Scarabino T, Perfetto F, Giannatempo G M, Ceddia A, D'Angelo V, Cammisa M, Salvolini U
Servizio di Neuroradiologia, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG).
Radiol Med. 1996 Dec;92(6):671-6.
The Authors report their personal experience with postoperative neuroradiologic studies in surgical patients with a herniated disk and/or degenerative cervical spondylosis. Twenty-six patients were enrolled: 16 of them underwent anterior diskectomy, 7 posterior decompressive laminectomy and 3 vertebral body removal. The patients were submitted to pre- and postoperative MRI with high field equipment (Signa 1.5 T, General Electrics), using sagittal SE T1- (TR/TE 360/15), PD and T2-weighted (TR/TE/FA 2000/40/120) sequences and T2-weighted GE axial sequences (TR/TE/FA 400/34/30). FSE sequences (TR/TE/ETL 4000/95/8) were used in 15 cases instead of the above T2-weighted SE sequences. The main postoperative MR findings were analyzed. In particular, the morphological and signal features of bone grafts, of vertebral end-plates, of the subchondral bone and of the surgical site were studied. After anterior diskectomy, the most frequent MR features were massive signal changes in the bone graft and lower vertebral plates, which were hypointense in T1 and hyperintense in T2; the adjacent subchondral bone also exhibited signal changes. Other postoperative MR findings accounted for early postoperative mobility (4 cases of persistent myelomalacia and 3 of bone graft fracture with consequent spinal instability) and late mobility (2 cases of herniated disk, 5 of spinal stenosis and one pseudomeningocele). The main limitation of MRI in postoperative cervical spine studies was the presence of ferromagnetic artifacts during SE, and even more GE, sequences; these artifacts were the main cause of misdiagnoses. In our experience, this troublesome limitation was overcome with FSE sequences but diagnostic accuracy remained poor in 4 patients. MRI, thanks to its multiparametric and multiplanar yield, is the gold standard for the examination of several early and late postoperative features and of postoperative mobility in the cervical spine. Moreover, T2-weighted FSE acquisitions are better than conventional SE to this purpose, because examination time is shorter, myelographic effect is improved and the sensitivity to ferromagnetic artifacts reduced.
作者报告了他们在患有椎间盘突出和/或退行性颈椎病的手术患者中进行术后神经放射学研究的个人经验。共纳入26例患者：其中16例行前路椎间盘切除术，7例行后路减压椎板切除术，3例行椎体切除术。患者在术前和术后使用高场设备（通用电气公司的Signa 1.5T）进行MRI检查，采用矢状面SE T1加权序列（TR/TE 360/15）、质子密度加权序列和T2加权序列（TR/TE/FA 2000/40/120）以及T2加权GE轴位序列（TR/TE/FA 400/34/30）。15例患者使用FSE序列（TR/TE/ETL 4000/95/8）替代上述T2加权SE序列。分析了主要的术后MR表现。特别研究了骨移植、椎体终板、软骨下骨和手术部位的形态和信号特征。前路椎间盘切除术后，最常见的MR表现是骨移植和下位椎体终板出现大量信号改变，T1加权像呈低信号，T2加权像呈高信号；相邻软骨下骨也出现信号改变。其他术后MR表现包括早期术后活动异常（4例持续性脊髓软化和3例骨移植骨折导致脊柱不稳）和晚期活动异常（2例椎间盘突出、5例椎管狭窄和1例假性脑脊膜膨出）。MRI在颈椎术后研究中的主要局限性在于SE序列甚至GE序列期间存在铁磁性伪影；这些伪影是误诊的主要原因。根据我们的经验，FSE序列克服了这一麻烦的局限性，但仍有4例患者诊断准确性较差。由于其多参数和多平面成像特点，MRI是检查颈椎术后多种早期和晚期特征以及术后活动异常的金标准。此外，在此方面，T2加权FSE采集优于传统SE序列，因为检查时间更短，脊髓造影效果更好，对铁磁性伪影的敏感性降低。
