脊髓造影和CT扫描对椎间盘突出症的诊断评价

本文总结91例腰椎间盘突出症脊髓造影或/和CT扫描的诊断结果.单纯造影28例.手术符合串85%;单纯扫描29例,手术符合率89%;同时做造影和扫描34例,两项相符者的手术符合率100%.认为根据典型病史及体格检查,结合脊髓造影大部可确定诊断.对间盘突出合并椎管狭窄或造影出现多处压迹难以确诊的疑准病例,可采用CT扫描或造影后扫描.     

三维影像诊断腰椎间盘突出症

本文报道92例径脊髓造影后立即又行脊髓造影CT检查,即三维影像的检查方法诊断腰椎间盘突出症。其中53例为手术治疗,手术与三维影像诊断的符合率为96.2％。作者认为三维影像检查能以冠状、矢状及横切面上获得腰椎管疾患更多可靠信息,较单纯脊髓造影或单纯CT平扫检查的准确率更高。     

腰椎间盘突出症几种诊断方法的再评价

本文对经手术证实的268例腰椎间盘突出症的物理检查加X线平片、脊髓造影、CT扫描结果进行了对照分析。男197例,女71例。平均年龄51岁。发病时间平均6年8个月。物理诊断加X线平片与手术探查的符合率为87.3％,脊髓造影为97.2％,CT为70.1％。作者认为腰椎间盘突出症的术前诊断根据典型症状,体征进行诊断是目前一种主要手段,脊髓造影最可靠,CT扫描不宜首选或作常规检查,更不能单凭CT所见而进行手术。     

动态脊髓造影诊断腰椎间盘突出症

目的：探讨动态脊髓造影对于腰椎间盘突出症的诊断价值。方法：对186例腰椎间盘突出症患者进行脊髓造影，动态观察，拍摄不同体位的X线片。186例均经CT检查，110例经CTM检查，106例经手术治疗。结果：186例中213个椎间隙诊断为腰椎间盘突出，96个椎间隙诊断为腰椎间盘膨出，动念脊髓造影检查结果与手术诊断符合率为93．62％，CT检查结果与手术诊断符合率为86．74％，CTM检查结果与手术诊断符合率为96．88％。结论：动态脊髓造影检查克服了传统脊髓造影、CT、MRI检查静态观察的缺陷，降低了假阳性率和假阴性率，对L5／S1间盘突出诊断效果更为明显，并可鉴别诊断腰椎问盘突出和膨出。     

脊髓造影动态观察对腰椎间盘突出症的定位诊断

对423例患者进行脊髓造影，采用连续动态观察和拍摄不同体位的X线片，413例诊断为腰椎间盘突出症，406例接受手术治疗。其中164例同时接受CT检查，将脊髓造影和CT诊断与手术所见比较，结果：动态脊髓造影检查诊断腰椎间盘突出症的假阳性率为2．58％，假阴性为2．58％，与手术结果符合率为92．5％；CT扫描的诊断与手术结果符合率为81．4％。脊髓造影站立位观察腰间盘突出造成的压迹更为明显，腰仰伸位可以使L3~4、L4~5、及部分L5~S1的腰间盘突出平面的压迹更明显，L5~S1间隙的间盘突出在腰仰伸位显示率占65％，而屈腰位显示率为35％。     

腰椎间盘突出症的定位诊断及影像学对比研究

方法：回顾性分析３８０例腰椎间盘突出症术前临床定位诊断、术前脊髓造影、ＣＴ扫描和ＭＲＩ成像等四组术前诊断的手术诊断符合率，探讨临床定位诊断和三种影像学诊断在腰椎间盘突出诊断中的价值。结果：经Ｘ检验，三种影像检查对单纯间盘突出诊断的手术符合率与临床定位诊断的手术符合率有非常显著差别。对于间盘突出合并侧隐窝狭窄的手术诊断符合率分别是ＣＴ９２１％，ＭＲＩ２８６％，脊髓造影２６３％。结论：在定位诊断中要明确是否合并侧隐窝狭窄，高分辩率的ＣＴ扫描应列为首选检查方法。     

脊髓造影在腰椎管疾病诊断中的应用

目的探讨脊髓造影存腰椎管疾病诊断中的应用价值。方法通过32例手术证实脊髓造影诊断符合率及与CT、MRI影像比较。结果55例造影阳性49例，手术32例中与造影诊断完全符合27例，占84．4％。结论对临床症状、体征疑似腰椎管病变，而CT、MRI显示不明显或影像与体征不符者，可选用脊髓造影进一步明确诊断，以减少手术探查的盲目性，获得最好的治疗效果。     

