螺旋CT扫描多平面重建（MPR）诊断颈椎退行性病变

目的 :探讨螺旋CT扫描并多平面重建 (MPR)对颈椎退行性病变的诊断价值。材料和方法 :对 45例颈椎病患者利用常规颈椎CT扫描和螺旋CT扫描并行MPR重建 ,对比分析扫描结果。结果 :螺旋CT扫描并MPR重建除显示 42例表现为一个以上椎间盘突出并压迫神经根及硬脊膜囊外 ,还显示椎体后缘骨质增生 3 0例 ,钩椎关节骨质增生 2 1例 ,2 3例共 2 7个椎间孔狭窄 ,12例共 15个横突孔狭窄 ,9个狭窄横突孔边缘骨质硬化增白 ,并可整体直观的观察韧带骨化、肥厚及椎管狭窄情况。结论 :螺旋CT扫描并MPR重建在显示颈椎退行性变各种病理改变方面比常规CT扫描具有重要的价值。     

CT旁矢状位重建对腰椎间孔狭窄的诊断价值

目的探讨螺旋CT旁矢状位重建对腰椎间孔狭窄的诊断价值。方法2003-01～2004-04,对腰腿疼患者临床和常规CT检查考虑有椎间孔狭窄时,使用螺旋CT旁矢状位二维重建,诊断并手术腰椎间孔狭窄症15例。结果15例螺旋CT旁矢状位重建均显示有L4～5或L5～S1椎间孔狭窄,2例极外侧型椎间盘突出,8例椎体终板后外缘局限性增生骨化突入椎间孔,1例腰椎滑脱峡部裂假关节,4例后外侧椎间盘突出间隙狭窄并黄韧带肥厚小关节增生、上移。水平狭窄型7例,垂直狭窄型8例。Ⅱ度狭窄6例,Ⅲ度狭窄9例。结论螺旋CT旁矢状位重建可以弥补常规横断CT扫描的不足,对椎间孔显示清晰直观,对手术减压有定位指导意义,有较高诊断价值。     

颈椎横突孔狭窄与椎动脉供血、临床症状的关系探讨

目的提高颈椎横突孔直径变化对椎动脉型颈椎病影响的认识。方法颈椎椎间盘联合椎体扫描,在颈椎常规扫描椎间盘的基础上同时加扫C4～6椎体,测量C4～6椎体横突孔直径及观察横突孔周围组织的CT改变。结果 60例颈椎横突孔狭窄病例中,横突孔先天狭窄32例,增生性狭窄28例;轻度狭窄28例、中度狭窄21例、重度狭窄11例;C4椎体横突孔狭窄10例,C5椎体横突孔狭窄26例、C6椎体横突孔狭窄24例;一侧狭窄49例,两侧狭窄11例。结论改进后的CT扫描不仅可观察颈椎椎间盘、颈椎横突孔的变化,而且对椎动脉型颈椎病的病因诊断有较高的临床价值。     

颈椎后纵韧带骨化导致椎间孔狭窄的CT诊断

引起颈椎椎间孔狭窄的常见原因为椎间盘退行性变所引起的椎体骨质增生、骨赘形成以及关节突的增生和肥大等所致;我们在1986年2月至1987年2月一年间内,经CT检查证实的颈椎后纵韧带骨化有23例,其中10例患者,后纵韧带骨化除了导致椎管狭窄,脊髓压迫外,骨化可沿椎间盘后缘,向侧方延伸至椎间孔内,引起椎间孔狭窄,部分病人除了出现脊髓压迫症状外,同时出现神经根刺激症状。 一、一般临床资料 23例颈椎后纵韧带骨化患者中,有10例韧带的骨化延伸至椎间孔内,其中男性9例,女性1例,年龄范围47—62岁之间,病程均在1年以上;9例出现脊髓损害的症状,合并根性     

256层螺旋CT一站式重建诊断颈椎病的临床应用

目的探讨256层螺旋CT一站式重建诊断颈椎病的应用价值。资料与方法对500例临床拟诊为颈椎病的患者进行颈椎容积扫描后在EBW4.0工作站进行模拟常规椎间盘扫描重建及一站式重建[包括容积再现(VR)、多平面重组(MPR)及曲面重组(CMPR)],分别观察并比较两种扫描模式对颈椎曲度、颈椎序列、颈椎椎体骨质增生、椎小关节异常、钩椎关节增生、骨性椎管狭窄、横突孔异常、椎间隙变窄、侧隐窝狭窄、椎体许氏结节、椎间盘异常、椎旁软组织异常、神经根受压、前后纵韧带骨化、项韧带骨化等颈椎病相关的15项征象的显示能力。结果两种重建模式下,椎旁软组织异常(P=0.500)、颈椎序列异常(P=0.499)、横突孔异常(P=0.685)、侧隐窝狭窄(P=0.447)、项韧带骨化(P=0.346)差异无统计学意义,其余观察指标差异均有统计学意义(P<0.05)。结论 256层螺旋CT颈椎一站式重建能够准确地显示更多的颈椎病相关征象,为临床准确诊断提供更多有效的影像信息。     

