MRI动态对比增强及DWI对脊柱良恶性压缩性骨折的临床诊断价值

Clinical Value of MRI Scan and DWI in Diagnosing Benign and Malignant Compression Fractures of Vertebral Column

目的:探讨MRI动态对比增强及DWI对脊柱良、恶性压缩性骨折的诊断及鉴别诊断的价值,为临床治疗提供依据。方法:回顾临床资料完整的椎体骨折患者64例,分析其MRI常规、动态对比增强及DWI成像特点。结果:良性椎体压缩骨折患者34例(良性组),共计40个病变椎体,31个在T2WI上呈等高混杂信号,T1WI为部分低信号,9个在T2WI上呈混杂高信号,T1WI上呈低信号;Ⅰ度7个、Ⅱ度8个、Ⅲ度15个和Ⅳ度10个。恶性椎体压缩骨折患者30例(恶性组),43个病变椎体,35个T2WI呈混杂高信号,7个呈低信号,T1WI上均呈低信号;Ⅰ度20个、Ⅱ度11个、Ⅲ度7个和Ⅳ度5个。良性组ADC值高于恶性组,差异存在统计学意义(P<0.05)。恶性组椎体压缩性骨折动态对比增强Emax、ES显著高于良性组,而TTP低于正常良性组,差异均有统计学意义(P<0.05)。结论:MRI常规检查、动态对比增强及DWI成像有利于脊柱良、恶性压缩性骨折的临床诊断,为二者的鉴别诊断提供了客观依据,值得临床推广应用。

Objective： To investigate the value of MRI scan（dynamic contrast enhancement） and DWI in diagnosis and differential diagnosis of benign and malignant compression fractures of vertebral column,to provide valuable basis for clinical treatment.Method： Data on 64 patients with fracture of vertebra body and complete clinical data were retrospectively analyzed,and the imaging features of MRI scan（routine and dynamic contrast enhancement） and DWI were analyzed.Results： Among 64 patients,there were 34 suffered benign vertebral body crush fracture（benign group）,and totally 40 vertebral bodies were attacked,among which,31 presented iso-attenuation mixed signals on T2WI and partly hypointensities on T1WI,and 9 presented mixed hyperintensities on T2WI and hypointensities on T1WI;7 suffered fracture of degree I,8 suffered fracture of degree Ⅱ,15 suffered fracture of degree Ⅲ,and 10 suffered fracture of degree Ⅳ.Among the 64 patients,there were 30 suffered malignant vertebral body crush fracture（malignant group）,and 43 vertebral bodies were attacked,among which,35 presented mixed hyperintensities and 7 presented hypointensities on T2WI,and all presented hypointensities on T1WI;20 suffered fracture of degree I,11 suffered fracture of degree Ⅱ,7 suffered fracture of degree Ⅲ,and 5 suffered fracture of degree Ⅳ.The ADC value of the benign group was higher than that of the malignant group,and the difference was statistically significant（P0.05）.The Emax and ES on the MRI（dynamic contrast enhancement） of the compression fracture of vertebral body of the malignant group were significantly higher than those of the benign group,while TTP was lower than that of the normal benign group,and all the differences were statistically significant（P 0.05）.Conclusion： MRI scan（routine and dynamic contrast enhancement） and DWI imaging is beneficial to the clinical diagnosis of benign and malignant compression fractures of vertebral column,can provide objective foundations for the differential diagnosis between the two methods,and consequently is worthy of clinical application.