胸腰椎骨折的影像学.ppt

Imaging of Thoracic and Lumbar Spine Fractures Fractures of the thoracic and lumbar spine are common in patients who have sustained high-energy spinal trauma, and are associated with injury to the spinal cord in up to 50% of cases .[1] Accurate early assessment is essential because delay in diagnosis may result in the development of neurologic complications. Clinical assessment of these patients is often challenging,and as a result,diagnostic imaging usually plays a central role in our management. The purpose of this slides is to explore this role by answering the following 4 questions: (1) What are the imaging options? (2) Who should be imaged? (3) How should they be imaged? (4) What are the imaging findings for the most common types of thoracolumbar fractures? 1. What are the imaging options? Radiography Radiography is typically the first modality used to evaluate the thoracolumbar spine after trauma. In the thoracic spine, anterposterior (AP) and lateral views are usuelly supplemented with a swimmer`s lateral view (y) In the lumbar region, AP and lateral views are typically sufficient. Computed Tomography The advent of computed tomography (CT) has revolutionized spine imaging. This technique allows for very rapid scanning and results in the acquisition of a continuous dataset that can be used to create extremely thin axial slices as well as exquisite reconstructed images in any plane. An additional advantage of this technique is that data from CT scan of the chest, abdomen,and pelvis obtained to evaluate for visceral injury can be uesd to simultaneously generate reconstructed images of the spine without the need for rescanning the patient. CT is clearly superior to radiographs for demonstrating fractures of the thoracolumbar spine with a sensitivity of 94%-100% compared with 33%-73% for radiographys. [2] CT is also more accurate than MRI for detecting factures Analysis of images in all 3 standard planes is necess