X线平片、CT、MRI诊断颈椎病的价值

目的:分析和总结500例颈椎病例的临床及影像学表现,以提高诊断水平.材料和方法:回顾性分析1994-01～2007-01经临床及影像学诊断的500例颈椎病例.所有病例均行X线平片检查和CT检查.其中10例行食管吞钡检查,284例行MRI检查.结果:神经根型颈椎病例150例,CT表现为神经根受压移位;交感神经型颈椎病例56例,CT表现同于椎动脉型颈椎病;脊髓型颈椎病64例,CT表现为椎管狭窄、椎间盘突出或硬膜囊、脊髓受压、变形、移位;椎动脉型颈椎病例78例,CT表现为钩突肥大和钩椎关节骨质增生,横突孔变小,分隔;食管型颈椎病例10例;混合型颈椎病例142例.结论:综合分析临床资料及影像学表现可提高颈椎病的早期诊断和定性诊断的水平.     

颈椎病MRI和CT影像学诊断比较分析

目的比较和分析颈椎病不同检查方法的影像学特征,以提高临床中对本病诊断的准确性。方法回顾性分析20例颈椎病患者的CT和MRI的影像学及相关临床资料,比较不同影像检查方法在临床应用中的诊断价值。结果对于颈椎病患者中存在颈椎椎管狭窄、椎小关节增生硬化和后纵韧带骨化,CT显示优于MRI检查;MRI对脊髓受压评估和颈椎间盘突出的显示优于CT检查。结论 CT和MRI检查均对颈椎病的病变显示具有较好的敏感性和准确性,综合分析临床资料及影像学表现可提高颈椎病的早期诊断和定性诊断的水平,提高临床诊断准确性,以利于临床及时、准确治疗。     

颈椎病的影像学检查方法

颈椎病即由于颈椎间盘退行性变本身及其继发改变所致的失稳，压迫邻近组织而引起一系列症状和体征。颈椎病是临床常见病多发病其诊断及确诊主要依靠影像学表现及临床症状。颈椎病诊断不仅要求显示出颈椎复杂的骨性结构．还必须能观察骨性椎管内的硬膜囊和脊髓、脊神经、韧带、椎间盘、椎旁软组织。在过去10年中颈椎影像学发展变化较     

脊髓型颈椎病的MRI改变及其临床意义

目的探讨脊髓型颈椎病的MRI改变及其临床意义。方法回顾分析经手术和临床证实的脊髓型颈椎病23例的MRI改变。结果在全部患者的MRI上主要影像学改变为椎间隙变窄、椎间盘信号减弱、受累节段椎体后缘有信号减弱的致压物,受压颈髓弯曲、变形、向后移位等异常信号。结论MRI对脊髓型颈椎病的诊断、治疗方法选择和预后判断有重要价值。     

钩椎关节骨质增生在颈椎病诊断中的临床意义

目的：探讨钩椎关节骨质增生在颈椎病诊断中的应用价值及临床意义。方法：回顾分析40例经彩色多普勒检查发现椎动脉供血不足的颈椎病患者钩椎关节的X线平片影像学改变。结果：40例颈椎病患者其颈椎钩突肥大、变尖延长、弯曲以及骨赘形成35例（85％）；钩椎关节变窄，关节面显示硬化5例（15％），并可伴有颈椎椎体前后缘骨刺形成、韧带骨化等X线影像学改变。结论：颈椎X线平片简便、费用低廉，对钩椎关节影像学改变的初步观察．可提示椎动脉型颈椎病的存在，具有一定的临床价值。     

神经根型颈椎病的影像学诊断及神经根障碍的相关性研究

目的 探讨神经根型颈椎病的影像学诊断价值并进行神经根障碍的相关性研究.方法 对188例经临床证实且影像学资料完整的神经根型颈椎病进行回顾分析,比较其CR、CT及MRI的影像学特点并结合临床特征分析神经根障碍的相关因素.结果 (1)CR 6位片可以显示颈椎的整体表现:正侧位及功能位显示颈椎生理曲度改变122例(占64.9%),椎间隙变窄96例(占51.2%),椎体滑动或失稳49例(占26.1%);双斜位显示椎间孔变小或狭窄87例(占46.3%),Luschka关节增生82例(占43.2%).(2)CT显示Luschka关节及椎间关节骨赘76例(占40.4%),显示椎间盘突出及软骨结节钙化80例(占42.6%),黄韧带肥厚或钙化66例(占39.8%).(3)MRI显示椎间盘变性、突出105例(占55.8%),黄韧带肥厚或钙化51例(占27.1%),神经根及脊髓受压69例(占36.7%),脊髓水肿或变性23例(占12.2%).结论 神经根型颈椎病的神经根障碍与影像学表现密切相关,综合分析影像学资料及临床特征对该病的早期诊断、早期治疗有重要价值.     

