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。     

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     

Intraarticular fractures of the calcaneus: value of CT findings in determining prognosis.

The prognosis of intraarticular calcaneal fractures is variable, ranging from severe functional impairment and pain to complete return of normal function. Clinical assessment and CT scanning were performed 1-11 years after fracture in 45 patients (51 fractures) to determine the relationship between the CT findings and clinical status. Conservatively treated (n = 18) and surgically treated (n = 33) fractures were assessed. Clinical assessment included evaluation of subjective parameters (pain, activity, gait, and use of orthotics) and objective measurement of subtalar motion. CT evaluation included assessment of abnormalities in the posterior subtalar joint, loss of calcaneal height, tendon abnormalities, and calcaneocuboid joint abnormalities. A poor clinical outcome, caused by loss of subtalar motion, was more common when CT showed incongruity or degeneration of the posterior facet (p = .04) and when Bohler's angle was decreased (p = .0006). Other CT findings, such as loss of calcaneal height and tendon abnormalities, did not correlate with clinical outcome. An unexpected finding was that surgical screws were intraarticular in eight (24%) of 33 surgically treated patients; however, this finding was not significantly associated with poor clinical outcome. Our findings indicate that the CT findings of degenerative change and incongruity of the posterior subtalar joint correlate significantly with poor clinical outcome.     

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.     

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 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.     

High-dose i.v. contrast in CT scanning of the postoperative lumbar spine

Evaluation of the postoperative lumbar spine is sometimes difficult because of obliteration of epidural fat by hypertrophic scarring. We examined 70 patients using a high-dose intravenous contrast technique in an attempt to distinguish hypertrophic scarring from herniated disk. The CT interpretation was confirmed in all 17 patients who had follow-up operations. Thirteen had herniated disk material associated with scar and four had hypertrophic scarring only. The latter four patients underwent reoperation because of concomitant foraminal or spinal canal stenosis seen on CT. Twelve of the herniated disks had the expected appearance of a nonenhancing mass surrounded by a rim of enhancing scar tissue. In the 13th patient, homogeneous enhancement of the herniated disk was seen. It is thought that chronically herniated disks, such as this one, may incite enough surrounding scar to give the CT appearance of an enhancing disk. Finally, marginal enhancement in the anulus fibrosus region was seen in over 90% of disk spaces examined. Although an anatomical explanation cannot be given at present, this phenomenon is thought to represent a normal finding.     

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。     

The value of routine MR myelography at MRI of the lumbar spine

PURPOSE: To determine whether a commercially available automated MR myelogram sequence improves the interpretation and diagnostic yield at MRI of the lumbar spine. MATERIAL AND METHODS: A total of 207 consecutive patients referred for MR examination of the lumbar spine for evaluation of low back pain or spinal radicular symptoms were included for study. All patients had initial imaging with sagittal T1-W and T2-W scans, followed by axial T2-W images. Subsequently an MR myelogram was acquired in each case in coronal, sagittal and oblique planes. MR myelogram images were evaluated initially and a diagnosis was established and recorded. Subsequently, a diagnosis was established by review of conventional images of the lumbar spine in sagittal and axial planes, in conjunction with the MR myelogram. The utility of the MR myelogram in establishing the diagnosis was graded on a 4-point scale, where grade 0 indicated that it contributed no additional information and grade 3 indicated that it was essential for diagnosis. Analysis of the additional value of myelography in patients with multilevel disease was made. RESULTS: Primary diagnoses were disc herniation in 69 cases (33%), degenerative disc disease in 51 cases (26%), spinal stenosis in 19 cases (9%), isolated lateral recess stenosis in 5 cases (2%), or other diagnoses, including facet degeneration in 48 cases (23%). Scans were normal in 15 cases (7%). MR myelography was graded as grade 0 in 151 cases (73%), grade 1 in 44 cases (21%) and grade 2 in 12 cases (6%). In no case was MR myelography essential for diagnosis (grade 3). In patients with multilevel disease (n=27), in 17 cases MR myelography was graded as grade 1 (63%) and in 8 cases grade 2 (30%). CONCLUSION: MR myelography when employed in routine practice was of limited value, assisting in establishing a diagnosis in a minority of cases (6%). The technique was of limited additional value in patients with multilevel pathology and to a lesser extent in patients with scoliosis, where it helped to establish the level most likely to account for pathology.     