CT图像三维重建在复杂颈椎骨折的诊断和治疗中的应用价值

目的 直观立体地显示复杂颈椎骨折的图像,探讨螺旋CT医学图像三维重建在复杂颈椎骨折诊断中的价值及其对手术的指导意义。方法 对113例颈椎骨折采用螺旋CT进行薄层扫描和三维重建进行诊断。CT扫描全部采用Siemens SOMATOM Sensation 16型多排高速螺旋CT机,1.0mm层厚。扫描所得断层资料,通过网络传送至计算机工作站处理。采用Window.NT 3.51平台上Insight三维重建软件进行三维重建。结果 三维CT图像能够围绕X轴和Z轴任意旋转、切割,以从不同角度观察,能够清晰显示复杂的颈椎骨折和狭窄椎管的解剖形态特点。结论 三维CT重建在颈椎骨折方面具有较大的临床应用价值,有助于提高颈椎骨折手术的安全性和精确性,并对患者预后的估计提供帮助。     

周围型腰椎管狭窄及椎间静脉压迫症的临床与CT分析

目的:探讨周围型腰椎管狭窄及椎间静脉压迫症的CT表现,为骨科手术方式的选择和术中处理提供依据。方法:分析经手术病理证实的周围型腰椎管狭窄及椎间静脉压迫症的患者52例,全部行CT平扫,部分CT增强扫描。分析其各种类型的CT表现和不同术式的选择及术中所见。结果:大多数病例术中所见与CT表现相一致。CT诊断侧隐窝狭窄、椎间孔狭窄及椎间静脉压迫症的原因有:椎间盘的病理性膨突、侧方椎间盘突出、上关节突增生肥大、椎体后外缘骨质增生、黄韧带肥厚、腰椎滑脱等。结论:选择合理的CT扫描方法可以提高诊断符合率和特异性。正确的CT诊断有助于术式选择和术中处理,能有效的减少术后并发症。     

关节骨折的螺旋CT三维重建评价

目的：探讨螺旋CT三维重建技术在关节骨折中的诊断价值。方法：使用Philips Aura螺旋CT对31例患者的损伤关节进行容积扫描，所得原始数据传送到工作站做三维重建处理，显示立体图像，并与X线平片及CT平扫比较。结果：螺旋CT三维重建技术逼真地显示关节骨折的情况，与临床实际相符，确诊率96．8％，明显高于X线平片(67.7％)及CT平扫(87．1％)。结论：螺旋CT三维重建技术能清楚显示关节骨折的细节，有利于临床诊断和治疗，减少手术创伤。     

螺旋CT三维重建立体显示在军事训练膝关节损伤中的应用

目的探讨螺旋CT三维重建立体显示在军事训练膝关节损伤中的应用价值。方法对24例膝关节外伤的伤员行X线和螺旋CT扫描,用三维观片镜对三维重建图像立体显示,观察图像。重建方法为表面遮盖显示法（SSD）、模拟内窥镜、最大密度投影（MIP）与容积重建（VR）。结果螺旋CT扫描三维显示比X线具有显著优势,检出率显著高于X线检查（χ2=19.05,P〈0.01）。结论螺旋CT三维重建立体显示在膝关节损伤的诊断上具有重要的临床价值。     

颈椎病的CT研究：椎间盘突出神经根型和椎动脉型颈椎病

本文观察了62例颈椎病(神经根型34例、椎动脉型22例及椎间盘突出25例),探讨了颈椎病发病机理和CT 表现.CT 表现:(1)钩突骨质增生;(2)椎间孔狭窄;(3)颈椎失稳;(4)椎间盘突出;(5)其它:椎体周缘骨赘和韧带骨化.     

