脊柱ct和mri檢查偶然發(fā)現(xiàn)的病變

1、脊柱CT和MRI檢查偶然發(fā)現(xiàn)的病變,偶發(fā)病變？,與主訴無明顯關(guān)系的病變,發(fā)現(xiàn)偶發(fā)病變重要性何在？,影響臨床決策影響患者預(yù)后,認識偶發(fā)病變對影像科醫(yī)生很重要！,18,860 lawsuits demonstrated that 47% of the radiology lawsuits related to missed diagnosesBerlin L, Berlin JW. Malpractice and radiolog

2、ists in Cook County, IL: trends in 20 years of litigation. AJR Am J Roentgenol 1995;165:781e8,同行的關(guān)注,Lung cancer detected at cardiac CT: prevalence, clinicoradiologic features, and importance of full–field-of-view images

3、. Radiology 2010;255(2):369–376.Unsuspected extracolonic findings at screening CT colonography: clinical and economic impact. Radiology 2008;249(1):151–159.Extracolonic abnormalities discovered incidentally at CT colon

4、ography in a male population. Radiology 2005;236(2):519–526.,,Extracardiac findings on coronary CT angiograms: limited versus complete image review. AJR Am J Roentgenol 2010;195(1):143–148.Incidental findings on cardiac

5、 imaging. AJR Am J Roentgenol 2008;191(3):882–884.Incidental findings found in “healthy” volunteers during imaging performed for research: current legal and ethical implications. Br J Radiol 2010;83(990):456–465.,,3488例

6、CT檢查40%患者偶然發(fā)現(xiàn)病變14%進行額外檢查0.8%進行積極治療,Xiong T, Richardson M, Woodroffe R, et al. Incidental lesions found on CT colonography: their nature and frequency. Br J Radiol 2005;78:22e9,脊柱偶發(fā)病變？,除脊柱和椎管內(nèi)病變以外的病變,,一個回顧性研究分析100例腰椎CT

7、（平均年齡68歲）均以后背疼痛來診3例發(fā)現(xiàn)腹主動脈瘤，直徑均大于4cm,,認為腰椎掃描時，如果患者年齡大于55歲，出現(xiàn)后背疼痛，應(yīng)推薦大FOV進行腰椎掃描Gouliamos AD, Tsiganis T, Dimakakos P, et al. Screening forabdominal aortic aneurysms during routine lumbar CT scan:modification of the

8、 standard technique. Clin Imaging 2004;28:353e5.,,一項對2500例腰椎MRI 進行回顧性分析，183個患者發(fā)現(xiàn)202例偶發(fā)病變病變主要位于腎臟、肝臟、子宮、腎上腺和淋巴結(jié)5例為惡性病變，1例轉(zhuǎn)移瘤,Wagner SC, Morrison WB, Carrino JA, et al. Picture archiving and communication system: effect

9、 on reporting of incidental findings. Radiology 2002;225:500e5.,,一個對300例患者進行的腰椎MRI檢查，發(fā)現(xiàn)25個偶發(fā)病變Green L. PACS: effect on incidental findings. Radiol Manage 2004;26:26e9,MRI檢查可能發(fā)現(xiàn)的偶發(fā)病變,椎旁軟組織結(jié)構(gòu)FOV 范圍內(nèi)器官結(jié)構(gòu),頸椎MRI需額外觀察？,有

10、無腫大淋巴結(jié)、腫塊腮腺或甲狀腺病變鼻咽部有無異常,,矢狀位：顱內(nèi)情況、有無扁桃體下疝旁正中矢狀位：評估頸動脈情況，尤其創(chuàng)傷患者應(yīng)觀察有無栓子,,Thyroid lesions不論良性或惡性在T2WI 信號均不均勻MRI 很難鑒別良惡性偶發(fā)的甲狀腺孤立結(jié)節(jié)需進行臨床進一步檢查、如超聲、穿刺活檢、核醫(yī)學(xué)顯像,胸椎觀察？,胸椎胸壁胸腔肺：SPN（Solitary pulmonary nodule）縱膈結(jié)構(gòu)推薦：軸位,

11、Figure 3 A 69-year-old male smoker presented withabnormalities of gait. Cervicothoracic MRI revealeda solitary pulmonary nodule in the right lung. This wasfurther investigated with CT,腰椎觀察？,腹膜后、腹腔、盆腔器官腹壁結(jié)構(gòu)應(yīng)結(jié)合矢狀位進行附

