屈颈MRI对青年性上肢远端肌萎缩症的诊断价值

目的评价屈颈MRI对青年性上肢远端肌萎缩症的诊断价值。方法男性患者5例，平均年龄21岁，临床表现为一侧或两侧上肢远端肌萎缩。对照组为健康志愿者，21岁男性8例。2组均行常规及屈颈颈椎MR平扫，矢状、轴面SET1WI、T2WI、液体衰减反转恢复（FLAIR）序列扫描。结果常规颈椎扫描：5例患者下段颈髓变细；屈颈位MR扫描：下颈段颈6以下脊髓前屈、变扁平，矢状径4～6mm，硬膜囊后壁前移，硬膜后间隙明显增宽，可见多发条状、迂曲流空信号影及软组织信号。对照组：常规扫描，下颈段脊髓（颈6～胸2）可见颈膨大，屈颈位脊髓略变细（6～7mm），硬膜囊后壁无前移，硬膜后间隙未见扩张血管影。结论屈颈MRI有助于显示下颈段脊髓及硬膜囊改变，结合临床资料可准确诊断青年性上肢远端肌萎缩症。     

比率法判定颈椎管狭窄的应用价值

作者对经临床确诊为颈椎管狭窄的２００例影像学资料，包括Ｘ线平片和ＣＴ扫描片各１００份，测量Ｃ＿（４－５）椎管与椎体的矢状径与横径。将椎管矢状径为１１ｍｍ及其以下者（绝对值法）和椎管下矢径／椎体中矢径之比率值为０．７１及其以下者（比率法），暂作为颈椎管狭窄的判定标准。分析并比较两种方法对颈椎管狭窄的检出率。结果提示，比率法平片组与ＣＴ组均明显优于绝对值法。运用比率法诊断颈椎管狭窄，Ｘ线平片与ＣＴ扫描同样有效。     

颈椎自然位MRI对平山病的诊断价值

目的：探讨平山病(HD)颈椎自然位 MRI 的表现及其诊断价值,提高 HD MRI 诊断水平。方法观察15例 HD 患者及40例对照组自然位颈椎 MRI 特征,分析其特异性及灵敏性,并测量低位脊髓矢状径/脊髓横径(CSD/CTD)比值。结果病例组低位颈髓 CSD/CTD 与对照组差异有统计学意义(t=7.99,P =0.00)。LOA 的灵敏性为86.7%,特异性为88.4%。低位颈髓萎缩的灵敏性80.0%,特异性79.5%。脊柱曲线异常灵敏性40.0%,特异性65.2%。髓内异常信号灵敏性46.7%,特异性87.5%。硬膜腔外异常信号灵敏性20.0%,特异性96.8%。结论 HD 低位颈髓自然位 MRI 具有一定特征性,结合临床症状和体征对诊断HD 具有重要临床价值。     

不同体位颈椎MRI对平山病的影像诊断

目的 探讨平山病患者自然位和前屈位颈椎MRI表现及其诊断价值.资料与方法 对6例经临床确诊的平山病患者及6名正常自愿者均行颈椎自然位+前屈位+增强MRI,对比分析平山病患者低位颈髓的MRI表现.结果 自然位:6例患者颈椎生理曲度变直,低位颈髓变细;6名正常自愿者可见颈膨大(约脊髓C6～T2段).前屈位:6例患者低位颈髓变扁、萎缩,两种体位低位颈髓前后径差值与正常自愿者相比差异有统计学意义(P<0.05),另可见背侧硬膜囊后壁前移、硬膜外间隙增宽,内见迂曲、条形流空信号,增强后明显强化;正常自愿者低位颈髓较自然位略变细,背侧硬膜囊无前移、扩张,其内未见流空信号.结论 不同体位MRI均能显示平山病患者颈椎的异常表现,尤其是前屈位对平山病的诊断具有重要价值.     

腰椎峡部裂并脊椎滑脱的MRI表现及影像学比较

目的 :探讨MRI在腰椎峡部裂并脊椎滑脱症中的诊断价值。方法 :分析总结 5 3例腰椎峡部裂并脊椎滑脱症的传统X线片、CT、MR扫描表现并进行比较。结果 :传统X线平片表现为腰椎滑脱、峡部裂、局部骨质增生硬化 ;CT表现为峡部裂、局部骨质增生硬化、韧带肥厚、椎管狭窄及矢状径增大 (双管征 )、椎间盘变形 ;MRI表现为峡部骨髓信号连续性中断、局部骨质呈T1、T2 低信号、韧带肥厚、腰椎滑脱、椎间孔变形 (双叶征 )、神经根卡压、节段性椎管扩张和狭窄。结论 :MR扫描对腰椎峡部裂并脊椎滑脱症的诊断具有重要的临床应用价值     

