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(rèn)識(shí)偶發(fā)病變對(duì)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(jìn)行額外檢查0.8%進(jìn)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(gè)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(dòng)脈瘤，直徑均大于4cm,,認(rèn)為腰椎掃描時(shí)，如果患者年齡大于55歲，出現(xiàn)后背疼痛，應(yīng)推薦大FOV進(jìn)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(xiàng)對(duì)2500例腰椎MRI 進(jìn)行回顧性分析，183個(gè)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(gè)對(duì)300例患者進(jìn)行的腰椎MRI檢查，發(fā)現(xiàn)25個(gè)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(píng)估頸動(dòng)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(hào)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(jìn)行臨床進(jìn)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(jìn)行附

12、件結(jié)構(gòu)觀察,,Hepatic lesionsRenal lesionsPelvisUterusAortaLymph nodes,,冠狀位可對(duì)椎旁結(jié)構(gòu)進(jìn)行總體評(píng)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(hào)不均勻良惡性病變鑒別需進(jìn)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(duì)椎旁結(jié)構(gòu)進(jìn)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(hào)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(dòng)脈瘤胸主動(dòng)脈瘤,M/85 后背疼,,Lymph nodes

14、主動(dòng)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(bào)告這些病變,,一個(gè)系統(tǒng)的脊柱MRI 應(yīng)包括除對(duì)脊柱本身病變的觀察同時(shí)應(yīng)發(fā)現(xiàn)尤其對(duì)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(jìn)行腰椎CT檢查時(shí)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(jí)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(jìn)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(jìn)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(shí)性腎臟腫塊、腹主動(dòng)脈瘤,,隨訪對(duì)脊柱外C-RADS E3 and E4病變進(jìn)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(gè)病變3例患者有3個(gè)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(dòng)脈擴(kuò)張?jiān)?.6-2.9cm之間也進(jìn)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(jìn)行進(jìn)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(dòng)脈瘤