胸椎黄韧带肥厚的磁共振表现

黄韧带肥厚(thickening of ligamentum flavum,TLF)是引起胸椎椎管狭窄和脊髓及神经根压迫症状的主要疾病之一，以往文献中相关报道较少。本文报道36例经手术病理证实的TLF，对其MRI表现进行回顾性分析，探讨其临床诊断价值。     

黄韧带肥厚的磁共振诊断

笔者对37例经手术与病理证实的黄韧带肥厚(HLF)之临床与磁共振表现及离体标本之光镜与电镜所见进行了分析。认为磁共振对HLF的诊断价值是:(1)可多方位显示HLF的位置、形态与厚度,对HLF在椎管内折曲情况及脊神经根管内神经根受卡压程度的判定优于其它影象检查。(2)可大范围、富有连续性地观察黄韧带周围的其它组织,有利于发现HLF之并存症,对多部位的HLF及多种病因引起之椎管狭窄症的诊断有重要价值。(3)对脂肪组织的显示甚为灵敏,有助于观察硬膜外脂肪的形态改变,可较精确测量硬膜囊矢状径、借助于硬膜囊受压百分比的测定可提示脊髓受压的程度。(4)可观察脊髓充血、水肿及变性引起之MR信号改变。 本组病例诊断中之假阴性与假阳性率为7％,文中探讨了降低假阴性与假阳性率的方法。 HLF的病理改变主要是弹力纤维的萎缩、断裂、纤维化及脂肪浸润与钙化,本组病例显示弹力纤维的钙化具有由外向内发展的方向性与规律性,此点在文献中尚未见报道。     

胸椎小关节骨质增生与脊髓改变的MRI探讨

胸椎小关节增生可以引起椎管狭窄,本文旨在探讨其ＭＲＩ表现且与脊髓异常之间的关系,以达到早期诊断,治疗。材料与方法,对１１例共３０处胸椎小关节骨质增生伴有胸段脊髓异常的病例进行回顾性分析。结果其中单个小关节增生４例,多个增生７例,单侧发生８处,双侧发生２２处;脊髓囊变１例,软化１例,脊髓空洞症１０例。     

颈椎后纵韧带骨化的MRI分析

目的　探讨后纵韧带骨化 (OPLL)的MRI表现及MRI对其诊断价值。方法　回顾性分析 36例颈椎OPLL的MRI表现。结果　本组病例OPLL的厚度为 2～ 7mm ,平均 3.9mm。病变范围从单个节段至 4个节段。多发生于C3～ 6 水平。OPLLT1WI 2 4例呈低信号 ,12例为低信号内见等或高信号 ;T2 WI 31例呈低信号 ,5例为低信号内见等信号。OPLL压迫脊髓 2 8例、压迫神经根 4例。 12例脊髓内出现异常信号。结论　MRI是颈椎OPLL最理想的检查方法     

胸椎黄韧带骨化性椎管狭窄的MRI和CT对比研究

目的:本文对54例胸椎黄韧带骨化性椎管狭窄患者进行MR和CT对比研究。 材料和方法:男性43例,女性11例,年龄32～78岁。全部患者采用1.0T超导磁共振机,全身CT扫描机,行矢状T_1和T_2W1扫描,T_1W1病变区或/和T_2W1横轴扫描及相似层面的CT横断对照扫描。 结果:54例(108椎间)胸椎黄韧带骨化性椎管狭窄,单椎间发生者14例,多椎间40例(94椎间)。MR主要表现为黄韧带附着区丁T_1W1和T_2W1像增厚的异常低信号影,CT则全部表现为不同程度的骨样密度吸收区。 结论:MR是显示胸椎黄韧带骨化和脊髓受压情况的最佳方法,CT在诊断胸椎黄韧带骨化性椎管狭窄所合并的其他脊柱退行性变方面优于MRI。MRI结合CT平扫为诊断胸椎黄韧带骨化性椎管狭窄的最佳方法。     

黄韧带骨化脊髓受压性损伤的MRI评价

目的：探讨ＭＲＩ评价黄韧带骨化（ＯＬＦ）导致脊髓受压性损伤的意义。材料与方法：对３６例ＯＬＦ患者的ＭＲＩ及临床表现进行回顾性分析。结果：脊髓轻度受压１１例，中度受压１６例，重度受压９例，ＭＲＩ脊髓受压分度与临床症状和体征关系密切，脊髓重度受压者于Ｔ２加权像髓内出现高者预后不良。结论：ＭＲＩ是评价脊髓受压性损伤的可靠方法，髓内局限性Ｔ２高信号为脊髓重度损伤的指征，ＭＲＩ脊髓受压分度在判断脊髓损伤及预     

