases of spinal trauma but provides detailed information about soft tissue structures including the intervertebral disc, the ligaments, the epidural space, the blood vessels, and the spinal cord. MR imaging provides information on these structures not obtained from other modalities. Patients with spinal cord injury may suffer devastating long-term neurologic deficits, so prompt and efficient spinal imaging guidelines are necessary in all trauma centers.     

Evaluation of expansive myelo-vertebral pathology using different radiologic modalities, magnetic resonance excluded

The authors review their personal experience in tumors of the spine and the spinal cord, based on 30 cases evaluated with plain x-ray film of the spine, plain Computed Tomography (CT), myelography and myelo-CT. The value of both plain film of the spine and CT in tumoral lesions involving the skeleton is assessed; however, as far as nervous structures are concerned myelography and myelo-CT are necessary. Both myelography and myelo-CT showed high sensitivity (96%), thus allowing the definition of intra- extra-thecal extension of the tumor, and its relationships with the spinal cord and surrounding structures. Myelo-CT turned out to be extremely useful in myelographic stop: the upper extension of the lesion could be defined in 85% of cases. However, the contribution of myelography and myelo-CT was relatively limited when positive findings were present at CT. The evaluation of the density of the lesions proved to be of limited value since no significant differences could be recognized in different tumors. Finally, a diagnostic protocol is proposed for patients with spinal neurologic symptoms, based upon the clinical level of the lesion.     

Can chest and abdominal trauma CT eliminate the need for plain films of the spine? – Experience with 329 multiple trauma patients

Purpose: To compare the accuracy of spine plain films with chest and abdominal trauma CT in detection of spine fractures. Methods: The study prospectively enrolled 329 multiple trauma patients. Of these, 38 patients had both chest CT for trauma and thoracic spine plain films, and 87 patients had both abdominal CT for trauma and lumbar spine plain films. Results: Of the fractures visible at either chest trauma CT or thoracic spine plain film examination, all were diagnosed on CT and 62 % on plain films. Of fractures visible at either abdominal trauma CT or lumbar spine plain films, 94 % were diagnosed on CT and 67 % on plain films. The one false negative CT involved an articular process fracture, which was visible but not mentioned, in a patient with a sacral fracture. Conclusion: Evaluation of the digital scout images and bone windows when a patient has chest and abdominal trauma CT appears to be as accurate as thoracic and lumbar spine plain films in the evaluation of spinal trauma.     

MRI of cervical spine injuries complicating ankylosing spondylitis

OBJECTIVE: The objective was to study characteristic MRI findings in cervical spine fractures complicating ankylosing spondylitis (AS). Technical issues related to MRI are also addressed. MATERIALS AND METHODS: A review of 6,774 consecutive cervical spine multidetector CT (MDCT) scans obtained during 6.2 years revealed 33 ankylosed spines studied for suspected acute cervical spine injury complicating AS. Of these, 20 patients also underwent MRI. RESULTS: On MRI, of these 20 patients, 19 had a total of 29 cervical and upper thoracic spine fractures. Of 20 transverse fractures traversing both anterior and posterior columns, 7 were transdiskal and exhibited less bone marrow edema than did those traversing vertebral bodies. One Jefferson's, 1 atlas posterior arch (Jefferson's on MDCT), 2 odontoid process, and 5 non-contiguous spinous process fractures were detectable. MRI showed 2 fractures that were undetected by MDCT, and conversely, MDCT detected 6 fractures not seen on MRI; 16 patients had spinal cord findings ranging from impingement and contusion to complete transection. CONCLUSION: Magnetic resonance imaging can visualize unstable fractures of the cervical and upper thoracic spine. Paravertebral hemorrhages and any ligamentous injuries should alert radiologists to seek transverse fractures. Multiple fractures are common and often complicated by spinal cord injuries. Diagnostic images can be obtained with a flexible multipurpose coil if the use of standard spine array coil is impossible due to a rigid collar or excessive kyphosis.     

Multidetector computed tomography of cervical spine fractures in ankylosing spondylitis

PURPOSE: To analyze multidetector computed tomography (MDCT) cervical spine findings in trauma patients with advanced ankylosing spondylitis (AS). MATERIAL AND METHODS: Using PACS, 2282 cervical spine MDCT examinations requested by emergency room physicians were found during a period of 3 years. Of these patients, 18 (16 M, aged 41-87, mean 57 years) had advanced AS. Primary imaging included radiography in 12 and MRI in 11 patients. RESULTS: MDCT detected one facet joint subluxation and 31 fractures in 17 patients: 14 transverse fractures, 8 spinous process fractures, 2 Jefferson's fractures, 1 type I and 2 type II odontoid process fractures, and 1 each: atlanto-occipital joint fracture and C2 laminar fracture plus isolated transverse process and facet joint fractures. Radiographs detected 48% and MRI 60% of the fractures. MRI detected all transverse and odontoid fractures, demonstrating spinal cord abnormalities in 72%. CONCLUSION: MDCT is superior to plain radiographs or MRI, showing significantly more injuries and yielding more information on fracture morphology. MRI is valuable, however, in evaluating the spinal cord and soft-tissue injuries. Fractures in advanced AS often show an abnormal orientation and are frequently associated with spinal cord injuries. In these patients, for any suspected cervical spine injuries, MDCT is therefore the imaging modality of choice.