腰椎间盘突出症三种诊断方法的比较

腰椎间盘突出症是腰腿痛常见原因,我科从脊髓造影,CT扫描和肌电图三个方面对1990年10月～1997年7月入院,诊断为腰椎间盘突出症并接受手术治疗的42例患者作了总结。诊断符合率分别为82％,83％和80％。 临床资料 本组42例患者,男性29例,女性13例,年龄最小26岁,最大63岁,病程最短3周,最长30年,根据病史,临床表现,均诊断为腰椎间盘突出症,进行手术治疗。术前行脊髓造影40例,CT检查41例,肌电图检查20例。     

临床、椎管造影及CT检查对腰椎间盘突出症诊断的比较分析

本文对我院1988.1～1991.12期间,经临床检查诊断,椎管造影检查和CT扫描检查诊断,并经过手术证实的272例腰椎间盘突出症作以比较性分析。272例中,临床诊断99例,椎管造影诊断118例次,CT扫描诊断68例次,(其中13例同时行椎管造及CT扫描检查)共285例次,经手术证实,手术符合率为:临床组90.9％,造影组92.9％,CT组94.1％。L_(4～5)及L_5～S_1部位的定位符合率分别为75.7％和75％;96％和82.9％;94.8％和94.2％。讨论了三种诊断方法的优缺点,强调临床综合检查诊断的重要性及椎管造影和CT检查的重要价值、强调三种诊断方法的互补作用,特别对双间隙突出者应引起临床医师的重视,以避免遗漏。     

CTM诊断腰椎间盘突出症

方法：报告了３６例临床诊断为腰突症患者，均先行脊髓造影后又行ＣＴＭ检查。结果：经手术证实，脊髓造影诊断符合率为８７５％，ＣＴＭ诊断符合率为９６９％。结论：故ＣＴＭ检查诊断准确率较脊髓造影高，且ＣＴＭ对于腰椎间盘膨出或小关节突肥大合并侧隐窝狭窄也有较高的诊断价值。     

脊髓造影与CTM联合应用诊断腰椎间盘突出症46例报告

本文报告手术证实的46例腰椎间盘突出症术前经正位、侧位的中立、过伸、过屈位脊髓造影符合率为87%,CTM的符合率为97.7%,而两者联合应用则诊断准确率可提高到100%.     

骶部硬膜外囊肿的临床影像学表现与外科治疗(18例报告及文献综述)

[目的]结合文献探讨骶部硬膜外囊肿（SEC）的临床表现、影像学特点与外科治疗，以便提高对该病的临床诊断和治疗水平。[方法]本组18例，其中腰骶部钝痛17例（95％）、下肢放射性疼痛和间歇性跛行16例（90％）、神经功能损害14例（77％）、盆腔或下腹部无痛渐进性肿块并压迫临近器官2例（11％）。18例均行腰骶部及骨盆X线片检查，其中17例行CT扫描、11例行MRI检查、7例行脊髓造影、4例行CTM扫描。[结果]本病临床误诊率为78％，X线诊断率17％，CT诊断率72％；MRI检查、脊髓造影、CTM扫描诊断率100％。18例均手术切除，病理报告为硬膜外囊肿，椎管内型、积液型、单发囊肿为多数；随访15～32个月，平均24个月，未发现症状加重和复发病例。[结论]骶部硬膜外囊肿临床与影像学具有特征性表现；微创术和腹腔镜、脊髓或椎管镜摘除骶椎管内囊肿的临床应用疗效有待于定论；显微外科技术的应用提高了SEC全切除率，手术是治疗和防止本病复发的最主要和最可靠方法。     

医学影像检查方法的选择在诊断椎管内肿瘤中的意义

目的：医学影像检查方法的选择及其结果的评价对早期诊断椎管内肿瘤十分重要。本文就医学影像检查在诊断椎管内肿瘤中的作用提出讨论,试图寻找一个较为合理的选择方案。方法：将７３例经手术治疗,病理证实的原发性椎管内肿瘤的临床资料、医学影像检查结果进行分析。结果：椎管造影,ＣＴＭ,ＭＲＩ确诊率高,Ｘ线平片和ＣＴ则较低。结论：Ｘ线平片作为一般性鉴别诊断是必要的,在神经系统定位体征不明显时首选椎管造影,否则选用ＭＲＩ,ＣＴ作为首选方法应慎重。结果的评价应结合临床,不应唯影像学为是。     

Diagnosis of lumbar arachnoiditis by magnetic resonance imaging

Twenty-four cases of lumbar arachnoiditis were evaluated by magnetic resonance (MR) imaging. The morphologic changes of arachnoiditis by MR were compared in 20 cases with CT myelography (CTM) and plain film myelography (PFM). An abnormal configuration of nerve roots was seen by MR. Three anatomic groups were identified. Group 1 showed conglomerations of adherent nerve roots residing centrally within the thecal sac. Group 2 demonstrated nerve roots adherent peripherally to the meninges, giving rise to an "empty sac" appearance. Group 3 showed a soft tissue mass replacing the subarachnoid space. Magnetic resonance imaging resulted in accurate diagnosis, and had excellent correlation with CT myelography and plain film myelographic findings in the diagnosis of lumbar arachnoiditis.     

