磁共振不同序列成像在腰椎压缩性骨折分型及良恶性鉴别中的应用

The application of different magnetic resonance imaging in classification of lumbar compression fractures and differentiation of benign and malignant

目的探讨磁共振(MRI)不同序列在腰椎压缩性骨折分型及良恶性鉴别中的应用价值。方法回顾性分析,收集2020年6月—2021年12月宜春市中医院收治的80例行腰椎压缩性骨折手术治疗的腰椎压缩性骨折患者的临床资料,患者术前均行MRI常规序列及DWI序列检查。以患者手术结果为金标准,统计多序列MRI检查腰椎压缩性骨折分型情况、腰椎压缩性骨折良恶性结果,分析MRI不同序列对腰椎压缩性骨折分型及良恶性的诊断价值。结果手术结果显示,80例腰椎压缩性骨折患者骨折范围在第1腰椎至第5腰椎(共103个椎体出现骨折),骨折Denis分型:A型20例、B型23例、C型19例、D型18例;骨折性质:恶性腰椎压缩性骨折38例、良性腰椎压缩性骨折42例。多序列MRI共检出101个椎体出现扁平形或凹陷,椎体骨折检出率为97.09%(101/103),其对腰椎压缩性对骨折Denis分型诊断的准确率为96.25%(77/80),经Kappa一致性度量,多序列MRI评估腰椎压缩性骨折患者的骨折分型与手术结果的一致性较好(Kappa=0.950,P<0.001)。经Kappa一致性度量,MRI常规序列检查腰椎压缩性骨折良恶性结果与手术病理结果的一致性一般(Kappa=0.474,P<0.001),而DWI检查腰椎压缩性骨折良恶性结果与手术病理结果的一致性较好(Kappa=0.825,P<0.001)。DWI检查腰椎压缩性骨折性质的准确度、灵敏度、特异度均高于MRI常规序列检查(P<0.05)。结论多序列MRI成像可有效评估患者术前骨折Denis分型,其中DWI序列成像对鉴别腰椎压缩性骨折良恶性有较好的应用价值,与MRI常规序列检查比较,具有更高的准确度、灵敏度及特异度。

Objective To explore the application value of different magnetic resonance imaging(MRI)sequences in the classification of lumbar compression fractures and the differentiation of benign and malignant fractures.Methods Retrospective analysis was conducted to collect the clinical data of 80 patients with lumbar compression fractures who underwent surgical treatment of lumbar compression fractures in Yichun Hospital of Traditional Chinese Medicine from June 2020 to December 2021.All patients completed MRI routine sequence and DWI sequence examination before operation.Taking the patient’s surgical results as the gold standard,the classification of lumbar compression fractures and the benign and malignant results of lumbar compression fractures examined by multi sequence MRI were statistically analyzed,and the diagnostic value of multi sequence MRI for classification and benign and malignant of lumbar compression fractures was analyzed.Results The surgical results showed that the fracture range of 80 patients with lumbar vertebral compression fractures was from the first lumbar vertebra to the seventh lumbar vertebra(a total of 103 vertebral fractures).According to Denis classification,there were 20 cases of type A,23 cases of type B,19 cases of type C and 18 cases of type D;fracture nature:38 cases of malignant lumbar vertebral compression fractures,and 42 cases of benign lumbar vertebral compression fractures.A total of 101 vertebral bodies were detected to be flat or sunken by multi sequence MRI,and the detection rate of vertebral fractures was 97.09%(101/103).The accuracy of Denis classification of lumbar compression fractures was 96.25%(77/80).According to kappa consistency measurement,the consistency between fracture classification of patients with lumbar compression fractures evaluated by multi sequence MRI and surgical results was good(Kappa=0.950,P<0.001).According to kappa consistency measurement,the consistency between the benign and malignant results of conventional MRI sequences and the surgical pathological results of lumbar compression fractures was general(Kappa=0.474,P<0.001);the results of DWI examination of benign and malignant lumbar compression fractures were in good agreement with the results of surgical pathology(Kappa=0.825,P<0.001).The accuracy,sensitivity and specificity of DWI in examining the nature of lumbar vertebral compression fractures were higher than those of MRI routine sequence examination(P<0.05).Conclusion Multi sequence MRI can effectively evaluate Denis classification of preoperative fractures in patients.DWI sequence imaging has a good application value in differentiating benign and malignant lumbar compression fractures.Compared with conventional MRI sequence,it has higher accuracy,sensitivity and specificity.