Magnetic resonance and computed tomography-based scoring system for the differential diagnosis of vertebral fractures caused by osteoporosis and malignant tumors
Magnetic resonance and computed tomography-based scoring system for the differential diagnosis of vertebral fractures caused by osteoporosis and malignant tumors
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DOI：
10.1007/s00776-005-0910-z
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发表时间：
2005-07-01
影响因子：
1.7
通讯作者：
Takaoka, K
中科院分区：
文献类型：
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作者：
Yuzawa, Y;Ebara, S;Takaoka, K
背景以前的报道描述了磁共振成像(MRI)的表现，据称是由恶性病变引起的脊柱骨折的特异性表现。利用这些发现进行鉴别诊断通常是困难的，尤其是在骨折的早期阶段。在任何单一影像发现相对不准确的情况下，根据影像发现的组合建立有效的评分系统可能会提高诊断的准确性。本研究的目的是建立一种基于MRI和CT的骨质疏松性椎体骨折与恶性肿瘤所致椎体骨折的诊断评分系统。回顾分析57例骨质疏松性椎体骨折和43例肿瘤性骨折的10种MRI和CT表现，分析其对椎体骨折良恶性的鉴别能力。选择以下4种MRI表现和2种CT征象作为评分系统的依据：椎弓根或其他后方受累；侵犯椎旁区；保留正常骨髓信号；MRI T2加权像上连续的黑色线条代表椎体后缘；骨质破坏；CT上清晰的骨折线。通过结合脊椎骨折的MRI和CT扫描常见的表现，设计了一个简单的评分系统。该评分系统可提高对脊柱良恶性病变所致骨折的影像诊断准确率。
Background Previous reports have described magnetic resonance imaging (MRI) findings alleged to be specific for vertebral fractures caused by malignant lesions. Using such findings for differential diagnosis is often difficult, especially during the early phase of the fracture. With the relative inaccuracy of any single imaging finding, a validated scoring system based on a combination of imaging findings might lead to enhanced diagnostic accuracy. The purpose of this study was to establish a diagnostic scoring system for discriminating osteoporotic vertebral fractures from those caused by malignant tumors on the basis of MRI and computed tomography (CT) findings.Methods. Ten MRI and CT scan findings of 57 osteoporotic vertebral fractures and 43 neoplastic fractures were retrospectively evaluated for their ability to discriminate between malignant and benign vertebral fractures.Results. The following four MRI and two CT findings were selected as the basis for the scoring system: pedicle or other posterior element involvement; extension into the paravertebral region; preservation of normal bone marrow signal; a continuous black line representing the posterior vertebral body margin on T2-weighted MRI images; osteolytic destruction; and distinct fracture lines on CT.Conclusion. By combining the findings common to MRI and CT scans of vertebral fractures, a simple scoring system was devised. This scoring system was found to enhance the accuracy of imaging diagnosis of fractures caused by benign or malignant spinal lesions.