12、件結(jié)構(gòu)觀察,,Hepatic lesionsRenal lesionsPelvisUterusAortaLymph nodes,,冠狀位可對椎旁結(jié)構(gòu)進行總體評估可確定在其它序列發(fā)現(xiàn)的異常,,Hepatic lesions肝囊腫需與血管瘤鑒別出血囊腫信號不均勻良惡性病變鑒別需進一步檢查,,Renal lesions腎囊腫最常見注意囊性腎癌約5-10%腎癌呈囊性病變,如果脊柱MRI表現(xiàn)不能解釋患者臨床癥狀

13、 應(yīng)對椎旁結(jié)構(gòu)進行觀察,,Pelvis盆腔器官盆壁結(jié)構(gòu),F/64 后背疼伴左下肢放射性疼痛,,Uterus正常子宮內(nèi)膜在T2WI呈高信號增生表現(xiàn)為子宮內(nèi)膜彌漫增厚絕經(jīng)后婦女如果內(nèi)膜厚度大于4mm，異常,,子宮肌瘤那氏囊腫,F/65后背疼,,Ovarian lesions卵巢囊腫子宮內(nèi)膜異位卵巢腫瘤,,Aorta腹主動脈瘤胸主動脈瘤,M/85 后背疼,,Lymph nodes

14、主動脈旁腫大淋巴結(jié),小結(jié),脊柱的偶發(fā)病變在MRI常見的可能比脊柱本身的病變更重要放射科醫(yī)生任務(wù)在于發(fā)現(xiàn)、定性、報告這些病變,,一個系統(tǒng)的脊柱MRI 應(yīng)包括除對脊柱本身病變的觀察同時應(yīng)發(fā)現(xiàn)尤其對臨床有意義的偶發(fā)病變,脊柱CT偶然發(fā)現(xiàn)的病變,Extraspinal Findings at Lumbar Spine CT Examinations: Prevalence and Clinical Importance2012 m

15、arch Radiology,,Purpose 回顧性分析400例門診患者進行腰椎CT檢查時發(fā)現(xiàn)的脊柱外病變的情況,,Materials and Methods:年齡：平均49歲212例男性188例女性主要臨床癥狀腰痛、根性疼痛,,排除已知罹患惡性腫瘤患者觀察原始圖像以最大FOV重建FOV :16CM層厚和層間距：2.5mm、1.5mm,,病變分級系統(tǒng)Colonography Reporting and Data

16、System (C-RADS）Zalis ME, Barish MA, Choi JR, et al. CT colonography reporting and data system: a consensus proposal. Radiology 2005;236(1):3–9.,,C-RADS E1 ：正常解剖變異C-RADS E2 ：無明顯臨床意義病變，無需進一步處理的病變，如腎臟單純囊腫、憩室,,C-RADS E

17、3 ：不典型病變，可能是良性的，需進行臨床隨診或處理的病變，如復(fù)雜腎囊腫C-RADS E4 ：有重要臨床意義的病變，需臨床處理的病變，如實性腎臟腫塊、腹主動脈瘤,,隨訪對脊柱外C-RADS E3 and E4病變進行 24–36 months,,Results400例患者中其中162例(40.5%)發(fā)現(xiàn)脊柱外的病變160例中其中127例(79.4%)采用最大FOV清楚顯示脊柱外病變33例患者發(fā)現(xiàn)2個病變3例患者有3個病

18、變病變總數(shù): 201,,C-RADS E1 ：2例分別左側(cè)下腔靜脈、雙集合系統(tǒng),TABLE1summarizes the data in 160 patients with C-RADS E2, E3, or E4 extraspinal findings.,,C-RADS E2 :最多，101例以憩室和腎臟單純囊腫為主,Classification of All C-RADS E2 (Benign) Extraspinal

19、Findings according to Organ System and Frequency,,C-RADS E3：42例其中1例患者發(fā)現(xiàn)2處E3病變最常見的病變?yōu)槟I臟病變腹主動脈擴張在2.6-2.9cm之間也進行隨診,,42例C-RADS E3患者中39 例(92.9%)中以前不知曉其中14例患者進行進一步檢查包括CT（7） MR（1） US（14）檢查，,,C-RADS E4： 17 (4.3%)最常見為腹主動脈瘤