腰椎峡部裂并脊椎滑脱的MRI表现及影像学比较

目的 :探讨MRI在腰椎峡部裂并脊椎滑脱症中的诊断价值。方法 :分析总结 5 3例腰椎峡部裂并脊椎滑脱症的传统X线片、CT、MR扫描表现并进行比较。结果 :传统X线平片表现为腰椎滑脱、峡部裂、局部骨质增生硬化 ;CT表现为峡部裂、局部骨质增生硬化、韧带肥厚、椎管狭窄及矢状径增大 (双管征 )、椎间盘变形 ;MRI表现为峡部骨髓信号连续性中断、局部骨质呈T1、T2 低信号、韧带肥厚、腰椎滑脱、椎间孔变形 (双叶征 )、神经根卡压、节段性椎管扩张和狭窄。结论 :MR扫描对腰椎峡部裂并脊椎滑脱症的诊断具有重要的临床应用价值     

腰椎峡部裂的CT扫描技术及其诊断探讨

目的：探讨椎弓峡部CT扫描的最佳方法，正确认识腰椎峡部裂的CT表现、诊断价值。方法：将45例X线诊断椎弓峡部裂患者随机分成三组，分别用不同的方法进行CT扫描，将扫描结果进行对比、分析。结果：45例峡部裂中L32例，L418例，L5 25例。双侧裂44例，单侧裂1例。四表现有：裂隙征，假性椎间盘膨出，双关节征．双边征，椎管冗长征，椎管、侧隐窝及椎间孔狭窄。以椎弓的平行线为CF扫描基线组显示椎弓最完整，最直观。结论：应以椎弓的平行线为椎弓CT扫描基线，“裂隙征”是椎弓峡部裂的特征表现，且CT也是检查腰椎峡部裂的首选方法。     

腰椎峡部裂CT诊断:MSCT后处理重组技术的优势

目的:探讨MSCT多平面重组(MPR)和容积再现(VR)技术在诊断腰椎峡部裂中的临床应用价值。方法:搜集42例行腰椎MSCT容积扫描并经后处理重组检出的腰椎峡部裂患者的病例资料,分析MPR、VR成像对峡部裂及其继发病变的显示情况,并与常规椎弓横轴面CT图像进行对照。结果:MPR冠状面、经椎弓矢状面重组结合VR成像,能清晰显示42例84处峡部裂;常规椎弓CT横轴面图像仅检出28例58处峡部裂,漏诊14例,漏诊率33.3%(14/42)。与常规椎弓横轴面CT图像比较,MPR结合VR图像重组在显示峡部裂特征以及裂隙骨赘、椎间孔狭窄、椎体滑脱、椎间盘后突等继发病变征象方面,二组数据差异有显著性意义(P<0.05)。结论:MSCT容积扫描和MPR、VR重组对峡部裂及其继发病变具有良好的显示能力,是检出腰椎峡部裂及其继发病变的理想成像方法。     

CT薄层扫描对腰椎峡部裂的诊断价值分析

目的探讨CT薄层扫描对腰椎峡部裂的诊断价值。方法选取我院2016年7月至2018年12月22例腰椎峡部裂确诊患者的临床资料进行回顾性分析,所有患者均接受CT薄层扫描,对扫描结果做出总结。结果 22例患者共有38处在薄层重建图像上,可见椎弓峡部无连续完整骨结构的"裂隙征"等特征性CT表现,部分患者峡部骨痂增生表现明显,椎弓峡部断裂、错位,部分患者断端形成假关节等。结论证实CT薄层扫描对腰椎峡部裂具有明显诊断价值,可为临床提供诊治依据。     

MSCT多平面重组在腰椎峡部裂诊断中的应用

腰椎峡部裂是指椎弓根峡部骨质断裂,是引起腰腿痛的原因之一,此部位解剖结构特殊,常规X线若拍片角度不当难以如实反映病变,而常规CT扫描又容易漏诊。我院使用MSCT多平面重组（multiplanereformation,MPR）技术诊断腰椎峡部裂,以探讨该技术在诊断腰椎峡部裂中的临床应用价值。     

腰椎峡部裂MSCT双倾斜重建技术的诊断价值

目的:研究MSCT双倾斜重建技术在腰椎峡部裂诊断中的方法与价值。方法:32例腰椎峡部裂患者经16排螺旋CT扫描后进行了双倾斜多平面重建及容积重建。结果:MSCT双倾斜重建技术能清楚显示腰椎峡部的正常解剖结构和腰椎峡部裂的CT征象,其主要的影像表现有"环裂征"、"双关节征"、"多关节征"、椎管矢状径增大、局部骨质增生硬化、腰椎滑脱、椎间盘变性、椎小关节退变等。以手术结果为金标准,MSCT双倾斜重建技术对32例腰椎峡部裂的诊断准确率为93.8%,常规轴位的诊断准确率为68.8%,前者的诊断准确率明显高于后者(P<0.05)。结论:MSCT双倾斜重建技术能直观地显示峡部裂的影像特征,具有较好的临床应用价值。     