CT与MRI在胸椎黄韧带骨化症的诊断价值

目的 探讨CT与MRI在胸椎黄韧带骨化症(TOLF)的诊断价值.方法 回顾性分析自2008年1月至2012年6月15例经手术病理证实TOLF的DR、CT、MRI表现,探讨其在临床诊断、选择手术方式、疗效、术后随访方面的作用,手术后疗效评分与椎管狭窄程度关系比较,最后通过等级评分进行疗效标准评价.结果 15例TOLF影像诊断与临床手术病理诊断相符合,TOLF均发生于下胸段椎管(Th7～12),2例单节段者(Th9 ～ 10)为外侧型和结节型;13例为多节段连续性TOLF,均为弥漫型(分别为Thg～10～Th10～11～Th11～126例,Thg～10 ～ Th10～113例,Th7～8～Th9 ～10 ～ Th10-11～ Th11～12 1例,Th10～11 ～ Th11～12 3例).Ⅰ度椎管狭窄5例,Ⅱ度狭窄9例,Ⅲ度狭窄1例.15例均采用经后路椎管减压及选择性椎弓根螺钉内固定术,术后优5例(33％),良6例(40％),可3例(20％),差1例(7％),术后随访(24～ 36个月)无重要并发症或后遗症.结论 CT、MRI是TOLF的主要诊断方法,它可清楚显示病灶范围、形态、椎管占位与脊髓受压变性情况,在判定手术方式、疗效、术后随访中具有重要价值.     

胸椎黄韧带骨化与脊髓病变MRI诊断(附23例分析)

目的 :探讨胸椎黄韧带骨化 (OLF)与脊髓改变的MRI诊断意义。方法 :对 2 3例OLF患者的MRI表现 ,临床表现 ,椎管狭窄程度进行回顾性分析。结果 :黄韧带骨化以下胸椎为多 ,伴有不同程度的椎管狭窄。Ⅰ°5例 ,Ⅱ°13例 ,Ⅲ°5例。Ⅲ°狭窄者脊髓内于T2 加权像出现高信号改变其预后不良。结论 :OLF是引起椎管狭窄和脊髓及神经根压迫症状的常见疾病之一 ,T2 WI可准确检出OLF的大小范围以及骨髓受压程度。     

颈椎黄韧带肥厚与性别及年龄的相关研究

目的:探讨黄韧带的增厚(HLF)与年龄和性别之间的关系。方法:对150例颈椎黄韧带肥厚的患者使用美国GE公司生产的1.5T超导型MRI装置,测量所有的黄韧带厚度。结果:150例患者C3～4、C4～5、C5～6、C6～7水平肥大黄韧带共计562条黄韧带,所统计的黄韧带增厚标准均在横轴位上,黄韧带厚度>3.0mm,黄韧带肥厚多发生于C3～6水平。且随着年龄的增加,黄韧带肥厚的程度也在增加;而男女性别之间黄韧带肥厚发生率无显著性差异。结论:颈椎黄韧带的肥厚与性别无关,与年龄相关,左侧黄韧带增厚几率明显大于右侧。     

Neuroradiological examination of thoracic radiculo-myelopathy due to ossification of the ligamentum flavum

Summary Sixteen cases of thoracic radiculomyelopathy due to ossification of the ligamentum flavum (OLF) were analyzed. The patients ranged in age from 39 to 78 years (average 57 years). There were 13 men and 3 women. A significant predilection of OLF for the lower thoracic spine (T9/10, T10/11, T11/12) was noticed. Plain X-ray of the thoracic spine and multidirectional tomography could give important information about the site of ossification. Computed tomography with the intrathecal injection of the water-soluble contrast material clearly demonstrated the ossification and the degree of compression of the spinal cord. The disadvantages of using computed tomography for diagnosing OLF included the necessity for the scan level to be previously decided by other methods because computed tomography of the entire spine was impractical. Magnetic resonance imaging was performed in 14 patients and gave important information about OLF and the compression of the spinal cord. The combination of MRI and computed tomography seems the most useful for the precise diagnosis of OLF.     

Compressive myelopathy in fluorosis: MRI

We examined four patients with fluorosis, presenting with compressive myelopathy, by MRI, using spin-echo and fast low-angle shot sequences. Cord compression due to ossification of the posterior longitudinal ligament (PLL) and ligamentum flavum (LF) was demonstrated in one and ossification of only the LF in one. Marrow signal was observed in the PLL and LF in all the patients on all pulse sequences. In patients with compressive myelopathy secondary to ossification of PLL and/or LF, fluorosis should be considered as a possible cuase, especially in endemic regions.     

Ossification of the ligamentum flavum

Summary A case of thoracic myelopathy due to ossification of the ligamentum flavum is presented. A fifty-five year old female complained of sensory and motor disturbance of lower limbs. Neuroradiologically, in addition to ossification of the posterior longitudinal ligament throughout the spines, ossified ligamenta flava were found at the Th10–11 level and magnetic resonance imaging (MRI) clearly showed the spinal cord compressed at the same level by a low-intensity-signal lesion. Laminectomy and removal of the ossfied ligamenta flava improved her neurological dysfunction. The usefulness of the MRI in the neuroradiological diagnosis was confirmed.     

