椎体压缩性骨折的磁共振诊断

Magnetic Resonance Imaging of Benign and Malignant Vertebral Compression Fractures

目的:分析椎体良、恶性压缩性骨折的MRI表现。材料和方法:22例椎体良性压缩性骨折及49例病理性压缩性骨折患者,男43例,女28例,年龄34～76岁,平均58.3岁。全部行MR平扫+增强扫描。结果:压缩椎体的信号改变对骨折甚为敏感,但对良、恶性骨折的鉴别缺乏特异性。压缩椎体残留有正常的骨髓信号者多见于良性骨折(P<0.001)。压缩椎体后缘膨出、椎管狭窄常见于病理性骨折(P<0.001)。椎弓根受侵(P<0.001)及椎旁软组织肿块(P<0.001)是病理性骨折所特有的征象。增强后椎体信号均匀与否对诊断有帮助(P<0.001)。结论:病理性压缩性骨折多表现为椎弓根信号异常,椎体后缘明显膨隆,椎管狭窄,椎旁软组织肿块及增强后压缩椎体不均匀强化。椎弓根变形膨大一般不出现于良性骨折。

Purpose: To evaluate the magnetic resonance imaging characteristics that will allow differentiation of benign or malignant vertebral compression fractures. Materials and Methods: Twenty - two patients of atraumatic compression fractures and forty - nine patients of malignant compression fractures that had undergone magnetic resonance imaging were retrospectively reviewed.Conventional magnetic resonance imaging with T1 - and T2 - weighted gradient - echo MR images and gadolinium enhancement were obtained in all cases. Results:Decreased T1 - weighted and increased T2 - weighted signals are sensitive but not specific for tumor involvement. Normal marrow preservation of the compressed vertebral body are familiar in osteoporotic fractures to malignant fractures.posterior vertebral expansion(P < 0.001) are useful for differentiation of malignant from osteoporotic. Pedicle involvement (P < 0.001) or an associated soft tissue mass(P< 0.001) are specific for a tumor compression fracture. MR enhancement pattern(P < 0.001) help to establish a diagnosis.Conclusion: Malignant compression fractures tended to have an abnormal signal involvement of the pedicle , a marked and heterogeneous MR enhancement pattern, a tumor - like paravertebral soft tissue and a posterior vertebral expansion. Pedicle change with expansile lesion totally excluded a benign fracture.