Usefulness of MRI in the preoperative diagnosis of cervical disk herniation

Summary We investigated the preoperative diagnostic value of MRI, myelography, and CT myelography (CTM) in a retrospective analysis of 17 patients (15 men and two women) who were surgically treated for cervical disk herniation. Their ages ranged from 29 to 63 years, with a mean of 49 years. Anterior interbody fusion using iliac bone grafts was performed following microscopic diskectomy in all patients. MRI, myelography, and CTM were performed in 13 patients, while four patients were operated on after MRI alone. Neurological improvement was observed in all 17 patients after the surgery. MRI proved useful for determining the level of symptomatic cervical disk herniation. Surgery can be carried out on the basis of MRI findings alone when there is disk herniation at a single level which corresponds with the patient's symptoms and signs.     

腰骶神经根管非骨性段狭窄的动态影像学与临床研究

对临床具腰腿痛并脊髓造影显示单或双侧腰骶神经根影中断者，做了椎管斜位伸屈造影（３５例）和动态ＣＴＭ扫描（１３例），观察了根影动态变化。其中１７例术中加用伸屈腰椎拱桥探查了椎管前外侧角与神经根间关系。上述研究结果结合临床症状、体征发现：Ｌ５、Ｓ１神经根受椎管非骨性段挤压机会显著高于Ｌ４神经根。分析认为：常遇的腰骶神经根中断多发生在非骨性段的椎管前外侧角，椎间盘与黄韧带退变是神经根受压的主要病理因素，症状可随体位变动减轻或加重。斜位椎管造影和动态ＣＴＭ对判断不同狭窄节段与指导手术有重要参考价值。     

Metrizamide-enhanced computed tomography as an adjunct to metrizamide myelography in the evaluation of lumbar disc herniation and spondylosis

Eighty patients with operatively proven lumbar disc herniation or lumbar spondylosis were preoperatively evaluated with metrizamide myelography followed by metrizamide-enhanced computed tomography (CT). The x-ray films were reviewed without knowledge of the operative findings, and the patients were subdivided into those with disc extrusions, spondylosis, or recurrent abnormalities. For the group as a whole, CT was correct in 82% and myelography was correct in 77%. Both CT and myelography together were accurate in 91%, a significant improvement (P less than 0.02). The authors conclude that, if both studies are performed, the percentage of cases correctly diagnosed is increased. Therefore, both metrizamide myelography and metrizamide-enhanced CT should be obtained in selected cases. A review of the literature is included.     

A comparison of CT scanning and myelography in the diagnosis of lumbar disc herniation

Computerized tomographic (CT) scanning of the fourth and fifth lumbar disc spaces with the GE CT/T8800 scanner followed by metrizamide myelography was obtained for 134 consecutive patients with suspected lumbar disc disease. There was an overall concordance rate of 85% between CT scanning and myelography. In those 52 patients treated by surgery, concordance between the CT and the myelogram was similar at 86.5%. Myelography and surgical findings were in agreement in 94.2% of cases, while CT findings and surgical finding agreed in 92.3% of cases. The authors' data indicate that the CT scan is as accurate as myelography in the diagnosis of lumbar disc disease. When the CT scan interpretation is supported by clinical findings, the myelogram may be eliminated in the preoperative patient. Myelography may be reserved for equivocal cases.     

骶部硬膜外囊肿的诊断

目的 探讨骶部硬膜外囊肿诊断中临床表现和CT、MRI、腰椎管造影检查的价值。方法 对13例经手术证实为骶部硬膜外囊肿患者的术前病史、体检及CT、MRI、腰椎管造影检查作回顾性分析。结果 腰腿痛与体位变化有关系，在诊断中具有重要意义，阳性率CT为53．8％，MRI为75％，腰椎管造影为84．6％。结论 在骶部硬膜外囊肿诊断中，应重视腰腿痛与体位变化的关系，强调腰椎管造影时站立延迟透视的重要性。CT、MRI及腰椎管造影检查不能互相替代。