脊髓型颈椎病与颈椎管狭窄

颈椎病为颈椎退行性变引起脊髓，脊神经根，椎动脉或交感神经丛压迫的复杂综合征，但实践中发现颈椎病的退行性变程度与临床症状常不一致（1，2），即有颈椎病X线表现但可无症状；相反有明显脊髓压迫症状者X线改变可能轻微，这种现象是否因颈椎管发育大小或颈椎病引起椎管狭窄程度不同所造成的，值得进一步分析。本文报告103例脊髓型颈椎病，并对其发病机理，临床及X线征和椎管狭窄的关系进行探讨，同时复习100例非脊髓型颈椎病，并测量100例正常成人颈椎矢状径，以兹对照观察。     

颈髓内畸胎瘤2例及文献回顾

为探讨颈髓内畸胎瘤的临床表现及手术治疗，分析2例颈髓内畸胎瘤的临床资料及复习有关文献。结果表明，颈髓内畸胎瘤患者颈椎平片多见颈椎骨性畸形，MRI检查肿瘤多为混杂信号影，术中见肿瘤呈囊实性，可有骨及软骨成分，肿瘤全切困难，可次全切除。结合病例及文献,作者认为颈椎平及MRI对颈髓内畸胎瘤有定性及定位意义，手术切除是有效的治疗手段。     

颈椎管狭窄的影像学分析

一般资料本组33例患者，全部摄取颈椎侧位、双斜位及正位片，26例行CT常规扫描，均采用椎管比值(颈椎管率)法测量，即：椎管比值=颈椎椎管矢状径(mm)/颈椎椎体矢状径(mm)。颈椎椎管矢状径测量：为椎体后缘中点到椎板连线中点间的距离，颈椎矢状径测量：为椎体前缘中点心至椎体后缘间距离。正常两者之比值应在0．75以上     

颈椎过屈位磁共振成像在平山病诊断中的应用

目的:研究颈椎过屈位MRI对平山病诊断的价值。材料和方法:对13例临床确诊为平山病的患者和10例正常对照者进行颈椎过屈位MRI矢状面和轴面扫描,观察低位脊髓萎缩、变扁、C6椎体上缘水平颈髓前后径及硬膜外异常信号。结果:①低位颈髓的萎缩:病例组9例(69%),对照组1例(10%)。②低位脊髓变扁:仅见于病例组11例(84%),其中有10例(77%)为不对称变扁,脊髓呈"梨形",1例(7%)呈三角形变扁。对照组未出现脊髓变扁的表现。③C6水平颈髓前后径与对照组相比明显变窄,差别有统计学意义(t=-4.54,P<0.05)。④低位颈椎椎管内硬膜后方T_2WI异常信号:仅见于患者组的10例(77%)。结论:颈椎过屈位MRI对诊断平山病有重要的价值。     

颈椎后纵韧带骨化症的影像学表现

目的　探讨OPLL的影像学表现 ,评价X线检查、CT和MRI检查的价值。方法　回顾性阅读颈椎侧位片 2 3 977份发现 13 4例OPLL ,观察分析骨化块的长度、厚度及形状 ,测量和计算椎管矢径和椎管矢径狭窄率 ,并对 13 4例中的 62例进行了CT或 和MRI检查 ,均有阳性表现。结果　骨化块形状有条形、带形、桥形、拱形和棒形 ,它们可呈连续状、分节状 ,骨化平均长度 3 .6cm ,平均厚度 4.43mm ,椎管矢径狭窄率为 11%～ 61.5% ,椎管狭窄率 >3 6% ,均有较明显症状。结论　OPLL的诊断①要具有完整详细的病史、体征和症状 ;②颈椎侧位片是重要的、必不可少的检查方法 ;③对症状复杂 ,脊髓受损害明显者要进行CT或和MRI检查 ,其中MRI检查优于CT检查     

颈椎过伸性损伤X线片与MRI比较分析

目的：评价对比X钱片与MRI对颈椎过伸性损伤的诊断价值。材料和方法：回顾性分析收治入院的53例颈椎过伸性损伤患者的临床特点、X线片、MRI特点。结果：X线片提示损伤34例，占总数的64．15％；MRI表现有推前血肿和水肿、积液、脊髓受压变形、脊髓内水肿、前纵韧带断裂、椎间盘水平性撕裂、椎间盘突出、脊髓部分及完全性横断等以及椎管狭窄、OPLL、颈椎病等，所有患者的MRI均发现不同的损伤征象，还发现7例椎动脉损伤。结论：MRI优良的软组织成像能力使之对于颈椎过伸性损伤的检出、损伤机制和损伤程度描述均优于其他方法，是目前的最佳方法，对治疗方法的选择亦具有很好的指导意义。     

