椎体压缩骨折患者CT、MRI影像学特点及良恶性鉴别分析

CT and MRI Features of Patients with Vertebral Compression Fractures and Differential Diagnosis of Benign and Malignant

目的总结椎体压缩骨折患者CT、MRI影像学特点及良恶性鉴别要点。方法收集我院2010年1月至2016年3月期间所收治的椎体压缩骨折患者50例作为研究对象进行回顾性分析,以病理结果为基准对患者CT及MRI征象进行统计,并明确良性与恶性椎体压缩骨折的CT、MRI征象差异。结果 50例椎体压缩骨折患者中,18例为良性、32例为恶性。CT与MRI征象均以双边征、充气征、骨质破坏、椎旁软组织影、骨膜反应、辐条车轮状高密度征为主。其中良性与恶性患者双边征、充气征、骨质破坏、椎旁软组织影、骨膜反应等征象的出现率无显著差异(P>0.05);77.8%(14/18)的良性椎体压缩骨折患者出现辐条车轮状高密度征,显著高于恶性椎体压缩骨折患者所出现的比率,差异有统计学意义(P<0.05)。结论双边征、充气征、骨质破坏、椎旁软组织影、骨膜反应、辐条车轮状高密度征为椎体压缩骨折的常见CT与MRI征象,其中辐条车轮状高密度征可作为鉴别良性及恶性椎体压缩骨折关键征象,利于椎体骨折病变性质的判定,可为患者治疗方案的制定提供参考。

Objective To summarize the CT and MRI features of patients with vertebral compression fractures and the main points for differential diagnosis of benign and malignant.Methods Fifty cases of patients with vertebral compression fractures treated in our hospital between Jan. 2010 and Mar.2016 were retrospectively analyzed. Based on the pathological results, the CT and MRI signs of patients were statistically analyzed, and the differences of CT and MRI signs between benign and malignant vertebral compression fractures were analyzed.Results Of the 50 patients with vertebral compression fractures, 18 cases were benign and 32 cases were malignant. The main CT and MRI findings included bilateral sign, inflation sign, bone destruction, paravertebral soft tissue shadow, periosteal reactions, spokes and wheel-shaped high density sign. There were no significant differences in the incidence of bilateral sign, inflation sign, bone destruction, paravertebral soft tissue shadow and periosteal reactions between benign and malignant patients （P〉0.05）. 77.8% （14/18） of patients with benign vertebral compression fracture had spoke and wheel-shaped high density sign. The percentage was significantly higher than that of patients with malignant vertebral compression fractures （P〈0.05）.Conclusion Bilateral sign, inflation sign, bone destruction, paravertebral soft tissue shadow, periosteal reactions, spokes and wheel-shaped high density sign are common CT and MRI signs. Spokes and wheel-shaped high density sign can be used as a key sign for differential diagnosis of benign and malignant vertebral compression fractures, which is conductive to judging the nature of vertebral fractures and can provide reference for formulation of treatment plan.