Schütz Uwe H W
Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland.
Orthopädie und Schmerzmedizin am Grünen Turm, Grüner-Turm-Str. 4-10, 88212, Ravensburg, Deutschland.
Orthopade. 2019 Jan;48(1):5-43. doi: 10.1007/s00132-018-03672-8.
Radiological imaging is important in the preoperative diagnosis of many forms of spinal pathology and plays a fundamental role in the assessment of p.o. effects, which can be verified on the spinal column as well as on the surrounding soft tissues, depending on the imaging method used.
The article provides an overview of the current status and possibilities of radiological diagnostic methods for the verification of possibly recommended spine surgery in the context of degenerative, inflammatory-infectious, post-traumatic or p.o. pathologies and changes in the spine: X‑rays, computed tomography (CT), magnetic resonance imaging (MRI). The supplementary nuclear medicine procedures (scintigraphy, PET[-CT], SPECT, etc.) which may be required for special questions are not discussed.
The merits and limitations of the techniques used in the investigation of advanced degenerative spinal pathologies and post-traumatic conditions are discussed, with multidetector CT being the focus of attention in spinal clearance for traumatic injuries. In most cases of spinal infection, MRI images, as a central diagnostic tool, show typical findings such as destruction of adjacent endplates, bone marrow and intervertebral disc abnormalities, and paravertebral or epidural abscesses. However, it is not always easy to diagnose a spinal infection, especially if atypical MR patterns of infectious spondylitis are present. Knowledge of them means misdiagnosis and improper treatment can be avoided.
It is shown that high-quality modern radiological examinations are essential for diagnosis and p.o. management, as these provide answers to the main questions in the treatment: Is the entity/injury stable or unstable, acute or old, benign or malign; is there a myelopathy or p.o. complication?
The main indications for p.o. diagnostic imaging, difficulties such as metal artefact formation, and potential pitfalls are analyzed. Entity-specific radiological image patterns, imaging algorithms and differential diagnostic peculiarities are presented and discussed based on current literature and selected case studies.
放射影像学在多种脊柱疾病的术前诊断中具有重要意义，在评估术后效果方面发挥着基础性作用，根据所使用的成像方法，可在脊柱以及周围软组织上得到验证。
本文概述了在退行性、炎症感染性、创伤后或术后脊柱病变及改变的背景下，用于验证可能推荐的脊柱手术的放射诊断方法的现状和可能性：X线、计算机断层扫描（CT）、磁共振成像（MRI）。未讨论特殊问题可能需要的补充核医学检查程序（闪烁扫描、PET[-CT]、SPECT等）。
讨论了用于研究晚期退行性脊柱病变和创伤后情况的技术的优缺点，多排CT是创伤性损伤脊柱清除术中关注的焦点。在大多数脊柱感染病例中，MRI图像作为主要诊断工具，显示出典型表现，如相邻终板破坏、骨髓和椎间盘异常以及椎旁或硬膜外脓肿。然而，诊断脊柱感染并不总是容易的，特别是如果存在非典型的感染性脊柱炎MR模式。了解这些模式意味着可以避免误诊和不适当的治疗。
结果表明，高质量的现代放射学检查对于诊断和术后管理至关重要，因为这些检查能回答治疗中的主要问题：病变/损伤是稳定还是不稳定、急性还是陈旧性、良性还是恶性；是否存在脊髓病或术后并发症？
分析了术后诊断性成像的主要适应证、金属伪影形成等困难以及潜在陷阱。根据当前文献和选定的病例研究，展示并讨论了特定病变的放射影像学图像模式、成像算法和鉴别诊断特点。