16层螺旋CT三维重建对腰椎峡部裂的诊断价值

目的探讨16层螺旋CT重建技术对腰椎峡部裂的影像特点及诊断价值。方法对38例腰椎峡部裂患者进行螺旋CT扫描后,行表面遮盖法(SSD)和多层面重建(MPR)。结果轴位原始图像对骨、瘢痕增生、椎间盘病变等征象显示清晰;MPR对峡部裂的显示达100%;SSD重建技术在显示峡部裂方面不及MPR,但是图像直观,且在显示骨赘及椎体滑脱方面效果良好。结论16层螺旋CT三维重建技术对腰椎椎弓峡部裂及其所引起的相关改变具有良好的显示效果,可为临床治疗方案的选择提供可靠依据。     

腰椎峡部裂平行椎弓CT扫描的技术探讨及临床应用

目的：探讨平行于椎弓CT扫描对腰椎峡部裂的诊断价值及临床应用。方法：采用与椎弓平行扫描，包括整个椎弓，层厚3—5mm、层距3—5mm，以骨窗观察为主；对照正常CT表现，分析51例腰椎峡部裂的CT表现。结果：51例均显示腰椎峡部透光裂隙，边缘呈锯齿状并有增生硬化，密度增高，裂隙周围有大小不一，数目不等的碎骨块。当有脊椎滑脱时，椎管矢状径被拉长，呈长椭圆型或葫芦型。结论：平行于椎弓CT扫描诊断腰椎峡部裂简便易行，图像直观，解剖关系明确，是目前诊断腰椎峡部裂的重要手段之一。     

腰椎峡部裂的CT表现和临床意义

探讨ＣＴ在腰椎峡部裂诊断中的临床价值。分析了３４例腰椎峡部裂的ＣＴ表现，对腰椎峡部裂导致腰神经嵌压的ＣＴ表现与其临床症状进行比较。ＣＴ能显示峡部裂所致的椎管狭窄，侧隐窝和椎间孔狭窄及其他并发改变，ＣＴ表现与临床症状相符为７６％。ＲＰ     

黄韧带在腰椎峡部裂与关节突关节鉴别中的应用价值

腰腿痛的病因主要有椎间盘突出、腰椎峡部裂和关节突关节病变.对腰腿痛患者,临床一般考虑椎间盘病变而行椎间盘横断面CT扫描,常发生腰椎峡部裂的漏诊或把峡部裂误诊为关节突关节退行性变.近年来对腰椎峡部裂的CT诊断、扫描方法以及与关节突关节的鉴别已有报道,但尚未见黄韧带在腰椎峡部裂与关节突关节鉴别中的应用报道.本文通过对黄韧     

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.     

常规腰椎间盘CT扫描——椎管延长征与不典型椎弓峡部裂

目的分析L4和L5常规腰椎间盘CT扫描椎管前后径延长征与腰椎峡部裂的关系;探讨该征象对峡部裂假性椎间盘膨出与真性椎间盘膨出的鉴别诊断价值;验证补充椎弓峡部反机架角扫描的意义。资料与方法对28例椎管延长椎节做上下终板层面椎管前后径测量,并与正常组38例进行对比分析。椎管延长病例全部行反机架角扫描。结果对崩裂组和对照组L5进行P检验:男性:终板上缘为P1=0.21,终板下缘P2<0.01;女性:终板上缘P3<0.05,终板下缘P4<0.01。发现椎体下缘终板层面椎管前后径增大和对照组比较有显著差异。反机架角扫描全部病例均显示双侧椎弓峡部裂。结论当椎节无明显滑移时,腰椎峡部裂极易误诊或漏诊,椎间盘扫描椎管前后径延长征是主要间接征象,补充椎弓峡部反机架角扫描对峡部裂诊断有重要价值。     

腰椎退变性(假性)滑脱的CT诊断与鉴别诊断

目的研究腰椎退变性滑脱的CT特征,使之与腰椎峡部裂引起的真性滑脱鉴别。方法对80例无腰椎外伤史和腰椎椎弓峡部裂史腰椎退变性滑脱的CT资料作回顾性分析。CT扫描范围从滑脱椎体椎弓开始至下位椎体上缘,所扫层面与椎间盘平行。结果 CT扫描有以下特征:①椎间盘退行性改变。②椎骨和椎小关节退行性改变,腰椎椎体边缘骨质增生及腰椎骨质疏松,椎小关节面增生硬化、关节面下囊变、碎裂、关节间隙变窄或不对称和关节囊钙化;滑脱腰椎椎弓完整,椎体及附件整体向前(后)移位,向前滑脱时,滑脱椎体下关节突向前移位,其前缘几乎与下位椎体上椎小关节突前缘相平或超出下位椎体上椎小关节突前缘,关节方向向矢状方向转化。③椎管、椎间孔和侧隐窝狭窄。④终板双重轮廓。结论腰椎退变性滑脱有其CT特征,能与腰椎峡部裂引起的真性滑脱鉴别。     