腰椎椎体CT值与骨密度值的相关性研究

骨质疏松症(osteoporosis,OP)是一种以骨量低下,骨微结构损坏,导致骨脆性增加,易发生骨折为特征的全身性骨病[1].由于骨质疏松所引起的骨折给患者带来极大的痛苦,也给社会造成了很大的负担.因此,如何早期预测骨质疏松、预防骨折、提高人们的生活质量,已成为目前亟待解决的重大课题.双能X线骨密度仪(DXA)是一种二维的测量方法,腰椎测量值受到骨质增生和附件的影响而不够精确;定量CT (QCT)需要专门的软件而无法普及;上述2种方法使得骨质疏松的检出率难以提高.MSCT是临床最常用的一种检查方法,影像科医师可方便快捷地测量每1例接受腰椎或腹部CT检查的患者腰椎椎体CT值.本文通过对腰椎椎体CT值与骨密度值进行相关性分析,从而评估椎体CT值对骨质疏松的诊断价值.     

The value of computed tomography scanning in elusive fractures of the cervical spine

In three cases of injury to the cervical spine, in which plain films and tomographic studies provided inconclusive diagnoses, computed tomography scanning demonstrated the lesions unequivocally. When such diagnostic problems arise the use of this supportive technique is advocated.     

腰椎轴向负荷的CT、MR检查对腰椎退行性病变的诊断价值

目的：评价腰椎轴向负荷的CT、MR检查对腰椎退行性病变的诊断价值。方法：对100例腰腿痛的患者（79例表现为坐骨神经痛，20例为下腰痛，1例为神经性跛行）分别行腰大肌放松体位（PRP）和腰椎轴向负荷仰卧位（ACE）的CT或MR检查。其中CT检查40例，MR检查60例。硬膜囊面积在ACE检查中较PRP明显减小（〉15mm^2）并降到75mm^2以下、侧隐窝和（或）椎间孔狭窄、椎间盘突出程度增加及出现滑膜囊肿为腰椎轴向负荷检查的附加信息（AVI）。结果：40例CT检查的患者中，16例发现AVI。其中硬膜囊面积减小13例，椎间盘突出程度增加7例，侧隐窝和（或）椎间孔狭窄4例，未见滑膜囊肿的病例。60例MR检查的患者中，19例发现AVI，其中硬膜囊面积减小13例，椎间盘突出程度增加10例，侧隐窝和（或）椎间孔狭窄8例，未见出现滑膜囊肿的病例。79例坐骨神经痛的患者中32例（40．5％）出现AVI，20例下腰痛的患者中2例（10．0％）出现AVI（X2=7．45，P〈0．05）。结论：与常规腰椎CT、MR方法比较，腰椎轴向负荷的CT、MR检查更能反映腰椎直立状态下的椎间盘、硬膜囊、侧隐窝的状态。     

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.     

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。     

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.     

Magnetic resonance imaging of the lumbar spine with CT correlation

The results of magnetic resonance (MR) imaging and computed tomography (CT) in 18 patients with known degenerative disk disease of the lumbar spine were compared. In 60 intervertebral disk levels studied, there were 17 disks with degeneration and disk bulge, and 15 herniated disks. Final diagnoses were based on several factors, with surgical confirmation in five patients. There was good correlation between the two methods at 51 of the 60 levels studied. However, there were major discrepancies in interpretation at nine intervertebral disk levels. These included three false-positive MR imaging interpretations of a herniated disk and one false-negative herniated disk on MR imaging. MR imaging detected one case of disk herniation that was missed prospectively on CT. There were also four presumed degenerated disks seen on MR scans that appeared normal on CT. The conus medullaris was imaged in 16 of 18 patients. The sagittal view proved best for demonstrating both disk abnormality and the conus medullaris. The transaxial view was sometimes helpful in localizing a disk herniation, but partial-volume averaging in the 7-mm slice thickness limited its usefulness. There were five disk herniations that could not be accurately localized on the MR scan. MR imaging proved more sensitive than CT in detecting early disk disease, which appeared as decreased signal intensity within the disk. In three postoperative cases, MR imaging was better able to distinguish between recurrent disk herniation and postoperative scar formation. CT, on the other hand, was more specific in distinguishing herniated disk from disk bulge and proved far superior to MR imaging in localizing disk herniation.(ABSTRACT TRUNCATED AT 250 WORDS)     

CT在颈椎损伤中的诊断价值

目的：探讨CT扫描在颈椎损伤中的诊断价值。方法：回顾性分析32例颈椎损伤的CT与平片检查资料。结果：骨折28例（其中6例伴脱位）,单纯脱位4例,合并伤10例。结论：CT对颈椎损伤的检出率明显高于平片,能清晰显示其损伤的细节,并对判断失稳及椎管狭窄的程度均有重要价值。