MRI对椎体转移瘤与骨质疏松压缩性骨折鉴别诊断的价值

Value of magnatic resonance imaging in the differential diagnosis for vertebral metastases fracture and vertebral osteoporotic fracture

目的提高对椎体转移瘤骨折与椎体骨质疏松性骨折的MRI鉴别要点的认识。方法回顾性分析2011年7月～2012年4月本院所发现的25例椎体转移瘤骨折和33例椎体骨质疏松性骨折的MRI影像表现。比较此两类病理性质不同的椎体骨折的MRI影像差异。结果椎体转移瘤骨折常为单发,病椎呈多发或跳跃式分布,骨折的椎体以压缩变形多见,常累及椎体的附件,伴有椎旁软组织肿块;椎体骨质疏松性骨折以连续性多椎体骨折多见,椎体骨折以双凹状和楔状变形为主,较少累及附件,较少出现椎旁肿胀,邻近诸椎体通常伴有骨质疏松的信号异常;两种骨折均较少累及椎间盘。T1WI发现早期肿瘤侵犯是首选序列,T2WI及STIR对于骨折线走行显示较好;骨折的椎体信号早期改变均不具有特征性,到慢性期骨质疏松性骨折T1WI信号增高,有一定特征性。结论常规MRI征象有助于鉴别诊断椎体转移瘤与椎体骨质疏松压缩骨折,具有重要的临床意义。

Objective To enhance the cognition of identify key points of MRI on vertebral metastases fracture and vertebral osteoporotic fracture.Methods Image manifestations of 25 patients with vertebral metastases fracturely and 33 patients with vertebral osteoporotic fracture examined by MRI from July 2011 to April 2012 were retrospectively studied,and the image manifestation of two kinds of different pathological properties vertebral fracture were compared.Results Single vertebral fracture was common in vertebral metastases,metastatic lesions often appeared multiple or saltatory distribution in vertebral bodies,involvement of vertebral appendix and paravertebral soft tissue mass were often observed in vertebral metastasis;continuous multiple vertebral fracture was common in vertebral osteoporosis,fractural vertebral body often appeared biconcave or wedge deformity,involvement of vertebral appendix and paravertebral swelling were uncommon,abnormal signal intensity of osteoporosis was showed in adjacent vertebral bodies;involvement of intervertebral disc was also rare in both vertebral osteoporotic fracture and vertebral metastases fracture.T1WI sequence was preferred finding in early tumor invasion.T2WI and STIR were better for display of fracture line;there was no characteristic of signal changes for early vertebral fracture,the signal increased of T1WI was the characteristic to the chronic phase of osteoporotic fracture.Conclusion The routine MRI symptom contribute to differentiate vertebral osteoporotic fracture from vertebral metastases fracture,and it has important clinical significance.