摘要
目的分析骨质疏松与恶性肿瘤转移后所致椎体压缩性骨折MRI、CT影像学特点及鉴别诊断。方法回顾性分析2017年7月—2019年2月解放军总医院第一医学中心骨科收治的多发压缩性骨折患者236例,纳入经骨密度仪器检测(T值≤-2.5)、X线片等影像学证实为椎体骨质疏松改变并伴有压缩性骨折且具有完整CT、MRI影像资料的患者25例,以及经PET-CT、病理诊断为恶性肿瘤脊柱转移并引起压缩性骨折且具有完整CT、MRI影像资料患者15例。其中骨质疏松压缩性骨折组男性8例,女性17例;年龄43~86岁,平均67.1岁。恶性肿瘤转移椎体致压缩性骨折组男性6例,女性9例;年龄34~73岁,平均56.3岁。重点观察两组受累椎体为连续性或跳跃性、椎体受累范围及附件有无受累、椎体压缩性骨折的形状(楔形变、双凹形、扁平形)及椎体后缘情况、椎体信号特点(椎体终板下、椎体中央带、椎体后部)、椎间隙及椎旁软组织情况。结果骨质疏松椎体压缩骨折时,CT通常为多个连续椎体受累且基本不伴有椎体附件受累,以前柱1/3楔形变常见;MRI多呈椎体终板下或椎体中央带T1WI稍低T2WI稍高信号,椎间盘通常压缩改变,椎体后角通常无异常。恶性肿瘤脊柱转移引起压缩性骨折时,CT通常显示多个跳跃性椎体受累且伴有椎体附件受累明显,骨折线偶可见,椎体以前中柱2/3楔形变并伴有后缘局部膨隆改变;MRI多呈椎体中央带或附件区T1WI、T2WI混杂信号骨质破坏并伴有椎体后缘局部膨隆,椎间盘通常无受累。结论骨质疏松及恶性肿瘤椎体转移后所致压缩性骨折在MRI、CT表现各具特异性,区别二者对于临床诊断及治疗有极大帮助。
Objective To analyze the MRI and CT features of osteoporotic compression fracture and differentiate it from the compression fracture caused by vertebral metastasis of malignant tumor.Methods A retrospective analysis was conducted in 236 patients with multiple compression fractures,who were admitted to the Department of Orthopedics of the First Medical Center of PLA General Hospital from Jul.2017 to Feb.2019.Twenty-five cases were included,who were confirmed by the bone mineral density instrument(T value≤-2.5),X-ray and other imaging studies as osteoporosis of the vertebral body with compression fracture and had complete CT and MRI image data.Fifteen cases were included,who were diagnosed as malignant tumor spinal metastasis by PET-CT and pathology and had compression fracture with complete CT and MRI image data.There were 8 males and 17 females in the osteoporotic compression fracture group,with an average age of 67.1 years(43-86 years).There were 6 males and 9 females in the compression fracture group caused by metastasis of malignant tumors,with an average age of 56.3 years(range,34-73 years).The focus of the study was to observe whether the affected vertebrae were continuous or jumping,whether the affected area and accessories were involved,the shape of vertebral compression fracture(cuneiform,double concave,flat)and the posterior edge of the vertebrae,the signal characteristics of the vertebrae(under the end plate of the vertebrae,the central zone of the vertebrae,the posterior part of the vertebrae),the intervertebral space and the paravertebral soft tissue.Results When osteoporotic vertebral compression fracture occurred,CT usually involved multiple consecutive vertebral bodies without vertebral body appendages,and 1/3 of the anterior column was wedge-shaped.On MRI,the signal of T1WI was slightly lower and T2WI was slightly higher,the disc was usually compressed,and the posterior angle of the vertebral body was usually normal.When the vertebral body metastasis was caused compression fracture,CT usually sh
作者
邬晓勇
毕文志
崔翔
李佳
WU Xiao-yong;BI Wen-zhi;CUI Xiang;LI Jia(Department of Orthopedics,The First Medical Center of PLA General Hospital,Beijing 100853,China)
出处
《创伤外科杂志》
2020年第10期727-732,共6页
Journal of Traumatic Surgery
基金
国家自然科学基金青年项目资助(81702153)。
关键词
椎体压缩性骨折
骨质疏松
恶性肿瘤转移
影像学
vertebral compression fracture
osteoporosis
malignant tumor metastasis
imaging