颈椎损伤的CT诊断

目的：分析颈椎损伤的ＣＴ表现,评价其诊断意义。材料与方法：回顾分析２６例颈椎损伤的ＣＴ扫描资料。结果：椎体骨折３４节;单椎体骨折７例,多椎体骨折６例骨折伴脱位１１例,单纯关节脱位２例;三柱中以后柱（４７％）和前中后柱（２１％）骨折多见;椎管和神经孔狭窄率分别为５９．１％、１６．２％。结论：ＣＴ是颈椎听凭的重要检查手段,是诊断椎管和神经孔狭窄,横突孔破裂,出血、环椎横韧带损伤的有效方法。     

Degenerative diseases of the cervical spine: comparison of a multiecho data image combination sequence with a magnetisation transfer saturation pulse and cervical myelography and CT

Assessing degenerative disease in the cervical spine remains a challenge. There is much controversy about imaging the cervical spine using MRI. Our aim in this prospective study was to compare a T2*-weighted 2D spoiled gradient-echo multiecho sequence (MEDIC) with a magnetisation transfer saturation pulse with cervical myelography and postmyelographic CT. Using an assessment scale we looked at the vertebral bodies, intervertebral discs, neural foramina, anterior and posterior nerve roots, grey matter, ligamenta flava, oedema in the spinal cord and stenosis of the spinal canal. We also evaluated postmyelography CT and the MEDIC sequence for assessing narrowing of the neural foramina in a cadaver cervical spine. We examined 67 disc levels in 18 patients, showing 18 disc prolapses and 21 osteophytes narrowing the spinal canal or the neural foramina. All MRI studies showed these abnormalities findings equally well. Postmyelography CT was significantly better for showing the bony structures and the anterior and posterior nerve roots. The MEDIC sequence provided excellent demonstration of soft-tissue structures such as the intervertebral disc and ligamentum flavum. No statistical differences between the imaging modalities were found in the assessment of narrowing of the neural foramina or the extent of spinal stenosis. The cadaver measurements showed no overestimation of abnormalities using the MEDIC sequence.     

椎动脉型颈椎病的MRI分析

目的 探讨椎动脉型颈椎病的ＭＲＩ诊断价值及其限度。材料与方法 选取我院近２年来经临床诊断为椎动脉型颈椎病患者４２例,全部行颈部ＭＲＡ检查,其中２３例同时行颈椎ＭＲＩ,观察椎动脉全段ＭＲＡ表现及颈椎横突孔以及钩椎关节的变化情况。选择２６例正常人作为对照组。全部行颈椎ＭＲＩ及椎动脉ＭＲＡ检查,方法条件和观察内容同病例组。结果 （１）４２例中７例椎动脉ＭＲＡ正常,其余３５例（３５／４２）分别显示不同程度     

Acute cervical spine trauma: evaluation with 1.5-T MR imaging

Twenty-one patients with acute neurologic deficits following cervical spine trauma were evaluated with magnetic resonance (MR) imaging (n = 21), computed tomography enhanced with intrathecal contrast material (CT myelography) (n = 18), myelography (n = 13), cervical spine radiography (n = 21), and intraoperative sonography (n = 7). MR imaging proved superior to other modalities in demonstrating parenchymal spinal cord injuries and cervical intervertebral disk herniation. Although both T1- and T2-weighted studies appear necessary to evaluate the anatomic relationship of the spinal cord, thecal space, intervertebral disks, and surrounding osseous and ligamentous structures, T2-weighted sequences were more sensitive than T1-weighted studies for detection of spinal cord injury. CT myelography was superior to MR imaging in demonstrating cervical spine fractures. In most cases, myelography revealed no information that was not apparent from both CT and MR imaging studies. Preliminary experience with MR imaging of acute cervical spine trauma suggests that it should be the study of choice in symptomatic patients who are otherwise clinically stable. CT may still be required in selected patients to evaluate complex fractures.     

Incidence and clinical importance of chronic reactive periosteal new bone formation in the cervical region in patients with differing neurologic symptomatology

81 patients classed into three groups with clinical evidence of neurological symptoms and posttraumatic pain of the cervical spine and the incidence of degenerative disorders were studied noninvasively via CT scanning. Imaging of osseous structures in the axial plane by CT was excellent in all cases, even in the lower part of the cervical spine where soft-tissue discrimination is often impossible because of shoulder artifacts. In about half of the patients with nerve-root symptomatology as well as with signs of involvement of long tracts, narrowing of the foramen intervertebral, respectively of the spinal tract, was seen, attributable to degenerative osseous apposition with excellent clinical segmental and (according to radicular symptoms) side correlation. In contrast to these results the group of patients with posttraumatic clinical symptoms showed almost 50 per cent less preexisting degenerative disorders of the cervical spine. In conclusion, we assume that high-grade osseous appositions of the dorsal part of the vertebral body play an important role in the development of radicular symptomatology and cervical myelopathy, respectively. Hypertrophic changes of the processus articularis with narrowing of the spinal canal occurred in 14 per cent and were therefore of minor clinical significance.     

