腰椎术后MR增强扫描的应用价值

MRI of the postoperative lumbar spine:assessment with Gd-DTPA

目的 将MRI和再次手术所见相对照 ,探讨钆喷替酸葡甲胺 (Gd DTPA)增强MRI在鉴别术后瘢痕粘连和椎间盘疝复发的应用价值和准确性。方法 2 2例腰椎术后病人因症状复发再次行腰椎MRI检查并接受第 2次手术。所有病人都做Gd DTPA增强前、后MR矢状面、轴面成像 ,9例病人获取延迟增强图像。结果 MRI诊断 2 2例病人的 2 7个腰椎平面硬膜前肿物 ,其中瘢痕结节6个 ,椎间盘疝 9个 ,椎间盘疝外包裹瘢痕 12个平面。与手术病理结果相对照 ,正确诊断 2 5个平面。2个平面不相符 ,1例MRI将骨赘诊断为突出椎间盘 ;另 1例MRI诊断为瘢痕 ,手术发现为瘢痕和手术残留椎间盘组织混合。所有 6个平面瘢痕组织 ,在注射对比剂早期均有持续强化 ;9个平面的突出椎间盘无一例出现上述强化 ;12个椎间盘加瘢痕平面 ,周边瘢痕均强化 ,中心椎间盘无早期强化 ,延迟扫描显示 4例中心椎间盘有轻度强化。结论 结合矢状面和轴面非增强MRI和Gd

Objective To define the value and accuracy of Gd DTPA enhanced MR imaging in differentiating cicatrix and recurrent herniated disk by comparing the imaging studies with surgical findings Methods 22 postoperative patients with failed back surgery had sagittal and axial MR imaging of the lumbar spine both with and without contrast administration Delayed enhanced MRI were obtained in 9 cases All the 22 patients had repeat surgery at 27 levels Results Postoperative MRI detected 27 anterior epidural masses in 22 cases: 6 cicatrices only, 9 disks only, 12 disks surrounded with cicatrices MRI diagnosis is accurate at 25 anterior epidural masses comparing surgical findings Surgical diagnosis differed from the MRI in 2 cases at two levels In one patient, disk was diagnosed on MRI while osteophyte was present at surgery In the other patient, cicatrix only was diagnosed by MRI, but the mixture of disk and cicatrix was found at surgery Cicatrix consistently enhanced early following injection at all 6 levels with cicatrices only At none of the 9 levels with herniated disk only did the disk material exhibit early enhancement Cicatrix consistently enhanced and the more central disk material did not enhance in all the 12 patients with disk and cicatrix at early scan Delayed enhanced MRI detected mild enhancement in the more central disk material in 4 cases Conclusion Sagittal and axial T 1 weighted MR imaging before and after administration of Gd DTPA is an effective method of differentiating cicatrix and recurrent herniated disk