+Gz associated stenosis of the cervical spinal canal in fighter pilots

Previous magnetic resonance imaging (MRI) studies have shown that repeated exposure to +Gz forces can cause premature degenerative changes of the cervical spine (i.e. a work-related disease). This paper reports on two clinical cases of +Gz-associated degenerative cervical spinal stenosis caused by dorsal osteophytes in fighter pilots. Conventional x-rays and MRI were used to demonstrate narrowing of the cervical spinal canal. The first case was complicated by a C6-7 intervertebral disk prolapse and a congenitally narrow spinal canal. The second case involved progressive degenerative spinal stenosis in the C5-6 disk space which required surgery. The findings in this case were confirmed by surgery which showed posterior osteophytes and thickened ligaments compressing the cervical medulla. These two cases suggest that +Gz forces can cause degenerative spinal stenosis of the cervical spine. Flight safety may be jeopardized if symptoms and signs of medullar compression occur during high +Gz stress. It is recommended that student fighter pilots undergo conventional x-rays and MRI studies in order to screen out and reject candidates with a congenitally narrow spinal canal. These examination methods might be useful in fighter pilots' periodic medical check-ups in order to reveal acquired degenerative spinal stenosis.     

Classification system based on kinematic MR imaging in cervical spondylitic myelopathy.

BACKGROUND AND PURPOSEFunctional myelographic studies are often used to evaluate the dynamic changes of the cervical spinal canal during flexion and extension. The purposes of this study were to use kinematic MR imaging to assess the dynamic changes of the cervical spine in patients at different stages of degenerative disease and to describe a classification system based on static and dynamic factors in the pathogenesis of cervical spondylitic myelopathy.METHODSEighty-one patients with different stages (I-IV) of degenerative disease of the cervical spine were examined with MR imaging. In the neutral position (0 degrees) and at maximum flexion and extension, spinal stenosis was classified for each segment according to the following grading system: 0 = normal, 1 = partial obliteration of the anterior or posterior subarachnoid space, 2 = complete obliteration of the anterior or posterior subarachnoid space, and 3 = cervical cord compression or displacement.RESULTSAt flexion and extension, the prevalence of spinal stenosis and cervical cord impingement increased as the stage of degenerative disease progressed. With regard to a pincer effect (anterior and posterior cord impingement) and cord encroachment at multiple segments, statistically significant differences were observed at stages III and IV as compared with stages I and II. Significant increase in cord impingement was seen in 22 (27%) of 81 patients at extension, as compared with four (5%) of 81 patients at flexion.CONCLUSIONRegardless of the stage of degenerative disease and grade of spinal stenosis at the neutral position (0 degrees), cervical spinal motion may contribute to the development of cervical spondylitic myelopathy.     

继发椎管狭窄与脊髓亚急性联合变性MRI异常信号的相关性

目的：研究脊髓亚急性联合变性(SCD)的 MRI 表现特点,探讨继发椎管相对狭窄与 SCD 的 MR 异常信号的相关性。方法收集56例 SCD 患者的临床及 MRI 影像资料,分析 SCD 病例中椎间盘膨出/突出、黄韧带增厚、后纵韧带增厚或两者以上协同作用下的椎管相对狭窄与脊髓内病灶的表现特点。结果56例 SCD 患者中,MRI 检查脊髓表现有病灶的45例,均表现为典型的SCD 影像表现。继发椎管相对狭窄并脊髓信号异常者37例,继发椎管相对狭窄脊髓未见异常信号者2例,无继发椎管相对狭窄脊髓信号异常者8例,无继发椎管相对狭窄脊髓也未见异常信号者9例。比较采用χ2检验统计继发椎管相对狭窄与脊髓异常信号有显著性差异(P <0.05)。37例 SCD 有继发椎管相对狭窄中15例行物理治疗后较对照组病程缩短。结论继发椎管相对狭窄致脊髓微循环障碍是导致 SCD 脊髓病变 MRI 表现更显著或更易于显现的重要因素。     