颈椎功能性滑脱的临床意义

目的：探讨颈椎功能性滑脱的临床意义。材料与方法：本文通过对９３例颈椎病患者及５０例对照组的颈椎过伸、过屈侧位片的比较分析。结果：发现颈椎病患者中３９．８％的人存在功能性滑脱，且其中有２４．８％的病例以其为主要表现，正常人群中出现这种改变的占１０％。同时发现椎间移位＜２．０ｍｍ时，其影像学变化与临床关系不密切。结论：功能性滑脱对颈椎病和颈椎失稳症的诊断具有十分重要的意义，在日常工作中既要把摄取动力性侧位片纳入常规项目，以便发现功能性滑脱的存在，也要紧密结合临床认真分析其存在的意义。     

颈椎病患者应用X线片和CT影像学诊断的临床价值探讨

颈椎病是颈椎骨关节炎、增生性颈椎炎、颈神经根综合征、颈椎间盘脱出症的总称,是一种以退行性病理改变为基础的疾患。现阶段颈椎病的发病率持续增高,对患者生活质量与身心健康造成了严重的影响。本研究探讨了探讨颈椎病患者应用X线片和CT影像学诊断价值,为临床提供参考。     

椎动脉CTA对椎动脉型颈椎病的应用研究

目的 研究椎动脉CTA对椎动脉型颈椎病的临床应用价值，探讨周围骨性结构对椎动脉影响的定量关系。方法21例正常对照与23例临床拟诊为椎动脉型颈椎病的患者行椎动脉CTA检查，用多平面重建(MPR)对椎动脉行冠，矢状位重建，分析椎动脉CTA的影像表现特点以及周围骨性结构对其影响的定量关系。结果正常组椎动脉走行较直，病例组13例钩突轻度骨质增生对椎动脉无影响，10例共22处C4-C7，钩突中、重度增生，当轴位钩突最突出点到相应上位椎体中线的垂直距离超过15．86mm时将对椎动脉造成推移或压迫。结论椎动脉CTA可以很好地显示椎动脉及其周围骨性结构，为临床提供更为直观的影像学依据。     

食管为主型颈椎病的X线诊断

颈椎病是一种常见病，它严重影响患者的身体健康和生活质量，人类对颈椎病的认识经历了一个漫长的历史过程。颈椎病随着年龄的递增而成倍增加，由于影像学技术的飞快发展，对颈椎病的认识日益加深。我们对2004年2月-2006年8月对我科做胃肠道气钡造影检查的患者，影像学显示食管有改变的患者287例做一总结。     

中央型肺癌的X线与CT诊断(附21例分析)

目的 分析中央型肺癌的X线与CT表现并比较这两种方法的诊断能力。方法 21例经纤维支气管镜或病理证实的中央型肺癌患者均经胸部X线与CT检查。对全部病例的X线与CT表现进行了回顾性分析。结果 在胸部X线与CT像上，中央型肺癌均表现为肺门肿块合并阻塞性肺炎和肺不张。此外，CT还显示了X线胸片未看到的支气管壁增厚和管腔变窄，以及纵隔淋巴结肿大等。结论 X线与CT是诊断中央型肺癌的主要方法，而CT的诊断能力明显优于X线平片。     

肾盂输尿管连接部梗阻X线诊断分析

目的：回顾性分析16例肾盂输尿管连接部梗阻病因、X线、CT表现，以进一步提高对病因诊断认识，提高术前诊断准确率。方法：采用排泄性尿路造影，逆行尿路造影，CT检查诊断肾盂输尿管连接部阻梗16例。结果：所有病例均清晰显示梗阻的连接部形态特征及尿路积水情况。结论：尿路造影结合CT检查是诊断肾盂输尿管连接部梗阻病因的重要手段，对病因定性、鉴别具有重要意义，对手术治疗可提供重要信息。     

颞下颌关节滑膜软骨瘤病的影像诊断

目的：探讨颞下颌关节滑膜软骨瘤病的X线、C T、M RI征象,提高对本病的认识。方法回顾性分析经手术病理证实的8例颞下颌关节滑膜软骨瘤病的X线、CT、MRI表现,8例患者均行普通X线和CT平扫检查,6例同时行MRI平扫检查,2例加做M RI增强扫描。结果8例均单侧发病,右侧6例、左侧2例。X线示颞下颌关节间隙增宽,关节周围多发结节状钙化影。C T平扫示关节周围软组织密度肿块伴多发钙化游离体。MRI平扫示关节腔内多发结节状长 T1、短T2信号,滑膜增厚并呈等 T1、等及稍长T 2信号,关节腔内积液。M RI增强示滑膜组织明显均匀强化,游离体呈边缘强化。结论颞下颌关节滑膜软骨瘤病有典型的影像学表现,总结其X线、C T、M RI表现可以为临床诊断及治疗提供一定帮助。     

