Ghanem Nadir, Uhl Markus, Müller Christoph, Elgeti Florian, Pache Gregor, Kotter Elmar, Markmiller Max, Langer Mathias
Department of Diagnostic Radiology, University Hospital Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany.
Eur Radiol. 2006 Nov;16(11):2533-41. doi: 10.1007/s00330-006-0310-6. Epub 2006 Jun 15.
In this study we evaluated magnetic resonance imaging (MRI) in trauma patients for assessing traumatised adjacent discs of fractured vertebrae before dorsoventral stabilisation. In a prospective study, MRI of 54 discs was performed with a 1.5-T MRI unit. The preoperative MRI with sagittal T1-W-SE and T2-W-TSE was compared to intraoperative discography, which was carried out on both intervertebral discs adjacent to the fractured vertebrae. Signal alterations, morphological changes in the adjacent discs, fractured vertebrae and associated ligament injuries were evaluated. In 47/54 (87%) of the intervertebral discs, the results of both imaging findings were concordant. The discs adjoining vertebral fractures were normal in 18 cases. Regarding the positive concordant imaging findings, MRI and discography revealed traumatised adjacent cranial and caudal discs in 22 discs. In 7 cases, only the cranial adjacent disc was affected. Moreover, 17 cases of intradiscal bleeding, 13 intraosseous herniations into the fractured vertebrae and 20 anuluar tears were visualised in MRI. Associated ligament injuries were detected in 18 cases. Findings were discordant in eight discs. In six discs, MRI was abnormal, demonstrating signal alterations suggestive of positive imaging findings, whereas discography demonstrated no disc injury. MRI failed to detect disc injury in two discs, whereas discography was positive, showing an irregular intradiscal contrast media distribution. MRI, as a non-invasive method for assessing fractures of the thoraco-lumbar spine, may detect traumatised adjacent intervertebral discs. MRI is superior to intraoperative discography. The performance of MRI of the thoraco-lumbar spine is recommended before dorsoventral stabilisation in trauma patients, as it can reveal additional preoperative information such as fractures, disc and associated ligament injuries.
在本研究中，我们评估了磁共振成像（MRI）在创伤患者中的应用，以在进行脊柱前后稳定术之前评估骨折椎体相邻椎间盘的损伤情况。在一项前瞻性研究中，使用1.5-T MRI设备对54个椎间盘进行了MRI检查。将术前矢状面T1加权自旋回波（T1-W-SE）和T2加权快速自旋回波（T2-W-TSE）MRI与术中椎间盘造影进行比较，术中椎间盘造影在骨折椎体相邻的两个椎间盘中均进行。评估了相邻椎间盘的信号改变、形态变化、骨折椎体及相关韧带损伤情况。在54个椎间盘中的47个（87%），两种影像学检查结果一致。18例中与椎体骨折相邻的椎间盘正常。关于影像学检查结果阳性且一致的情况，MRI和椎间盘造影显示22个椎间盘中相邻的头侧和尾侧椎间盘受到损伤。7例中仅头侧相邻椎间盘受影响。此外，MRI显示17例椎间盘内出血、13例骨折椎体内骨内疝和20例环形撕裂。18例检测到相关韧带损伤。8个椎间盘的检查结果不一致。6个椎间盘中，MRI异常，显示提示影像学检查结果阳性的信号改变，而椎间盘造影未显示椎间盘损伤。2个椎间盘中MRI未能检测到椎间盘损伤，而椎间盘造影呈阳性，显示椎间盘内造影剂分布不规则。MRI作为评估胸腰椎骨折的一种非侵入性方法，可能检测到相邻受损的椎间盘。MRI优于术中椎间盘造影。建议在创伤患者进行脊柱前后稳定术之前对胸腰椎进行MRI检查，因为它可以揭示额外的术前信息，如骨折、椎间盘及相关韧带损伤情况。
