The left ascending lumbar vein: a potential pitfall in CT diagnosis

A communication between the left ascending lumbar vein and the left renal vein may be mistaken for a para-aortic mass on abdominal computed tomography due to a localised dilatation at the confluence of these veins. The use of contiguous closely collimated sections and the injection of intravenous contrast medium overcomes this potential pitfall which may be particularly important in the staging of patients with testicular neoplasms.     

CT对腰椎退行性变的诊断价值

目的探讨ＣＴ在诊断腰椎退行性变中的价值。方法回顾分析３００例腰椎退行性变的ＣＴ检查资料,找出其影像变化的特征。结果在３００例ＣＴ诊断为腰椎退行性变的病例中,表现为：（１）椎体骨质增生１９４例,占６４７％;（２）椎间盘膨出１１０例,占３６７％;（３）椎间盘突出９７例,占３２３％;（４）椎小关节病９７例,占３２３％;（５）椎间盘膨出和突出６１例,占２０３％;（６）退变性骨性椎管狭窄中央型２３例,占７７％;侧隐窝狭窄１９例,占６３％;（７）黄韧带肥厚１８例,占６０％;（８）退变性脊椎滑脱６例,占２０％;（９）真空现象５例,占１７％。结论ＣＴ检查不仅能明确腰椎退行性变的诊断,而且能为临床表现的解释和治疗提供更多的信息和依据。     

单纯腰椎峡部裂的CT诊断

目的分析单纯腰椎峡部裂的CT表现,提高对单纯腰椎峡部裂CT征象的认识,减少漏诊。方法回顾性分析81例单纯腰椎峡部裂在侧定位像、横断位图像、椎弓反角度扫描或多平面重组（MPR）的CT表现。结果腰椎侧定位显示峡部裂隙56．8％,有可疑征象的37．8％,有异常征象的共计94．6％。横断位图像“环裂征”显示率约25．6％,椎弓反角度扫描或多平面重组图像“环裂征”显示率为100％。峡部裂的各种间接征象中,上关节突前上方小骨块影显示率约占50．0％;轻度假性椎间盘膨出约占38．0％;病变椎体下位小关节或椎间盘有较其他节段明显的退行性变,分别占13．4％和9．8％;螺旋扫描横断位图像椎管变形及椎板增厚约占17．6％。结论常规椎间盘横断位图像峡部裂隙容易被遗漏或误认为椎小关节,注意观察侧定位像和横断位的间接征象,发现可疑征象时加做椎弓反角度扫描或多平面重组图像,可有效避免漏诊。     

Functional rehabilitation of lumbar spine injuries in the athlete

Athletic injuries to the lumbar spine are relatively common, depending upon the specific sport. With proper management, the majority of injuries resolve quickly and allow for rapid return to sport. However, some of these injuries occur because of improper mechanics that adversely affect the core stability of the spine, or conversely these injuries cause instability of the spine through disruption of the spinal support mechanisms. Development of an appropriate treatment plan depends on a thorough understanding of the structures providing core stability and the exercises to correct identifiable deficits. A comprehensive rehabilitation program should include correction of flexibility and strength deficits, with subsequent progression to functional and sports-specific exercises. The purpose of this paper is to review current concepts regarding core stability and rehabilitation in the athlete.     

Plain CT of the degenerative lumbar spine

Degenerative processes of the lumbar spine consist of several disorders of various etiologies with different radiological manifestations. Computed tomography (CT) is well suited for evaluation of these processes since contours of soft tissues, subtle bone structure changes and small calcifications are easily demonstrated with this technique. Spiral CT scanning provides fast data acquisitions, and volumes of high quality for multiplanar reformatting. This review article describes the CT scanning techniques and diagnostic findings of the most common degenerative processes of the lumbar spine.     

CT of the lumbar spine: normal variants and pitfalls

Benign variants in the appearance of the lumbar spine on CT may be confused with significant lesions. Here such benign processes and their distinguishing features are illustrated.     

CT appearance of unfused ossicles in the lumbar spine

The computed tomographic (CT) appearance of unfused ossicles in the lumbar spine has had little attention. Unfused ossicles result from accessory ossification centers near the tip of the vertebral processes. Their main importance lies in distinguishing them from fractures. The CT appearance of unfused ossicles in the lumbar spine was correlated with that of the corresponding surface anatomy from a cadaver specimen. Thereafter, 100 consecutive CT studies were reviewed and two cases of presumedly unfused ossicles were found. The CT appearance of unfused ossicles and their differential diagnosis is discussed.     