Preoperative Evaluation of Cervical Radiculopathy and Myelopathy by Surface-Coil MR Imaging

During a 2-year period, 256 patients were screened for cervical radiculopathy and myelopathy with surface-coil MR images and plain films. Selected patients had follow-up examinations including CT, myelography, and CT myelography. Thirty-four of these patients underwent cervical spine surgery after MR imaging, which disclosed a total of 50 abnormalities in three major categories: herniated disks, bony canal stenoses, and intradural lesions. MR correctly predicted 88% of all surgically proved lesions compared with 81% for CT myelography, 58% for myelography, and 50% for CT. Missed herniated disks on either MR or CT myelography usually were the result of technically suboptimal studies caused by motion artifacts on MR and beam-hardening artifacts on CT myelography. Small osteophytes adjoining herniated disks sometimes were not predicted on MR, although such osteophytes invariably were seen on plain films and were palpable during standard anterior cervical diskectomy procedures. Herniated disks in the lateral root canals found in two patients appeared to be detected more readily by CT myelography than by MR. All proved lesions were detected by either screening MR images and plain films or by follow-up CT myelograms. MR replaced invasive evaluations by myelography and CT myelography in 32% of preoperative patients.We conclude that MR images, combined with plain films, offer an accurate, noninvasive test for the preoperative evaluation of cervical radiculopathy and myelopathy, while CT myelography is the preferred follow-up examination.     

Preoperative evaluation of cervical radiculopathy and myelopathy by surface-coil MR imaging

During a 2-year period, 256 patients were screened for cervical radiculopathy and myelopathy with surface-coil MR images and plain films. Selected patients had follow-up examinations including CT, myelography, and CT myelography. Thirty-four of these patients underwent cervical spine surgery after MR imaging, which disclosed a total of 50 abnormalities in three major categories: herniated disks, bony canal stenoses, and intradural lesions. MR correctly predicted 88% of all surgically proved lesions compared with 81% for CT myelography, 58% for myelography, and 50% for CT. Missed herniated disks on either MR or CT myelography usually were the result of technically suboptimal studies caused by motion artifacts on MR and beam-hardening artifacts on CT myelography. Small osteophytes adjoining herniated disks sometimes were not predicted on MR, although such osteophytes invariably were seen on plain films and were palpable during standard anterior cervical diskectomy procedures. Herniated disks in the lateral root canals found in two patients appeared to be detected more readily by CT myelography than by MR. All proved lesions were detected by either screening MR images and plain films or by follow-up CT myelograms. MR replaced invasive evaluations by myelography and CT myelography in 32% of preoperative patients. We conclude that MR images, combined with plain films, offer an accurate, noninvasive test for the preoperative evaluation of cervical radiculopathy and myelopathy, while CT myelography is the preferred follow-up examination.     

Exclusion of unstable cervical spine injury in obtunded patients with blunt trauma: is MR imaging needed when multi-detector row CT findings are normal?

PURPOSE: To retrospectively determine what information, if any, magnetic resonance (MR) imaging of the cervical spine in obtunded and/or "unreliable" patients with blunt trauma adds to multi-detector row computed tomography (CT) of the entire cervical spine (including routine multiplanar sagittal and coronal reformations) when the CT findings are normal. MATERIALS AND METHODS: The study was HIPAA compliant and institutional review board approved. Informed consent was not required. From April 2001 to November 2003, 1400 trauma patients underwent MR imaging of the cervical spine to evaluate potential cervical spine injuries. Multi-detector row CT of the cervical spine was performed with a four- or 16-detector row scanner. MR imaging of the cervical spine was performed with transverse gradient-echo, sagittal intermediate-weighted, sagittal short inversion time inversion-recovery, and sagittal T1- and T2-weighted fast spin-echo sequences. Many MR examinations were performed to exclude soft-tissue injuries in the cervical spine of obtunded patients with blunt trauma in whom cervical spine injury could not be excluded with physical examination. Complete cervical spine MR studies were obtained to evaluate soft-tissue injuries in 366 obtunded patients with blunt trauma (281 male and 85 female patients; age range, 13-92 years; mean age, 42.1 years). The patients had previously undergone total cervical spine multi-detector row CT with normal findings. The results obtained with these two modalities were compared. RESULTS: MR images were negative for acute injury in 354 of the 366 patients and negative for cervical spine ligamentous injury in 362. Seven of the 366 patients had cervical cord contusions, four patients had ligamentous injuries, three patients had intervertebral disk edema, and one patient had a cord contusion, a ligamentous injury, and an intervertebral disk injury. Four patients had ligamentous injuries; however, all of these patients had ligament injuries limited to only one of the three columns of cervical spine ligament support. Multi-detector row CT had negative predictive values of 98.9% (362 of 366 patients) for ligament injury and 100% (366 of 366 patients) for unstable cervical spine injury. CONCLUSION: A normal multi-detector row CT scan of the total cervical spine in obtunded and/or "unreliable" patients with blunt trauma enabled the authors to exclude unstable injuries on the basis of findings at follow-up cervical spine MR imaging.     

