正常胎儿标本颈、胸、腰段脊柱发育的MRI研究

目的探讨正常胎儿标本颈、胸、腰段脊柱和椎体体积随孕周生长变化规律。方法利用3.0 T MR扫描仪对55具17~42孕周胎儿尸体标本行全脊柱三维T2WI序列扫描,其中孕妇自发性流产获得标本20具,母体因严重疾病引产获得标本35具,胎儿标本均来源于山东大学医学院断层影像解剖学研究中心。标本经CT扫描均未发现脊柱异常。采用OsiriX软件(www.osirix-viewer.com),在重建横断面图像上沿椎体边缘逐层勾画椎体轮廓,获得脊柱颈、胸、腰段脊柱体积,将其除以各段椎体个数,获得椎体单位体积。逐一测量腰椎5个椎体体积。将颈、胸、腰段脊柱体积和腰椎椎体体积与孕周作回归分析,并分析各段脊柱增长规律。结果(1)胎儿颈、胸、腰段脊柱体积与孕周增长呈线性相关关系,线性回归方程分别为:颈段脊柱体积(mm3)=-1260.937+81.235×孕周(R2=0.974,P<0.05);胸段脊柱体积(mm3)=-5933.521+347.503×孕周(R2=0.972,P<0.05);腰段脊柱体积(mm3)=-5130.912+294.473×孕周(R2=0.976,P<0.05)。(2)胎儿脊柱生长速度:胸段>腰段>颈段;同一孕周阶段内,脊柱体积:胸段>腰段>颈段;椎体单体积增长速度及增长倍数:腰椎>胸椎>颈椎。(3)腰1~腰5椎体体积增长与孕周亦呈线性相关关系。结论孕中晚期胎儿标本颈、胸、腰段脊柱椎体体积的增长与胎龄呈良好的相关性,且不同节段生长速度不一。     

Vertebral bone mineral measurement using dual photon absorptiometry and computed tomography

The lumbar spine of 14 cadavers was studied both by 153Gd dual photon absorptiometry (DPA) and quantitative computed tomography (QCT) at 96 and 125 kVp. The intact spine and the individual vertebrae were analyzed. After these measurements the ash content of the vertebral body, the posterior elements, and the transverse processes was determined. The fat content of the vertebral body as well as its volume was also measured. With DPA, the bone mineral content (BMC) determined in situ as well as on excised spine specimens correlated highly with the amount of total vertebral ash (r greater than 0.92, SEE less than 3.2 g). The bone mineral density (BMD, area density) of 3 lumbar vertebrae correlated accurately with the mean ash density of the vertebral body (r greater than 0.81, SEE less than 0.015 g/cm3). The so-called corpus density and central density determinations were less accurate. No difference in accuracy was found between measurements when using 3 mm and 4.5 mm step intervals. Variations in the distribution of mineral between the vertebral body and the posterior elements contribute to the error in predicting vertebral body mineral with DPA. QCT gave a smaller error when a cylindric portion of the vertebral body with a 20 mm diameter was measured compared with one with a 9 mm diameter, when the dual energy technique was used (p less than 0.01). With dual energy QCT a correlation was found between a center segment of 3 vertebrae in the lumbar spine and the mean ash density of the vertebral body of r = 0.92 (SEE = 0.010 g/cm3).(ABSTRACT TRUNCATED AT 250 WORDS)     

The direct and computed radiographic assessment of vertebral locations in children with acute lymphatic leukemia]

The children affected with acute lymphoblastic leukemia (ALL) often exhibit secondary lesions of the spine. The diagnosis of spinal involvement is currently made by means of conventional radiography in postero-anterior and lateral views. The osteolytic lesions of the vertebral body present with collapse of the vertebral plates in a wide range of severity. Body evaluation is usually made by comparison with the adjacent vertebrae. Since leukemia is a systemic disease, several vertebrae are possibly involved in each case. In the attempt to develop a more sensitive method, which is less dependent on observers' evaluation, a quantitative and comparative analysis of vertebral bodies was performed. The radiographs in lateral view of the dorsal and lumbar spine of 14 children with ALL were analyzed: previous radiological reports suggested the lesion of one or more vertebral bodies. The area of each vertebral body was measured and digitalized by means of a backlighted graphic table and of a software developed to this purpose. The criteria to define the collapse of a vertebral body were the ratio between areas of adjacent vertebral bodies, in conformity to the anatomic and radiographic principle that, in the dorsal and lumbar spine, the body of a normal vertebra is equal to or bigger than that of the upper one. The data obtained by quantitative analysis were compared with conventional radiologic reports. A hundred and fifty-five vertebrae were analyzed by computerized analysis; 17 (10.9%) vertebrae, undetected at conventional analysis, were collapsed. This method allows a more precise diagnosis of collapsed vertebral lesions; its accuracy can be improved with further development of digital technology.     