无骨折脱位颈髓损伤的影像学特点与外科治疗

目的 分析探讨无骨折脱位颈脊髓损伤的MRI特点及相应的手术治疗。方法 对29例无骨折脱位型颈脊髓损伤病例，分类研究其影像学表现，并根据其不同的特点采用不同的手术方式，观察疗效。结果 MRI可明确脊髓的病理状况及脊髓以外软组织的病理变化。根据不同表现类型采用相应手术方法，术后29例病人都有不同程度的康复。结论 MRI对于外伤性无骨折脱位型颈脊髓损伤的诊断具有优越性，可以显示脊髓损伤后脊髓及周围软组织的各种改变。应根据脊髓损伤的表现及变化和MRI显示脊髓的病理状况采取具有针对性的不同入路减压手术及掌握恰当内固定指征，可取得较明显的疗效。     

颈椎损伤的MRI表现

本文报告颈椎损伤后行MRI检查者88例,着重分析了颈椎损伤的MRI表现.并就颈椎椎体骨折、脱位、椎间盘突出、脊髓受压及脊髓损伤进行了讨论,旨在探讨颈椎损伤的MRI诊断及颈椎损伤和临床表现的关系.     

扩散加权成像在脊髓型颈椎病中的应用

目的:研究扩散加权成像(DWI)在脊髓型颈椎病(CSM)中的应用价值。方法:30例临床及影像学证实为CSM患者,行颈髓MRI和扩散加权成像,分析病变表现并测量其ADC值。结果:30例中除2例因伪影明显未行ADC值测量外,余28例均成功行DWI及ADC值测量。CSM的MRI主要表现为颈椎曲度异常、椎体骨质增生、椎间盘突出、后纵韧带及黄韧带增厚等,相应部位的脊髓均有不同程度的受压改变,伴有椎管狭窄者20例。T2WI脊髓受压部位出现高信号者18例,其中16例DWI相应部位均表现为ADC值增高,2例表现为ADC值略减低;10例T2WI未见异常信号者中有5例亦表现为脊髓受压部位不同程度的ADC值增高。3例手术后复查DWI显示病变部位ADC值不同程度减低。结论:DWI对CSM的早期诊断具有较高的敏感性,且可以在手术疗效监测方面发挥重要作用。     

磁共振DWI成像技术在脊髓型颈椎病的临床研究

目的：研究扩散加权成像（DWI）在脊髓型颈椎病（CSM）中的应用价值。方法：对26例临床及影像学证实为CSM患者,22例非CSM患者行颈髓MRI和扩散加权成像,分析病变表现并测量其ADC值。结果：48例均获得弥散加权图像和弥散系数。CSM患者受压部位ADC值明显高于邻近部位和正常颈髓ADC值,差异有统计学意义（P〈0.05）;17例CSM脊髓受压部位T2WI出现高信号,ADC值增高;9例T2WI表现为等信号,其中有6例表现为脊髓受压部位ADC值增高,DWI显示不同信号组受压部位平均ADC值差别无统计学意义（P〉0.05）,但不同信号组受压部位与相应邻近正常部位平均ADC值比较,差异有统计学意义（P〈0.05）。结论：DWI可以通过受压脊髓ADC值改变更早的判断脊髓内部变化,比常规T2WI能更早、更准确显示脊髓受压的情况,从而有助于早期诊断和治疗。     

Cervical myelopathy: MRI evaluation of cord compression

In order to assess the consequences of cervical spinal cord compression in cervical myelopathy, MRI measurements of the sagittal diameter of the cervical spinal cord were obtained in 50 normal volunteers and 50 patients suffering from cervical myelopathy. Whatever the degree of stenosis, the values obtained in the latter group are significantly inferior to those of the normal control group (average mean diameter: normal group: 8.2 mm; cervical myelopathy: 6.2 mm).     

Cervical spinal stenosis with cord neurapraxia and transient quadriplegia

The purpose of this article is to define as a distinct clinical entity, the syndrome of cervical spinal cord neurapraxia with transient quadriplegia. Sensory changes include burning pain, numbness, tingling, or loss of sensation, whereas motor changes consist of weakness or complete paralysis. The phenomenon of cervical spinal cord neurapraxia occurs in individuals with (1) developmental cervical spinal stenosis, (2) congenital fusions, (3) cervical instability, or (4) intervertebral disc protrusions when associated with a decrease in the anteroposterior diameter of the spinal canal. There is no evidence that the occurrence of cervical spinal cord neurapraxia predisposes an individual to permanent neurologic injury. However, patients with this syndrome and associated with cervical spine instability or acute or chronic degenerative changes should be precluded from further participation in contact sports. Those with developmental spinal stenosis or spinal stenosis associated with congenital abnormalities should be treated on an individual basis.