多层螺旋CT重组技术对腰椎峡部裂的诊断价值研究

目的：分析多层螺旋CT（MSCT）容积扫描后的横断面及重组图像,并与传统X线片及常规CT椎间盘扫描图像比较,以探讨其能否提高对腰椎峡部裂的诊断准确率。方法：采用单盲法回顾性分析自2003年1月至2009年12月经手术证实的腰椎峡部裂患者156例,其中男91例,女65例;年龄16～73岁,平均32.7岁;病程3个月～10年,平均2.6年。将患者的影像资料按X线片、常规椎间盘CT扫描、MSCT容积扫描进行归类,其中X线片127份,常规椎间盘CT扫描图像79份,MSCT容积扫描并重组图像156份。由3位高年资医师在不知术后诊断结果的情况下共同对3种影像资料分别进行分析、诊断,最终将诊断结果与手术诊断结果比较,分别得出3种影像检查各自对腰椎峡部裂的诊断准确率。应用多样本率的卡方检验验证其差异是否有统计学意义。结果：以影像片中直接显示腰椎峡部骨不连接为诊断标准,127份X线片中,能准确诊断为腰椎峡部裂的有201处,与手术结果比较,有64处未检出,其对腰椎峡部裂的诊断准确率为75.8%。79份常规椎间盘CT扫描图像中,共检出腰椎峡部裂105处,与手术结果比较,有55处未检出,其对腰椎峡部裂的诊断准确率为65.6%。156份MSCT容积扫描后重组图像共明确诊断腰椎峡部裂324处,与手术结果完全吻合,其对腰椎峡部裂的诊断准确率为100.0%。3种影像检查各自对腰椎峡部裂的诊断准确率之间的差异有统计学意义（χ2=115.66,P〈0.005）。MSCT容积扫描后的重组图像对腰椎峡部裂的诊断准确率最高。结论：通过MSCT容积扫描并运用重组技术能获得丰富的影像信息。重组图像能清晰、立体、直观地显示椎弓峡部裂的影像特征,极大地提高了对腰椎弓峡部裂的诊断准确率。

The value of MSCT reformation techniques in the diagnosis of lumbar spondylolisthesis

Objective：To analyze cross section and custom-crafted image by MSCT volumetric scanning and compare with traditional X-ray and CT sanning,so as to confirm MSCT whether can improve diagnosis of lumbar spondylolisthesis（LS）. Methods：Form Jan.2003 to Oct.2009,156 patients with lumbar spondylolisthesis who had ever been in our hospital,the data of patients were retrospectively analyzed with the single blind trial. In all of the 156 cases,there were 91 males and 65 females with an average age of 32.7 years（ranged 16 to 73 years）;the course of disease ranged from 3 months to 10 years with an average of 2.6 years. The image data were classified according to X-ray,CT and MSCT volumetric scanning,among photographs,there were 127 X-rays,79 CT scanning and 156 MSCT volumetric scanning. All photographs were analyzed by three senior doctors respectively in unknown postoperative result and compared with the intraoperative findings and calculated the accuracy of the diagnosis each other. Chi-square test was performed for statistical analysis. Results：According to the diagnostic criteria that the nonunion at the lumbar arch isthmus can be demonstrated,201 sites of LS were detected in 127 X-rays,compared with the intraoperative findings,64 sites of LS were overlooked;105 sites of LS were detected in CT scanning and 55 sites of LS were overlooked. The accreted rate of diagnosis was respectively 75.8%,65.6% in X-ray and CT. All LS were explicitly diagnosed before operation by MSCT volumetric scanning. There was significant difference among the three kind of photographs for the diagnosis of LS（χ2=115.66,P0.005）. Conclusion：With the MSCT volumetric scanning,enormous image information can be obtained. LS can be displayed clearly and stereoscopically in the post-processing images such as multiplanar reconstruction （MPR） and volume rendering （VR）,and the accuracy of diagnosis can be increased greatly.