CAJ | 학술논문

目的 MRI鉴别多发椎体良恶性压缩骨折。方法 171个椎体压缩骨折（良性77个、恶性94个），16个经椎体活检，其余经3～6个月MRI追踪确诊。行T1WI，T2/T2*WI，T1WI脂肪抑制增强扫描。观察（1）异常信号形态和分布；（2）压缩椎体形态；（3）椎旁软组织肿块；（4）多发椎体病变的排列方式；（5）不同序列椎体信号变化；（6）测量T1WI脂肪抑制增强扫描后病灶信号增强率。结果恶性压缩骨折征象是，不均匀分布的穿凿样或片状异常信号（91%长T1信号、73%长T2信号），不同程度的团块样或片状强化，侵犯椎弓根，椎体后缘隆凸，椎旁软组织肿块，病变椎体呈跳跃排列。良性压缩骨折征象是椎体缘带状异常信号（62%长T1信号、42%长T2信号），带状强化（急性压缩骨折）或不强化（陈旧性压缩骨折），椎体后角后翘，椎弓根正常，无软组织肿块，病变椎体呈连续排列。结论鉴别良恶性压缩骨折最主要的MRI征象是椎体异常信号的形态和分布，T1WI脂肪抑制增强扫描有助于鉴别诊断。
목적 MRI감별다발추체량악성압축골절。방법 171개추체압축골절（량성77개、악성94개），16개경추체활검，기여경3～6개월MRI추종학진。행T1WI，T2/T2*WI，T1WI지방억제증강소묘。관찰（1）이상신호형태화분포；（2）압축추체형태；（3）추방연조직종괴；（4）다발추체병변적배렬방식；（5）불동서렬추체신호변화；（6）측량T1WI지방억제증강소묘후병조신호증강솔。결과악성압축골절정상시，불균균분포적천착양혹편상이상신호（91%장T1신호、73%장T2신호），불동정도적단괴양혹편상강화，침범추궁근，추체후연륭철，추방연조직종괴，병변추체정도약배렬。량성압축골절정상시추체연대상이상신호（62%장T1신호、42%장T2신호），대상강화（급성압축골절）혹불강화（진구성압축골절），추체후각후교，추궁근정상，무연조직종괴，병변추체정련속배렬。결론감별량악성압축골절최주요적MRI정상시추체이상신호적형태화분포，T1WI지방억제증강소묘유조우감별진단。
Objective　To distinguish benign from malignant multiple vertebral collapses.Methods　171 vertebral collapses (77 benign,94 malignancy) were studied in 58 patients with T1WI,T2/T2WI,contrast enhancement T1WI with fat saturation.Pathologic result was available in 16 vertebras,including 10 malignancy and 6 benign.The remaining patients were performed 3～6 months follow-up to confirm the final diagnosis.The following MR characteristics were reviewed:(1)The shape and distribution of abnormal signal intensity.(2)The shape of antero-or poster-border of compressive vertebral body.(3)Paravertebral soft tissue mass.(4)The change of lesions signal intensity on T1WI,T2WI and contrast enhanced MRI with fat saturation.(5)Signal intensity increasing ratio after contrast enhancement.Results　The malignant vertebral compression fractures showed as the punch or patchy low signal intensity on T1WI distributing anywhere in the compressive body and enhancement.It had the convex posterior cortex,pedicle involved,paravertebral soft tissue mass.The benign vertebral compression fractures showed as the band linear hypo-or-iso-intensity in end-plate,enhanced (acute fracture)or unenhanced(old fracture),retropulsion of posterior cortex,no pedicle involved and paravertebral soft tissue.Conclusion　The most important MR characteristics for differentiation of malignant or bengin vertebral compression are the shapes and distributions of the abnormal signal intensities of vertebral collapses.The contrast enhancement T1WI with fat saturation is helpful for imaging diagnosis.