Baker L L, Goodman S B, Perkash I, Lane B, Enzmann D R
Department of Diagnostic Radiology and Nuclear Medicine, Stanford University School of Medicine, CA 94305.
Radiology. 1990 Feb;174(2):495-502. doi: 10.1148/radiology.174.2.2296658.
Differentiation of benign from pathologic compression fractures of vertebral bodies was evaluated with magnetic resonance imaging in a prospective study of 53 patients. Twenty-six patients had 34 benign posttraumatic compression fractures. Twenty-seven patients had metastatic disease to the vertebral column and seven pathologic fractures. T1- and T2-weighted spin-echo (SE) sequences (1.5 T) were performed in all patients. A presaturation technique was used to obtain "fat" and "water" images to better assess the degree of normal fatty marrow replacement in fractured vertebrae. Short inversion-time inversion-recovery (STIR) images were also obtained. Discrimination between benign and pathologic compression fractures was generally possible with the SE sequences. Chronic benign fractures demonstrated isointense marrow signal intensity (SI), compared with that of normal vertebrae with all sequences. Pathologic fractures showed low SI on T1-weighted images and high SI on T2-weighted images. Fat images revealed complete replacement of normal fatty marrow, shown as absent SI in the involved vertebral body. Water and STIR images showed diffuse high SI in pathologic fractures, with STIR images having the highest contrast between abnormal and normal marrow. Acute benign compression fractures also demonstrated high SI on T2-weighted, water, and STIR images, but the SI was less pronounced and the pattern was generally more inhomogeneous than that of pathologic compressions. In general, fat images showed only partial replacement of normal fatty marrow by low SI, in contrast to the complete absence of marrow SI typical of pathologic fractures.
在一项对53例患者的前瞻性研究中，利用磁共振成像评估椎体良性与病理性压缩骨折的鉴别诊断。26例患者有34处良性创伤后压缩骨折。27例患者有脊柱转移瘤及7处病理性骨折。所有患者均行T1加权和T2加权自旋回波（SE）序列（1.5T）检查。采用预饱和技术获取“脂肪”和“水”图像，以更好地评估骨折椎体中正常脂肪骨髓替代的程度。还获取了短反转时间反转恢复（STIR）图像。利用SE序列通常可以鉴别良性与病理性压缩骨折。与正常椎体相比，慢性良性骨折在所有序列上骨髓信号强度（SI）等信号。病理性骨折在T1加权图像上呈低信号，在T2加权图像上呈高信号。脂肪图像显示正常脂肪骨髓完全被替代，受累椎体表现为无信号。水像和STIR图像显示病理性骨折呈弥漫性高信号，STIR图像上异常与正常骨髓之间的对比度最高。急性良性压缩骨折在T2加权、水像和STIR图像上也呈高信号，但信号强度较弱，且模式通常比病理性压缩更不均匀。一般来说，脂肪图像显示正常脂肪骨髓仅部分被低信号替代，这与病理性骨折典型的骨髓信号完全缺失不同。