Traumatic lumbar hernia: CT diagnosis

A lumbar hernia usually involves protrusion of extraperitoneal fat or bowel through an area of weakness in the posterolateral abdominal wall bounded superiorly by the 12th rib, inferiorly by the iliac crest, posteriorly by the erector spinae muscle, and anteriorly by the posterior border of the external oblique muscle. Most are due to an acquired nontraumatic or congenital cause. Acute blunt abdominal trauma is a rare cause of lumbar hernia; to our knowledge, the CT diagnosis of this variety has not been reported. Since 1985, approximately 850 patients have undergone emergent abdominal CT for evaluation of acute abdominal trauma at our hospital; in seven of these patients, a traumatic lumbar hernia was diagnosed prospectively. In three patients, CT showed a flank hematoma with herniation of bowel through the lumbar triangle. CT showed pelvic fractures in three other patients, accompanied by herniation of bowel in one patient, herniation of extraperitoneal fat in another, and herniation of extraperitoneal fat and blood in the third. One patient had both a flank hematoma and a pelvic fracture with herniation of bowel. Acute traumatic lumbar hernia is a rare but significant abnormality that should be considered in patients with blunt abdominal trauma, especially in those with large flank hematomas and pelvic fractures. The hernia contents, associated injuries, and disrupted muscle layers are all well demonstrated on CT.     

腰椎小关节综合征的CT诊断及与X线平片的对比

目的 评价CT对腰椎小关节综合症的诊断价值。方法 回顾分析24例腰椎小关节综合症的CT表现并与X线对比分析。结果 CT对腰椎小关节综合症的检出率明显高于X线，且对伴随椎间盘膨出、突出，侧隐窝和椎管挟窄，黄韧带肥厚和钙化，关节囊真空征等可一次性检出。结论 CT可充分显示椎小关节解剖结构和病理改变，为小关节综合征的诊断提供可靠的影像学根据。     

Synovial cysts of the lumbar spine: CT and MRI correlations

Intraspinal synovial cysts were diagnosed in six patients during a 5-year period and retrospectively studied. Plain films of the lumbar spine showed degenerative changes in all patients. Lumbar myelography showed a posterior and lateral defect caused by extradural compression. Using CT without constrast enhancement established the diagnosis in five of the six-patients. in four cases MRI was performed, three before and after injection of gadolinium diethyline-triamine penta-acetic acid )Gd-DTPA). Including the patient with a false negative CT, MRI was positive in all patients.     

CT of the postoperative lumbar spine: the value of intravenous contrast

Summary Sixty-five patients with recurrent radicular complaints after operation for lumbar disc herniation underwent CT examination before and after intravenous contrast application (volume: 1.5–2.0 ml/kg body weight; flow rate: 0.35 ml/s). Postsurgical hypertrophic scar tissue showed definite contrast enhancement, whereas disc herniation remained unenhanced. Intravenous contrast application is recommended in patients previously operated upon for disc herniation.     

The prone position for CT of the lumbar spine

In scanning the L5-S1 disk space, the known technical difficulty is limitation of the gantry angle. A prone scanning technique used to examine the lumbar spine may help to overcome or lessen this problem. A prospective CT scanning of the L5-S1 level was performed in both the prone and supine positions on 25 patients who had low back pain and who had not undergone previous laminectomy or fusion. The angle between the S1 vertebral end plate and maximum tilted gantry line (15 degrees on the G.E. 8800) was measured in the supine position and compared with the same angle in the prone position. In 20 of 25 cases (80%), significant improvement in alignment was noted in the prone position. The prone scanning technique is also more desirable if CT is performed with metrizamide. Finally, printed images from the prone technique allow easier image-patient orientation for viewing in the operating room.     

Extraspinal abnormalities identified on lumbar spine CT

Summary Retrospective review of 1517 lumbar CT examinations revealed extraspinal pathology in 22 (1.45%). Retroperitoneal tumors and lymphadenopathy as well as vascular, urinary tract and gynecologic abnormalities were identified. This study demonstrates the need to carefully evaluate the visualized portions of the abdomen and pelvis on all lumbar spine CT examinations even when the patient's symptomatology is suggestive of spinal abnormalities.     

