Greenan T J
Advanced Neuroskeletal Imaging, Bethesda, Maryland.
Clin Sports Med. 1993 Jul;12(3):487-505.
Diagnostic imaging is a dynamic field that has taken a quantum leap over the past several years with the advent of MRI. Accordingly, it is integral that the sports medicine clinician be well acquainted with the sundry imaging modalities at his or her disposal, and be able to choose the appropriate study or studies that will provide the most useful and accurate information. Conventional radiography should be the first study performed in every athlete with sports-related injury to the spine. If radiography reveals evidence of spondylolysis with or without spondylolisthesis, MRI would be an extremely helpful adjunct for evaluation of the disc spaces, nerve roots, and neural foramina. Osseous fragments in the vicinity of the pars defect are well seen on CT but not MRI. These fragments can migrate and become symptomatic. Therefore, in the work-up of this subset of patients, CT does offer important supplementary data to the MRI. When conventional radiographs of the cervical spine corrected for magnification render the diagnosis of congenital cervical spinal stenosis, MRI should invariably be the next procedure of choice for evaluation of the spinal cord and to assess the functional reserve of the spinal canal. MRI is also the modality of choice now for evaluation of the athlete with degenerative disc disease and for the identification of degenerative disc disease associated with lumbar Scheuermann's disease. In the athlete with an acute cervical spine injury, following conventional radiography, the patient should be evaluated with CT to better characterize and define the extent of the fracture and to search for additional fractures. MRI should be performed in these patients after CT as it provides extremely valuable information regarding the status of the spinal cord. MRI because of its unparalleled soft-tissue contrast, noninvasive nature, ability to image in three orthogonal planes, and myelographic effect with certain pulses sequences has become the ideal imaging modality for spinal disease, and sports-related spinal disorders are certainly no exception.
诊断成像领域发展迅速，随着磁共振成像（MRI）的出现，在过去几年中实现了巨大飞跃。因此，运动医学临床医生必须熟悉其可使用的各种成像方式，并能够选择能提供最有用和准确信息的一项或多项合适检查。对于每一位有脊柱运动相关损伤的运动员，常规X线摄影都应作为首选检查。如果X线摄影显示有或无椎体滑脱的椎弓根峡部裂证据，MRI将是评估椎间盘间隙、神经根和神经孔的极其有用的辅助检查。椎弓根缺损附近的骨碎片在CT上显示良好，但在MRI上则不然。这些碎片可能会移位并引发症状。因此，在对这部分患者的检查中，CT确实为MRI提供了重要的补充数据。当校正放大率后的颈椎常规X线片诊断为先天性颈椎管狭窄时，MRI始终应是评估脊髓和评估椎管功能储备的下一步首选检查。MRI现在也是评估患有椎间盘退变疾病的运动员以及识别与腰椎Scheuermann病相关的椎间盘退变疾病的首选检查方式。对于急性颈椎损伤的运动员，在进行常规X线摄影后，应进行CT检查以更好地描述和确定骨折范围，并寻找其他骨折。在CT检查后应对这些患者进行MRI检查，因为它能提供有关脊髓状况的极其有价值的信息。由于其无与伦比的软组织对比度、非侵入性、在三个正交平面成像的能力以及某些脉冲序列的脊髓造影效果，MRI已成为脊柱疾病的理想成像方式，与运动相关的脊柱疾病当然也不例外。
