评价MRI-IDEAL技术对脊柱压缩性骨折的诊断价值

To Evaluate the Diagnostic Value of MRI Ideal Technique for Spinal Compression Fracture

目的探讨MRI非对称回波三点法水脂分离技术(IDEAL)在诊断脊柱良恶性压缩骨折中的应用价值。方法选取经病理或临床证实的脊柱压缩骨折46例(共77个椎体)患者为观察对象,均行常规MRI平扫和IDEAL序列检查。其中良性骨折25例,包括单纯外伤9例,骨质疏松15例,结核1例,共43个椎体;恶性骨折21例,包括转移性肿瘤19例,骨髓瘤1例,白血病1例,共34个椎体。用IDEAL序列分析上述两组椎体在水脂像、同反相位的信号强度比(SIRS)(脂像信号强度/水像信号强度,反相位信号强度/同相位信号强度),即相对信号比值,并进行统计学分析,两组间用方差分析检验SIRS差异,P<0.05认为差异有统计学意义。结果椎体良性压缩性骨折组水脂像SIRS是0.63±0.11,恶性压缩性骨折组水脂像SIRS是0.13±0.05,两者差异有统计学意义(t=12.99,P<0.05);椎体良性压缩性骨折组同反相位SIRS是0.42±0.17,恶性压缩性骨折组同反相位SIRS是0.83±0.08,两者差异有统计学意义(t=7.05,P<0.05)。结论 IDEAL技术对椎体良恶性骨折的鉴别有较高的应用价值。

Objective To discuss the value of MR iterative decomposition of water and fat with echo asymmetric and least-squares estimation(IDEAL) in the benign and malignant vertebral compressed fractures. Methods 46 cases of compressed fractures(77 vertabral bodies) confirmed by pathology or the clinic were enrolled in this study. Conventional MRI plain scan and IDEAL were performed in these patients. 25 cases were benign fractures( including 9 traumas,15 osteoporosis and 1 tuberculosis,43 vertabral bodies),21 cases were malignant fractures( including 19 cases of metastersis,1 myeloma,1 leukocythemia,34 vertabral bodies). IDEAL was used to analyse the ratios of signal intensity of water image to fat image and that of out-phase to in-phase( fat signal intensity/water signal intensity and out-phase signal intensity/in-phase signal intensity respectively),that is relative signal intensity ratios( SIRS). SIRS in the 4 groups were calculated by statistical methods. SIRS difference was calculated by one-way ANOVA. P < 0. 05 was considered as statistical significance. Results SIRS of fat signal intensity/water signal intensity of benign vertebral compressed fractures was 0. 63 ± 0. 11 whereas in malignant vertebral compressed fractures was 0. 13 ± 0. 05( t = 12. 99,P < 0. 05). SIRS of out-phase signal intensity/inphase signal intensity of benign vertebral compressed fractures was 0. 42 ± 0. 17,whereas in malignant vertebral compressed fractures was 0. 83 ± 0. 08( t = 7. 05,P < 0. 05). Conclusion IDEAL is valuable in the differential diagnosing between the benign and malignant vertebral fracture.