地方性氟骨症的全脊柱MRI影像学特征分析

Whole spine MRI findings in endemic fluorosis

目的探究地方性氟骨症的全脊柱MRI表现,从整体角度评估其MRI特点。材料与方法回顾性分析35例地方性氟骨症患者的临床及全脊柱MRI影像学表现,对椎体骨质信号改变、后纵韧带及黄韧带骨化增厚、椎管狭窄、脊髓信号改变进行评估。结果35例患者椎体T1WI及T2WI信号均匀或不均匀减低,均伴有不同程度的骨质增生(100.00%)。后纵韧带厚度为4~9(6.89±2.23)mm,以颈椎最明显。后纵韧带骨化增厚的脊椎节段共216个,其中C2~T1有158个脊椎节段(73.15%),T1~L1有42个(19.44%),L1~S1有16个(7.41%)。黄韧带厚度为4~8(5.25±1.44)mm。35个病例中,黄韧带单发病变7例,多发病变21例,共计108个病变分布于C4~L5水平,其中59个病变分布于T8~T12平面,占总数的54.63%。胸段及腰段黄韧带骨化增厚的发生率明显高于颈段。椎管狭窄30例(85.71%),脊髓受压27例(77.14%),脊髓受压伴T2WI高信号16例(45.71%),脊髓受压伴T1WI低信号8例(22.86%)。结论地方性氟骨症病变累及范围广,全脊柱MRI可全面评估其脊柱骨质及周围韧带改变,从整体角度判断椎管狭窄、脊髓及神经受压情况等,为临床提供更准确、全面的影像学依据。

Objective:To investigate the MRI findings of the whole spine in patients with endemic skeletal fluorosis,and evaluate its MRI characteristics from a global perspective.Materials and Methods:To analyze the whole spine MRI and clinical characteristics of 35 cases with endemic fluorosis and evaluate the spinal signal changes,the thickened ossification of the posterior longitudinal ligament(OPLL)and the ligamentum flavum(OLF),spinal canal stenosis,and spinal cord signal changes.Results:Fat-containing marrow in the vertebral bodies with endemic fluorosis was decreased and unevenly distributed,accompanied with varying degrees of hyperostosis(100.00%).The thickness of OPLL was 4-9(6.89±2.23)mm.The thickened OPLL was most commonly found in the cervical spine,which showed continuous thickening.The distribution of thickened OPLL in thoracic and lumbar spine was segmental.The total amount of thickened OPLL were 216 segments of spine.Of the 216 spinal segments,158 spinal segments located in C2-T1(73.15%),T1-L1 had 42 lesions(19.44%),L1-S1 had 16 lesions(7.41%).The thickness of OLF were 4-8(5.25±1.44)mm.Of the 35 cases,the thickened OLF had unifocal lesion in 7 cases and multifocal lesions in 21 cases.Of 108 lesions located in C4-L5,59 lesions located in T8-T12(54.63%).The incidence of the thickened OLF in the thoracic and lumbar segments was significantly higher than that in the cervical segments.Spinal canal narrowing was found in 30 patients(85.71%),in which compression of the spinal cord was showed in 27 patients(77.14%)and high signal in T2WI was noted in 16 cases(45.71%),low signal in T1WI was noted in 8 cases(22.86%).Conclusions:Endemic skeletal fluorosis involves a wide range of lesions.Whole spine MRI can fully reflect the abnormities of diffuse bone and paravertebral ligaments,the degree of spinal canal stenosis,spinal cord and nerve compression in the patients with endemic fluorosis,provide more accurate and comprehensive imaging support for clinical use.