常规脊椎CT及MR检查椎体骨折漏诊原因分析

发布时间：2018-01-21 00:05

本文关键词： 骨质疏松椎体骨折脊椎CT 脊椎MR　出处：《北京协和医学院》2017年硕士论文　论文类型：学位论文

【摘要】：目的分析常规胸腰椎CT和MR椎体骨折诊断的漏诊情况,以提高放射科医生及临床医生对骨折漏诊的及规范的骨质疏松骨折治疗的重视。资料和方法分别回顾分析住院治疗的年龄大于45岁且临床主诉及分别申请CT及MR检查的原因均与骨质疏松症、肿瘤和骨折无关的808例(男性329例,女性479例)脊椎CT矢状重建图像及相应报告及1040例(男性:473例,女性:567例)脊椎MR矢状位图像及相应报告。依据Genant' s半定量(semiquantitative)法进行椎体形态评估和骨折及骨折分度判定,分别记录诸患者椎体压缩性骨折发生部位及程度,并将评估结果与其既往CT报告、MR报告、DXA检查结果、出院有关骨质疏松症的诊断和治疗信息分别进行比较分析。结果分析808例椎体CT矢状重建图像,共计发生椎体骨164例,其中单发椎体骨折106例/个(64.6%)。CT影像报告已诊断压缩骨折者75例,CT影像报告未诊断椎体骨折89例(54.27%)。漏诊椎体个数115个,其中Ⅰ度椎体压缩骨折未报告椎体个数108个。所有报告均未判定椎体骨质疏松性骨折程度。在放射科诊断并报告的75例中,行DXA检查者仅有16例,出院时明确骨质疏松症诊断者6例,出院予骨质疏松药物者仅21例。分析1040例MR矢状位图像中,共有265例(25.48%)发生椎体骨折,其中单发椎体骨折161例(60.75%)。MR报告明确诊断椎体骨折者仅89例(33.58%),未诊断椎体骨折176例(66.42%),漏诊骨折椎体个数247个,其中轻度压缩骨折224个(90.69%),中度压缩骨折20个(8.10%)。在MR报告椎体骨折者的89例中,28例椎体骨折同时伴随骨髓水肿的发生,放射科明确报告椎体骨髓水肿的仅14例(14/28,50%)。所有报告均未判定椎体骨质疏松性骨折程度。另外,诊断椎体骨折的89例中,仅20例(22.47%)进行了 DXA检查。49例(55.06%)在出院诊断中诊断了骨质疏松性骨折。仅28例(31.46%)对骨质疏松性骨折进行了临床的药物治疗或干预。结论骨质疏松性骨折在椎体CT矢状重建影像及MR矢状位图像上较易忽视,尤其是轻度椎体骨折。另外,对于放射科已报告的椎体骨折,临床干预及治疗也尚有不完善之处。因此,放射科医生和相关临床医生应对椎体形态的判定足够重视,相信有助于临床医师对骨质疏松症的防治的方案制定。
[Abstract]:Objective to analyze the missed diagnosis of conventional thoracolumbar vertebral fractures by CT and Mr. In order to increase the attention of radiologists and clinicians to the treatment of osteoporotic fractures with missed diagnosis and standard treatment, the data and methods the data and methods the data and methods of the hospitalized patients over 45 years old and clinical complaint and CT application were analyzed retrospectively. And the causes of Mr examination were correlated with osteoporosis. There were 808 cases (male 329, female 479) which had nothing to do with tumor and fracture. Sagittal reconstruction and corresponding report of vertebral CT were performed in 1040 cases (male: 473). Spinal MRI sagittal image and corresponding report. According to Genant's semi-quantitative semiquantitative method. Method to evaluate the shape of vertebral body and to judge fracture and fracture grading. The location and extent of vertebral compression fracture were recorded, and the results were compared with the previous CT reports and DXA findings. Results the sagittal reconstruction images of 808 cases of vertebral body CT were analyzed, 164 cases of vertebral body bone occurred. Among the 106 cases of single vertebral body fracture, 75 cases were diagnosed by CT imaging. Ct images showed that 89 cases of vertebral fracture were not diagnosed and 115 cases were missed. The number of vertebral body was not reported in 108 cases of first degree vertebral compression fracture. All the reports did not determine the extent of osteoporotic fracture of vertebral body. In 75 cases diagnosed and reported by radiology, only 16 cases were examined by DXA. 6 cases were diagnosed as osteoporosis at discharge, only 21 cases were treated with osteoporosis drugs. Among 1040 cases of sagittal Mr images, 265 cases (25. 48%) had vertebral fracture. Among the 161 cases with single vertebral body fracture, only 89 cases (33.58%) were diagnosed by Mr report, and 176 cases (66.42%) were not diagnosed. The number of missed fractures was 247, including 224 cases with mild compression fractures (90.69%) and 20 cases with moderate compression fractures (8.10%). 28 cases of vertebral body fracture accompanied by bone marrow edema, radiologists clearly reported vertebral bone marrow edema in only 14 cases of 14 / 28. All the reports did not determine the extent of osteoporotic fracture of vertebral body. In addition, 89 cases of vertebral fracture were diagnosed. Only 20 cases (22. 47) were examined by DXA. 49 cases (55.06) were diagnosed in the diagnosis of osteoporotic fracture. Only 28 cases (31. 46%). Conclusion Osteoporosis fracture is easy to be ignored in sagittal reconstruction of vertebral body and Mr sagittal image. In addition, the clinical intervention and treatment of vertebral fracture reported by radiology department is not perfect. Radiologists and related clinicians should pay enough attention to the determination of vertebral body morphology, which is helpful for clinicians to make plans for the prevention and treatment of osteoporosis.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R683;R816.8;R445.2

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