Opportunistic CT screening of osteoporosis on thoracic and lumbar spine: a meta-analysis

BackgroundOsteoporotic fractures are a major contributor to late life morbidity and mortality, and impose a substantial societal cost, yet osteoporosis remains substantially underdiagnosed and undertreated. The purpose of this meta-analysis was to assess the pooled diagnostic sensitivity and specificity of computed tomography (CT) images for diagnosing osteoporosis in patients who meet WHO dual X-ray absorptiometry (DXA) osteoporosis criteria using specific Hounsfield unit (HU) values as a threshold.MethodsSystematic literature searches in PubMed, Embase, Web of Science and Google Scholar were performed from the earliest available date through 1 July 2018, restricted to publications in English. Participants in all studies underwent CT scans that included the lumbar and/or thoracic spine for different indications and HU measurements were used to identify osteoporosis. DXA scans served as the reference standard.ResultsTen eligible studies were identified. The mean area under the hierarchical summary receiver operating characteristic (ROC) curve for diagnosis osteoporosis was 0.84 (95% CI: 0.81, 0.87). The pooled diagnostic sensitivity and specificity of CT images to identify osteoporosis were 0.83 (95% CI: 0.73, 0.90) and 0.74 (95% CI: 0.69, 0.79). The positive likelihood ratio (LR+), negative likelihood ratio (LR-), and diagnostic odds ratio were 3.4 (95% CI: 2.7, 4.5), 0.21 (95% CI: 0.12, 0.36), and 16.4 (95% CI: 7.8, 34.3), respectively. The bias-adjusted sensitivity and specificity of CT were 0.73 and 0.71. Meta-regression demonstrated that country of study, DXA criteria and scanner manufacturer were significant factors associated with the sensitivity of CT in detecting osteoporosis while scanner manufacturer was the only factor associated with specificity of CT.ConclusionsThis meta-analysis showed reasonable pooled sensitivity and specificity for using threshold values measured on CT scans to identify osteoporosis opportunistically.     

腰椎椎弓峡部裂的CT诊断价值

目的 :探讨CT对腰椎弓峡部裂的诊断价值。方法 :回顾性分析 48例腰椎弓峡部裂的CT表现。根据腰椎定位像 ,采用与椎间盘前后缘中点连线平行角度 ,扫描范围包括病变椎体的椎弓平面至下一椎体上缘 ,层厚、层距 5 .0mm ,必要时 2 .0mm ,骨窗和脊髓窗双窗位观察。结果 :48例均显示脊椎椎弓峡部层面关节突间部低密度裂隙 ,断面呈锯齿状 ,即“裂隙征”。裂隙周缘骨硬化和 /或出现碎骨片 ,呈现“假肥大小关节”。脊椎滑脱则呈现“假性椎间盘突出征”及”阶梯征”。结论 :椎弓峡部CT薄层扫描对于峡部裂的清晰显示率较X线平片高 ,具有重要的临床意义     

腰椎滑脱的CT诊断

X线平片易明确诊断腰椎滑脱,而CT能准确观察椎间盘和椎小关节等结构的改变及其对硬膜囊和神经根的影响。故腰椎滑脱的CT检查使诊断更加精确且具有非常重要的临床价值。现报告28例,并对其CT表现进行分析。1资料与方法28例中男20例,女8例;年龄42~76岁,平均55·2岁。按椎体移位的方向分为前滑脱和后滑脱两型。其中前滑脱22例,后滑脱6例。主要临床表现:腰痛28例,单侧或双侧下肢痛16例,麻木5例。直腿抬高试验阳性17例,髌/跟腱反射减弱或消失12例。所有病例均使用Toshiba TCT-300/EZ型CT机。患者仰卧位,在腰椎侧位定位像上确定扫描线,扫描线…     

Proper protocols key to CT of lumbar spine

MRI is clearly superior to CT in imaging the lumbar spine for evaluation of the postoperative back. The one area in which CT has been shown to be superior to MRI in the lumbar spine is in diagnosing spondylolysis. Pars defects can be very difficult to appreciate with MRI, yet are easily seen with CT. Other than spondylolysis, the postoperative spine, and bone marrow imaging, CT and MRI appear to be diagnostically equivalent.