CAJ | 학술논문

目的：比较常规磁共振成像（ magnetic resonance imaging，MRI）序列、短时间反转恢复序列（ short-tau inversion recovery，STIR）、多回波采集的T2 WI梯度回波序列（ multiple-echo image combination gradient-echo sequence， ME2D）、磁敏感加权成像（ susceptibility weighted imaging，SWI）序列在急性颈椎创伤中的应用价值。方法30例急性颈椎创伤患者，均应用德国西门子3.0T扫描机对其进行常规MRI（T1WI和T2WI）、STIR、ME2D及高分辨率SWI检查。比较T2 WI与STIR对椎体、椎间盘及椎旁韧带损伤的检出情况。对脊髓出血的患者，选择ME2D和SWI的同一层面（显示出血最清楚层面），分别测量脊髓出血与周围正常脊髓组织信号强度并计算其信号强度比。结果STIR检测急性创伤椎体异常信号、棘间韧带、项韧带损伤检出率高于T2 WI（χ2＝21.043、1063.499、859.982，P＜0.01）。两者对棘间韧带、项韧带损伤检出结果一致性较差（ Kappa＝0.336、0.329，）；T2 WI和STIR序列在检出椎间盘损伤及前、后纵韧带损伤程度方面的差异无统计学意义。SWI显示脊髓出血部位与周围正常脊髓组织的信号强度比低于ME2D，差异有统计性意义（ Z＝2.52，P＝0.014）。结论在颈椎创伤的MRI平扫中，STIR较T2 WI对椎体及后方韧带损伤的显示具有明显的优势，STIR应作为脊柱损伤的常规扫描序列；而SWI在显示及证实脊髓出血方面较常规T2 WI、ME2D更敏感，应作为脊髓损伤的重要补充序列。
목적：비교상규자공진성상（ magnetic resonance imaging，MRI）서렬、단시간반전회복서렬（ short-tau inversion recovery，STIR）、다회파채집적T2 WI제도회파서렬（ multiple-echo image combination gradient-echo sequence， ME2D）、자민감가권성상（ susceptibility weighted imaging，SWI）서렬재급성경추창상중적응용개치。방법30례급성경추창상환자，균응용덕국서문자3.0T소묘궤대기진행상규MRI（T1WI화T2WI）、STIR、ME2D급고분변솔SWI검사。비교T2 WI여STIR대추체、추간반급추방인대손상적검출정황。대척수출혈적환자，선택ME2D화SWI적동일층면（현시출혈최청초층면），분별측량척수출혈여주위정상척수조직신호강도병계산기신호강도비。결과STIR검측급성창상추체이상신호、극간인대、항인대손상검출솔고우T2 WI（χ2＝21.043、1063.499、859.982，P＜0.01）。량자대극간인대、항인대손상검출결과일치성교차（ Kappa＝0.336、0.329，）；T2 WI화STIR서렬재검출추간반손상급전、후종인대손상정도방면적차이무통계학의의。SWI현시척수출혈부위여주위정상척수조직적신호강도비저우ME2D，차이유통계성의의（ Z＝2.52，P＝0.014）。결론재경추창상적MRI평소중，STIR교T2 WI대추체급후방인대손상적현시구유명현적우세，STIR응작위척주손상적상규소묘서렬；이SWI재현시급증실척수출혈방면교상규T2 WI、ME2D경민감，응작위척수손상적중요보충서렬。
Objective To compare conventional MRI,short-tau inversion recovery( STIR ), multiple-echo image combination gradient-echo sequence( ME2D)and susceptibility weighted imaging (SWI)in acute cervical spine trauma. Methods Conventional T1WI,T2WI,STIR,ME2D and high-resolution SWI were performed in 30 patients with a history of acute cervical spine injury using a 3 Tesla MRI system( Verio,siemens,Germany ). The detection of vertebral body,intervertebral disc and paravertebral ligament injury by T2 WI and STIR were analyzed. The signal intensity in the hemorrhage and normal spinal cord were measured on the same slice of ME2D and SWI,respectively,and the signal intensity ratio of the hemorrhage to normal spinal cord were calculated. Results Compared with T2 WI, STIR sequence had higher detection rate in showing vertebral bodies injuries,interspinal ligament and nuchal ligament injuries(χ2 =21 . 043 ,1 063 . 499 ,859 . 982 ,P<0 . 01 ),the consistency of result of STIR and T2 WI in detecting injury of interspinal ligament and nuchal ligament was poor( Kappa= 0. 336 and 0 . 329 ). There was no significant difference between STIR and T2 WI in detecting injury of intervertebral disc,anterior longitudinal ligament and posterior longitudinal ligament. Compared with ME2D,SWI sequence could show lower signal intensity ratio of the hemorrhage to normal spinal cord,and there were statistical differences(Z=2. 52,P=0. 014). Conclusion Compared with T2WI,STIR has significant advantage in detecting injury of vertebral body and posterior ligament complex,so STIR should be included in the routine MRI sequence of acute cervical spine trauma;SWI is more sensitive than T2 WI and ME2 D in showing and confirming hemorrhage in acute cervical cord injury and should serve as important complement sequence for acute spinal cord injury.