颈椎挥鞭样损伤的MRI特征与临床意义

MRI finding and clinical significance in cervical whiplash injuries

[目的]探讨颈椎挥鞭样损伤的MRI表现及其诊断价值。[方法]对30例手术治疗的急性颈椎挥鞭样损伤纳入研究,以手术结果为参照,从椎前筋膜、前纵韧带、椎间盘、椎骨、后纵韧带、颈髓、颈后韧带复合体、颈椎稳定性方面回顾性分析其MR表现。[结果]椎前筋膜出血水肿(27例,90%),MRI上表现为椎前筋膜增厚肿胀伴信号改变,于T1WI序列上呈稍低信号、等信号或稍高信号,于T2WI及STIR序列上呈高信号;颈椎前纵韧带断裂(27例,90%),手术显示47个断裂平面,MRI上27例显示33个断裂平面(70.2%),表现为线状或斑点状异常信号改变,T1WI序列上等信号、T2WI及STIR序列上高信号;椎间盘损伤(30例,100%),MRI显示形态信号改变;颈椎骨折(6例,20%),MRI全部显示;颈椎后纵韧带断裂(12例,40%),手术显示15个断裂层面,MRI上显示8例11个断裂层面(73.3%),表现为线状或斑点状异常信号改变,T1WI序列上等信号、T2WI及STIR序列上高信号;MRI上还显示颈椎骨挫伤(4例,13.3%);颈椎不稳(25例,83.3%);颈髓损伤(25例,83.3%);颈后韧带复合体损伤(25例,83.3%)。[结论]颈椎挥鞭样损伤的MRI表现具有重要的临床诊断价值,与临床表现相结合可为临床诊断与治疗提供影像学依据。

[Objective]To investigate the MRI finding and clinical significance of cervical whiplash injuries.[Method]A total of 30 patients with acute cervical whiplash injuries,who underwent surgeries,were included in this study.MRI findings of prevertebral fascia,anterior longitudinal ligament,intervertebral disc,cervical vertebrae,posterior longitudinal ligament,spinal cord,posterior ligament complex and the stability of cervical spine were retrospectively analyzed and compared with the operative findings.[Result]Prevertebral fascia hemorrhage and edema were shown in 27 patients（90%）,which was presented with swelling and signal alteration,a slightly-hypo or iso-or slightly-hyper-intensity on T1WI and hyper-intensity on T2WI or STIR.Forty-seven segments of anterior longitudinal ligament rupture were found in 27 patients（90%） in the surgery,while only thirty-three segments were shown on MRI,which displayed as a linear or speckled iso-intensity on T1WI and hyper-intensity on T2WI or STIR.Disc injuries were found in all patients（100%）,in which abnormal shape and signal alteration were showed on MRI.Six cases（20%） of vertebral fracture were showed in the MRI which was proved by the surgery（100%）.Fifteen segments of posterior longitudinal ligament rupture were determined in 12 patients（40%） by the surgery,while eleven segments（73.3%） in the 8 patients were shown on MRI,which was presented as a linear or speckled iso-intensity on T1WI and hyper-intensity on T2WI or STIR.MRI also showed four vertebral contusion（13.3%）,25 cases of spondylotic instability（83.3%）,25 cases of spinal cord injury（83.3%） and 25 cases of posterior ligamentous complexes（83.3%）.[Conclusion]MRI findings in cervical whiplash injuries are especially valuable for clinical diagnosis and it could provide useful information for clinical treatment.