原发性胸椎原始神经外胚层肿瘤的动态增强MRI表现

目的 初步探讨原始神经外胚层肿瘤(PNET)的动态增强MRI表现，以及对其诊断及鉴别诊断的价值。方法 用动态增强MRI方法对已手术和病理证实的2例胸椎PNET行3次MR检查并进行前瞻性研究。结果 在信号强度-时间和对比增强率．时间曲线上，2例PNET3次检查均表现为快升慢降型，即肿瘤早期就开始迅速增强，上升峰极陡，60～120s即达到高峰水平，然后保持平坦，3．5min内未见明显下降曲线。结论 动态增强MRI扫描能帮助对PNET进行早期诊断和鉴别诊断，从而为临床选择治疗方案及估计预后提供较为可靠的依据。     

Subluxation of the upper thoracic spine in rheumatoid arthritis

Only single cases with rheumatoid arthritis of the thoracic spine with vertebral subluxation have been reported to date. In a review of 100 patients with severe rheumatoid arthritis who had undergone occipitocervical fusion, arthritis of the upper thoracic spine with subluxation was discovered on conventional radiographs in four patients. Two additional patients were found elsewhere. Magnetic resonance imaging (MRI) was performed in three of the patients, confirming the diagnosis of subluxation of the upper thoracic vertebrae. In addition, MRI revealed encroachment on the anterior sub-arachnoid space and compression of the spinal cord.     

地方性氟骨症的脊柱MRI表现

目的评价MRI在地方性氟骨症脊柱病变诊断中的作用.方法对81例地方性氟骨症的脊柱MRI进行分析和与X线比较.结果所有椎体内脂肪含量减少和分布不均,在T1WI上信号强度表现为均匀或不均匀性减低,其信号减低程度与X线骨密度的增高程度相比较无明确相关性.32例C3～7椎体的T1WI信号强度平均值明显低于100例对照组(P<0.001).81例中后纵韧带和黄韧带骨化71例(88%),其中后纵韧带骨化35例(43%),黄韧带骨化8例(10%),后纵韧带和黄韧带骨化28例(35%),与X平片所显示的相同.在T1WI上63例后纵韧带骨化和36例黄韧带骨化有中等信号强度区者分别为32例(51%)和31例(86%).81例中椎间盘突出68例(84%),椎间盘变性57例(70%),椎管狭窄75例(92%),脊髓受压63例(78%),其中脊髓内有病理学改变28例(35%).X线测量57例颈椎椎管前后径<9 mm(以此推断脊髓受压)41例(71.92%),MRI显示脊髓受压48例(84.21%,P=0.115).57例颈椎椎间盘后突出51例(89.47%),明显高于对照组(62%)(P<0.001);椎间盘变性37例(64.91%),与对照组(37%)相比较差异有非常显著性意义(P=0.001).结论 MRI显示地方性氟骨症的椎体信号强度均匀或不均匀性减低,可反应成骨活动增强程度和氟化钙及骨髓内脂肪含量及分布.MRI对显示脊髓受压,脊髓内病理学改变和椎间盘突出、变性优于X线.     

Cavernous hemangioma of the thoracic spinal cord

Summary A 25-year-old woman presented with a four-year history of progressive right-lower-extremity weakness and atrophy and a left hemisensory deficit was found. Metrizamide-enhanced spinal CT scan showed an intramedullary lesion at the level of T1-T2; this had expanded the cord in fusiform fashion but showed no evidence of a cystic component. Surgical resection was performed and the pathological diagnosis was cavernous hemangioma. Two and one-half years later, her left hemisensory deficit was worsening and a spinal MRI showed high signal intensity mass in the region of the previous surgery consistent with chronic hematoma which was re-evacuated with some improvement in the patient's neurological condition.     

Cyst of the ligamentum flavum

We report the case of a patient with sciatica resulting from a cyst of the ligamentum flavum. Received: 1 December 1999/Accepted: 2 May 2000     

Spontaneous ligamentum flavum hematoma in the lumbar spine

Lumbar or sacral nerve root compression is most commonly caused by intervertebral disc degeneration and/or herniation. Less frequently, other extradural causes may be implicated, such as infection, neoplasm, epidural hematoma, or ligamentum flavum pathology. We present the case of a patient with spontaneous ligamentum flavum hematoma compressing the L4 nerve root, without antecedent trauma. Although exceedingly rare, the diagnosis of ligamentum flavum pathology in general, and that of ligamentum flavum hematoma in particular, should be considered on those rare occasions when the etiology of lumbar or sacral nerve root compressions appears enigmatic on radiological studies. Usually surgical treatment produces excellent clinical outcome.