An H S, Andreshak T G, Nguyen C, Williams A, Daniels D
Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, USA.
Spine (Phila Pa 1976). 1995 Aug 15;20(16):1776-82. doi: 10.1097/00007632-199508150-00005.
The authors investigate the usefulness of magnetic resonance imaging in differentiating benign versus malignant compression fractures by reviewing patients and a fracture model in a canine model.
To determine the sensitivity and specificity of magnetic resonance imaging in differentiating benign versus malignant compression fractures of the spine and to obtain distinguishing features in magnetic resonance imaging.
The differentiation between benign and abnormal compression fractures of the thoracolumbar spine has important implications regarding patient treatment and prognosis. Plain radiographs, bone scans, and computed tomography are not accurate imaging modalities for this purpose.
Magnetic resonance imaging scans of 22 patients with confirmed lesions of the thoracolumbar spine were studied. There were 11 malignant and 11 benign lesions. Two experienced neuroradiologists blindly reviewed the magnetic resonance imaging scans and determined benign or malignant lesions. A canine study was performed to simulate a compression fracture model with a vertebral osteotomy in two dogs, and serial contrast-enhanced magnetic resonance imaging scans were performed 15, 30, 60 and 90 days after surgery.
The correct interpretation between two neuroradiologists was 77% and 95%. The combined sensitivity rate was 88.5%, and the specificity rate was 89.5%. Magnetic resonance imaging reliably distinguished benign versus malignant lesions based on the anatomic distribution and intensity of signal changes of bone and adjacent tissues, contrast enhancement characteristics, and changes over time. Only one malignant lesion was misinterpreted by both neuroradiologists as benign, whereas there was one additional missed malignant lesion and three misinterpreted benign lesions by one radiologist. In the canine study, signal changes and enhancement were found 60 days after surgery, but no signal changes or enhancement were noted on the scan 90 days after surgery.
Magnetic resonance imaging scans can detect malignant vertebral lesions early, but acute healing compression fractures may mimic the findings of metastatic lesions. The use of contrast-enhanced magnetic resonance imaging scans and serial magnetic resonance imagings are helpful for additional differentiation between benign and malignant compression fractures. In addition to magnetic resonance imaging scans, other diagnostic tests and clinical findings should be correlated before biopsy or surgery of the suspected lesion.
作者通过回顾患者以及犬类模型中的骨折模型，研究磁共振成像在鉴别良性与恶性压缩性骨折方面的效用。
确定磁共振成像在鉴别脊柱良性与恶性压缩性骨折中的敏感性和特异性，并获取磁共振成像中的鉴别特征。
胸腰椎良性与异常压缩性骨折的鉴别对患者治疗和预后具有重要意义。为此，X线平片、骨扫描和计算机断层扫描并非精确的成像方式。
对22例确诊胸腰椎病变的患者进行磁共振成像扫描研究。其中有11例恶性病变和11例良性病变。两名经验丰富的神经放射科医生在不知情的情况下对磁共振成像扫描进行评估，并确定病变为良性或恶性。进行了一项犬类研究，通过对两只犬进行椎体截骨术模拟压缩性骨折模型，并在术后15、30、60和90天进行系列对比增强磁共振成像扫描。
两名神经放射科医生之间的正确解读率分别为77%和95%。联合敏感度为88.5%，特异度为89.5%。磁共振成像能够根据骨骼及相邻组织的解剖分布、信号变化强度、对比增强特征以及随时间的变化可靠地区分良性与恶性病变。两名神经放射科医生均将1例恶性病变误判为良性，而一名放射科医生还漏诊了1例恶性病变，并误判了3例良性病变。在犬类研究中，术后60天发现了信号变化和强化，但术后90天的扫描未发现信号变化或强化。
磁共振成像扫描能够早期检测出恶性椎体病变，但急性愈合的压缩性骨折可能会模拟转移性病变的表现。使用对比增强磁共振成像扫描和系列磁共振成像有助于进一步鉴别良性与恶性压缩性骨折。在对疑似病变进行活检或手术之前，除了磁共振成像扫描外，还应综合其他诊断检查和临床发现。
