MR弥散加权成像对鉴别诊断良恶性椎体压缩性骨折的临床价值研究

目的：探讨MR弥散加权成像（DWI）鉴别诊断良恶性椎体压缩性骨折的临床价值。方法：对57例经临床或病理证实的椎体良恶性压缩性骨折患者行矢状位T1M、T2WI、T2WI／FS及DWI扫描，研究其在常规序列和DWI序列上的表现，将常规MR序列和DWI序列检出率进行比较，测量正常椎体及病变椎体的表观弥散系数（ADC）值，并进行统计学分析。结果：（1）MR常规序列和DWI序列（b=500s／mm2）表现：良性椎体压缩性骨折呈长T1长或等T2改变，T2WI／FS呈高信号，DWI可以呈高信号、等信号及低信号；恶性椎体压缩性骨折呈长T1长T2信号，大部分病灶T2WUFS及DWI呈高信号，少数变现为低信号；（2）MR常规序列和DWI序列（b=500s／mm2）病灶检出率的比较：T1WI、T2WI／FS及DWI序列病灶检出率均高于T2WI序列，其间的差别有显著性意义（P〈0．01），T1WI、T2WI／FS及DWI序列病灶检出率之间无显著性差异（P〉0．01）；（3）ADC值比较：在DWI（b=500s／mm2）上，良性组ADC值为（2．03±0．83）×10^3mm^2/s，恶性组ADC值为（1．37±0．75）×10^-3mm^2/s，正常组ADC值为（0．36±0．21）×10^-3mm^2／s，成像条件相同时，良性组高于恶性组，两组间有明显的统计学意义（P〈0．05）。结论：DWI可较好的反映椎体的弥散特征，ADC值作为量化指标可对良恶性椎体压缩性骨折进行可靠鉴别。

Clinical Value of MR Diffusion Weighted Imaging in the Differential Diagnosis of Benign and Malignant Vertebral Compression Fractures

Objective： To investigate the clinical value of MR diffusion weighted imaging in the differential diagnosis of benign and malignant vertebral compression fractures. Methods： 57 patients with vertebral compression fractures（confirmed by clinic or pathology） were performed with sagittal T1WI, T2WI, T2WI/FS and DWI respectively. The capability to show the lesion on T1WI,T2WI, T2WU FS and DWI （b=500 s/mm2）were compared. Meanwhile, on DWI（b=500 s/mm2）, the ADCs of the vertebral compression fractures and normal vertebral were analyzed. Results： （1）The appearance of routine MR sequence and DWI sequence （b=500s/mm2）： benign vertebral compression fractures showed long T1, long T2, T2WI/FS high signal, DWI could display high and low signal; malignant vertebral compression fractures long T1 and long T2 signal, most lesions on T2WI/FS and DWI showed high signal, few ones low signal; （2）The capability to show the lesions on DWI（b=500 s/mm2） and general MRI. The capability to show the lesions on T1WI, T2WI/FS and DWI （b=500 s/mm2） were similar（P 〉0.01）, which were higher than that of T2WI（P 〈0.01）. （3）The ADCs of lesions and normal vertebrae were： b=500 s/mm2,the benign group ADC value（2.03 ± 0.83）× 10^-3 mm2/s, the malignant group （1.37 ± 0.75）× 10^-3 mm2/s, the normal group （0.36 ± 0.21）× 10^-3 mm^2/s. The ADCs of benign group were higher than that of malignant group（P〈0.01）. Conclusion： DWI could efficiently reflect the diffusion characterizations. The benign and malignant vertebral compression fractures could be reliably distinguished by comparing the ADC.