颈椎病的X线诊断(附90例报告)

目的:评价X线对颈椎病的诊断价值。材料与方法:90例颈椎病患者,其中75例男性和15例女性,年龄为36～70岁,40岁以上者占90％,均经X线检查确诊,并对其主要X线表现的发生几率进行了定量描述。结果:颈椎病的主要X线表现及其发生率依序是:椎体缘骨质唇样增生(77.7％),钩椎关节退变(58.9％),颈椎旋转及滑脱(55.7％),颈椎生理曲度改变(54.5％),锥间孔变小、变形(47.7％),椎间关节退变(41％),椎间隙变窄(40％),以及韧带钙化(34.4％)。这些X线征象往往两种或两种以上并存于同一患者之中。结论:上述X线征象是诊断颈椎病的主要依据,而极为重要的是双进双突征和/或棘突偏斜征,颈椎失稳滑脱,可看作是早期诊断颈椎病的关键。     

腰椎轴向负荷CT检查的临床意义

目的:评估轴向负荷CT检查在腰椎退性行疾病诊断中的临床价值。方法:采用腰大肌放松体位(PRP)和腰椎伸位轴向负荷(ACE)两种体位进行CT检查,进行最大密度投影(MIP)重建,观察加压前后L2～S1各椎间盘中心层面的椎管腔最大横径、纵径及硬膜囊面积的变化,进行比较和统计学分析。结果:对比ACE与PRP体位CT检查,发现ACE体位检查后椎管横径、纵径变小,横截面积变小,均有显著性意义。结论:与PRP体位CT检查比较,ACE体位CT检查获得了更多的放射学诊断信息,可以作为临床诊断椎管狭窄的重要依据,其临床意义优于PRP体位CT检查。     

颈椎病的影像学检查及其临床意义

目的探讨颈椎病的临床及影像学表现,以期提高对本病的认识。方法对86例颈椎病X线,CT,MR影像学表现进行分析。结果86例中,颈椎病主要影像学改变为颈椎生理曲度异常,椎体和钩突关节骨质增生,椎间隙变窄,椎管狭窄和颈部韧带骨化。结论颈椎病影像学改变具有一定的特征性,有助于颈椎病的诊断,为临床治疗提供了依据和参考价值。     

Exclusion of unstable cervical spine injury in obtunded patients with blunt trauma: is MR imaging needed when multi-detector row CT findings are normal?

PURPOSE: To retrospectively determine what information, if any, magnetic resonance (MR) imaging of the cervical spine in obtunded and/or "unreliable" patients with blunt trauma adds to multi-detector row computed tomography (CT) of the entire cervical spine (including routine multiplanar sagittal and coronal reformations) when the CT findings are normal. MATERIALS AND METHODS: The study was HIPAA compliant and institutional review board approved. Informed consent was not required. From April 2001 to November 2003, 1400 trauma patients underwent MR imaging of the cervical spine to evaluate potential cervical spine injuries. Multi-detector row CT of the cervical spine was performed with a four- or 16-detector row scanner. MR imaging of the cervical spine was performed with transverse gradient-echo, sagittal intermediate-weighted, sagittal short inversion time inversion-recovery, and sagittal T1- and T2-weighted fast spin-echo sequences. Many MR examinations were performed to exclude soft-tissue injuries in the cervical spine of obtunded patients with blunt trauma in whom cervical spine injury could not be excluded with physical examination. Complete cervical spine MR studies were obtained to evaluate soft-tissue injuries in 366 obtunded patients with blunt trauma (281 male and 85 female patients; age range, 13-92 years; mean age, 42.1 years). The patients had previously undergone total cervical spine multi-detector row CT with normal findings. The results obtained with these two modalities were compared. RESULTS: MR images were negative for acute injury in 354 of the 366 patients and negative for cervical spine ligamentous injury in 362. Seven of the 366 patients had cervical cord contusions, four patients had ligamentous injuries, three patients had intervertebral disk edema, and one patient had a cord contusion, a ligamentous injury, and an intervertebral disk injury. Four patients had ligamentous injuries; however, all of these patients had ligament injuries limited to only one of the three columns of cervical spine ligament support. Multi-detector row CT had negative predictive values of 98.9% (362 of 366 patients) for ligament injury and 100% (366 of 366 patients) for unstable cervical spine injury. CONCLUSION: A normal multi-detector row CT scan of the total cervical spine in obtunded and/or "unreliable" patients with blunt trauma enabled the authors to exclude unstable injuries on the basis of findings at follow-up cervical spine MR imaging.