Cervical radiculopathy: value of oblique MR imaging

Eighteen patients with cervical radiculopathy were entered into a prospective study to compare the accuracy of surface coil magnetic resonance (MR) imaging with that of metrizamide myelography and computed tomography (CT) with metrizamide. All MR studies included tailored axial and oblique images as well as routine sagittal images. All imaging studies were evaluated for topography and type of disease. Nine of 18 patients subsequently underwent cervical surgery with an anterior interbody approach at 11 levels. The surface coil MR findings concerning disease topography and type concurred with the surgical findings at nine of 11 levels (82%). At three levels, the oblique view added important information not available on the sagittal images or clarified changes seen on the axial images. Metrizamide myelography with CT metrizamide myelography had findings concurrent with surgical findings at ten of 11 levels (91%).     

原发性脑淋巴瘤的CT及MRI诊断

目的探讨原发性脑淋巴瘤的CT及MRI影像学特征。方法对20例经手术病理证实的脑淋巴瘤患者的CT及MRI影像学表现进行回顾性分析。结果20例脑淋巴瘤患者17例单发，3例多发，共有24个病灶。其中，CT及MRI图像有以下特点：a）瘤灶多为单发，幕上多见，多为圆形或不规则形；b）CT平扫多呈等或略高密度，无钙化，MR T1WI呈略低或等信号，T2WI呈等或略高信号，瘤周水肿及占位效应相对较轻；c）CT及MRI增强扫描病灶多呈均匀明显强化，亦可不均匀呈环形或花瓣样强化。结论脑原发性淋巴瘤影像表现缺少特征性，确诊主要依靠病理检查。     

Uterine cervical cancer: assessment with high-field MR imaging

Nineteen patients with histologically proved cervical carcinoma were evaluated with magnetic resonance (MR) imaging. Clinical, MR, and surgical findings were compared to determine accuracy and clinical usefulness of MR in demonstrating mass and extent of disease. MR imaging enabled clear differentiation of corpus uteri, cervix, vagina, uterine ligaments, and tumor. Tumor was demonstrated as a high-intensity mass deforming the low-intensity cervix; the low background intensity of normal structures provided high contrast to the mass. MR imaging accurately demonstrated the tumor in all ten patients with locally advanced cervical carcinoma and showed a normal cervix in nine patients with early cancer. On sagittal images, the shape of corpus uteri, cervix, and vagina, and their relationship to the mass were clearly assessed, with their long axes usually in a single plane. On axial images, assessment of parametrial tumor extension was facilitated by clear definition of the low-intensity cervix and uterine ligaments. Although more study is needed to determine the accuracy of MR in staging, MR is a promising method in evaluating cervical carcinoma.     

Invasion of laryngeal cartilage by cancer: comparison of CT and MR imaging

Forty-two patients with laryngeal carcinomas were examined with computed tomography (CT) and magnetic resonance (MR) imaging. The accuracy of both CT and MR imaging in the depiction of cartilage invasion was evaluated in 16 patients by comparing findings at CT and MR with pathologic findings. Calcified cartilage that has been invaded by cancer is frequently seen on CT scans as having an intact contour. Tumor approaching nonossified cartilage may simulate cartilage invasion. On T1-weighted MR images, invaded marrow of ossified cartilage is of intermediate signal intensity, allowing it to be differentiated from normal bone marrow. On proton-density images, tumor is of increased signal intensity, which allows it to be differentiated from nonossified cartilage. In our experience, the specificities of CT and MR imaging were approximately equal (91% and 88%, respectively), but CT had a considerably lower sensitivity than MR (46% vs. 89%). Gross movement artifacts, which resulted in nondiagnostic images, occurred in 16% of the MR examinations. MR imaging is recommended as the modality of choice in the diagnosis of cartilage invasion.