Diagnosis and evaluation of spondylolisthesis and/or spondylolysis on axial CT

A critical review was made of the CT findings in 300 patients who underwent axial CT of the lumbar spine in which spondylolysis and/or spondylolisthesis had been diagnosed. Findings indicate that axial CT is superior to conventional radiographs in several areas: (1) for consistent and accurate demonstration of spondylolysis, (2) for disclosing the various changes in the apophyseal joints associated with degenerative and reverse spondylolisthesis, and (3) for uncovering minimal degrees of spondylolisthesis by the presence of a pseudobulging disk in many cases with equivocal or negative radiographs. Axial CT is a highly accurate method for diagnosing and evaluating spondylolysis and all types of spondylolisthesis.     

SPECT in the management of patients with back pain and spondylolysis

PURPOSE: Single photon emission computed tomography (SPECT) bone scans of the lumbar spine were evaluated in the management of patients with low back pain and suspected spondylolysis. MATERIALS AND METHODS: Thirty-three patients (mean age, 30 years) with high clinical suspicion of pars interarticularis defects were included in the study. The results of lumbar radiographs and SPECT bone scintigraphy were compared and the influence of these results on patient management was evaluated. RESULTS: Twenty-six of the 33 patients had abnormal results of lumbar radiographs. Of the 21 patients with radiographs indicating spondylolysis, six had abnormal uptake in the pars regions on bone scintigraphy. One patient with normal results of lumbar radiographs had a SPECT bone scan showing uptake in the region of the pars interarticularis. CONCLUSIONS: SPECT bone scanning of the lumbar spine has a role in the treatment of patients with symptomatic spondylolysis.     

歼击机飞行员腰椎峡部裂60例影像学分析（摘要）

目的探讨歼击机飞行员腰椎峡部裂影像学诊断。方法收集改装体检的歼击机飞行员腰椎峡部裂60例（62块病变腰椎）影像学资料,分析X线和部分CT、MRI表现以及其中20例6个月～7年随访复查的影像学变化。结果60例站立位x线腰椎正侧位和双斜位平片均显示峡部裂征象;仅3例x线显示单侧峡部裂,而CT证实为双侧。腰5椎峡部裂51／62块（82．26％）,其次为腰4椎峡部裂5／62块（8．06％）,腰3椎峡部裂3／62块）4．84％）,腰6椎（骶椎腰化）峡部裂2／62块（3．23％）,腰2椎峡部裂1／62块（1．61％）。60例中双侧峡部裂50块,其中伴有前滑脱者31块,     

Effect of a full and empty bladder on radiation dose to the uterus, ovaries and bladder from lumbar spine CT and X-ray examinations

This is a quantitative study of the effect of a full and empty bladder on the position of the uterus, ovaries and bladder relative to the lumbar spine. Data are used to estimate the difference in radiation dose to these organs from performing a lumbar spine CT investigation or a lateral lumbar spine radiograph with a full bladder compared with an empty bladder. 12 women of child-bearing age underwent pelvic magnetic resonance scans with full and empty bladders. The positions of the uterus, ovaries and bladder were matched with the radiation dose distribution that would have occurred either side of the inferior boundary of the CT scan volume and the lateral lumbar spine radiograph. These radiation dose profiles were measured on phantoms using a combination of ionization chambers and thermoluminescent dosemeters. When the bladder was emptied, the mean position of the endometrial cavity fundal tip moved from 4.1 cm to 6.1 cm inferior to the centre of the L5/S1 disc space, and from 0.87 cm to 1.12 cm anterior to the centre of the L5/S1 disc space. This movement on micturation would have reduced the mean dose to the uterine internal fundal tip during a pelvic CT scan from 6.8 mGy to 3.9 mGy, which represents a mean reduction of 43% (range 12-67%). The mean dose from a lateral lumbar spine examination would have been reduced from 197 microGy to 126 microGy. The change in ovary position results in the mean ovary dose being reduced by 48% for the lumbar spine CT scan and by 43%) for a lateral lumbar spine radiograph. When the bladder was emptied, the average position of the bladder wall moved from 7.2 cm to 10.3 cm inferior to the L5/S1 disc space. This change in bladder position reduces the mean dose to the wall of a full bladder from 5.7 mGy for a CT scan and 114 microGy for a lumbar spine radiograph to 2.2 mGy and 42 microGy, respectively, for an empty bladder.