MR扩散加权平面回波成像对良恶性椎体骨折鉴别诊断的价值

Evaluation of Diffusion-weighted MRI in the Differentiation of Benign with Malignant Vertebral Compression Fracture

目的 探讨单次激发平面回波SE序列扩散加权成像对良、恶性椎体压缩性骨折鉴别诊断的价值。资料与方法 对 46例 5 9个骨折椎体MR常规平扫后行扩散加权成像 ,良性组 2 7例 40个骨折椎体 ,恶性组 19例 19个骨折椎体 ,取b =0 ,2 0 0 ,40 0s/mm2 。测量病变椎体的信号强度比和信噪比。结果 在DWI上 ,良性骨折椎体与邻近正常椎体相比均呈低或等信号 ,恶性骨折椎体则呈高信号 ,2组骨折椎体的信号强度比和信噪比间存在显著差异(P <0 .0 1) ,诊断准确率 98%。而常规T1WI、T2 WI及STIR的误诊率达 6 .8%。结论 单次激发平面回波扩散加权成像对良、恶性椎体压缩性骨折的鉴别诊断是一种简便、有效的补充手段。

Objective To evaluate diffusion weighted MRI with single shot EPI (DWI/SSH EPI) in differentiating benign from malignant vertebral compression fracture.Materials and Methods Following routine MRI scanning, including T 1 weighted spin echo, T 2 weighted turbo spin echo and short inversion time inversion recovery (STIR), DWI/SSH EPI was further carried out in 46 cases, and 59 vertebral compression fractures were demonstrated. The lesions were divided into benign group n=40, 27 cases) and malignant group (n=19, 19 cases). Zero, 200 and 400s/mm 2 was taken as b value. The bone marrow contrast ratio and signal to noise ratio of the diseased vertebrae on DWI were estimated.Results Compared with the adjacent normal vertebrae on DWI, all the benign vertebral compression fractures showed hypo or iso intensity signal, while all the malignant vertebral compression fractures showed hyper intensity signal. Significant difference in bone marrow contrast ratio and signal to noise ratios existed between benign and malignant group P<0.01). The total diagnostic accuracy with DWI was 98%, while the misdiagnosis with routine MRI was up to 6.8%.Conclusion As a simple technique, DWI/SSH EPI provides an effective supplement to the routine MRI in the differentiation of benign with malignant vertebral compression fracture.