Bhalla S, Reinus W R
Mallinckrodt Institute of Radiology, St. Louis, MO 63110, USA.
AJR Am J Roentgenol. 1998 Jun;170(6):1563-9. doi: 10.2214/ajr.170.6.9609175.
We describe 11 patients with radiographically visible linear intravertebral vacuums to increase awareness of this benign finding that is diagnostic of ischemic necrosis of the vertebral body (Kümmell's disease).
We retrospectively reviewed the radiologic and clinical histories of 11 patients seen at our institution between 1991 and 1997 in whom the linear intravertebral vacuum phenomenon had been diagnosed. Imaging included plain radiographs in all patients, CT scans in three, bone scintigrams in three, and MR images in three.
Twelve linear intravertebral vacuums associated with vertebral compression deformities were visible in 11 patients from T8 to L2, four at T12, and four at L1. Of the 12 linear intravertebral vacuums, seven (58%) were seen by the initial interpreting radiologist. The mean age of these patients was 76.6 years. The female:male ratio was 10:1. During the period of analysis, two patients were known to have malignancy, one with metastasis to the spine but not to the affected vertebral body. One patient, who underwent equivocal MR imaging for malignancy, later underwent bone biopsy, which showed no neoplasm within the collapsed vertebra. Of the remaining nine patients, one was undergoing chronic corticosteroid therapy and another had a history of radiation therapy to the spine. Seven of the 11 patients had histories of falling, prompting radiographs of the spine. All 11 patients were radiographically osteopenic. Ultimately, none of the patients had clinical evidence of neoplasm or infection involving the affected vertebral body.
Recognition of the near-certain benign significance of a linear intravertebral gas collection revealed by radiography may prevent unnecessary imaging or biopsy in a patient with a suggestive vertebral compression deformity.
我们描述了11例影像学上可见椎体内线性真空的患者，以提高对这一良性表现的认识，该表现可诊断椎体缺血性坏死（Kümmell病）。
我们回顾性分析了1991年至1997年间在我院就诊的11例诊断为椎体内线性真空现象患者的影像学和临床病史。所有患者均行X线平片检查，3例行CT扫描，3例行骨闪烁扫描，3例行磁共振成像。
11例患者共发现12处与椎体压缩畸形相关的椎体内线性真空，位于T8至L2，其中T12有4处，L1有4处。12处椎体内线性真空中，7处（58%）最初由阅片放射科医生发现。这些患者的平均年龄为76.6岁。男女比例为10:1。在分析期间，已知2例患者患有恶性肿瘤，其中1例有脊柱转移，但未转移至受累椎体。1例因恶性肿瘤行磁共振成像检查结果不明确的患者，后来接受了骨活检，结果显示塌陷椎体内无肿瘤。其余9例患者中，1例正在接受慢性糖皮质激素治疗，另1例有脊柱放疗史。11例患者中有7例有跌倒史，因此进行了脊柱X线检查。所有11例患者X线片均显示骨质疏松。最终，所有患者均无受累椎体肿瘤或感染的临床证据。
认识到X线片显示的椎体内线性气体聚集几乎肯定具有良性意义，可避免对有提示性椎体压缩畸形的患者进行不必要的影像学检查或活检。