CT对腰椎附件发育异常的诊断价值

目的探讨CT对腰椎附件发育异常的诊断价值。方法回顾分析本院16例经X线平片和CT检查确诊的腰椎发育异常的病例。结果全部病例经1～2次X线平片检查均无阳性发现或仅见骨质增生改变;CT均可发现附件发育异常．如：椎板裂6例,横突不对称1例,关节突异常肥大2例,关节突呈“双突”畸形2例,双侧小关节不对称5例。结论CT是诊断腰椎附件发育异常的较好影像学方法。     

Measurements of vertebral shape by radiographic morphometry: sex differences and relationships with vertebral level and lumbar lordosis

Objective. To examine sex-related and vertebral-level-specific differences in vertebral shape and to investigate the relationships between the lumbar lordosis angle and vertebral morphology. Design and patients. Lateral thoracic and lumbar spine radiographs were obtained with a standardized protocol in 142 healthy men and 198 healthy women over 50 years old. Anterior (Ha), central (Hc) and posterior (Hp) heights of each vertebra from T4 to L4 were measured using a digitizing technique, and the Ha/Hp and Hc/Hp ratios were calculated. The lumbar lordosis angle was measured on the lateral lumbar spine radiographs. Results. Ha/Hp and Hc/Hp ratios were smaller in men than women by 1.8% and 0.7%, respectively, and these ratios varied with vertebral level. Significant correlations were found between vertebral shape and the lumbar lordosis angle. Conclusions. These results demonstrate that vertebral shape varies significantly with sex, vertebral level and lumbar lordosis angle. Awareness of these relationships may help prevent misdiagnosis in clinical vertebral morphometry.     

30d-6°头低位卧床对腰椎和椎旁肌肉面积的影响

目的 观察30 d-6°头低位卧床实验后志愿者腰椎高度、腰椎间隙中矢状位面积、腰椎前凸角度以及椎旁肌肉横切面积的变化.方法 14名健康男性参加30 d卧床模拟失重实验.于卧床前1天、卧床第30天分别进行腰椎核磁检测,同时测量人体腰椎高度、腰椎间隙中矢状位面积、腰椎前凸角度以及椎旁肌肉横切面积.结果 30 d卧床实验后志...     

Origins of the segmental arteries in the aorta: an anatomic study for selective catheterization with spinal arteriography

BACKGROUND AND PURPOSE: The segmental arteries, which include the posterior intercostal, subcostal, and lumbar arteries, are gateways for performance of selective spinal arteriography of the thoracolumbar level. We performed a cadaveric study to clarify the anatomic relationship between the origins of the segmental arteries in the aorta and the vertebral column. METHODS: Five adult cadaveric aortas with intact thoracolumbar spines were dissected under magnification. In each specimen, nine pairs of posterior intercostal arteries, one pair of subcostal arteries, and four pairs of lumbar arteries were examined in detail. RESULTS: The origin of the posterior intercostal arteries in the upper thoracic level was situated at most about two levels caudal to the feeding level, whereas the origins in the lower levels were just caudal to the corresponding levels. The position of the bilateral orifices of the segmental arteries in the axial plane of the aorta was on the medial side at the thoracic levels, whereas it was on the dorsal side at the lumbar level. The horizontal distance between the orifices in the lumen of aorta was found to be wider at the thoracic level than the lumbar level, and the longitudinal distance was higher at the lower level, corresponding to the height of the vertebra. CONCLUSION: Understanding the 3D relationship of the initial segment of the segmental arteries with reference to the aorta and vertebral column is necessary for performance of the selective spinal arteriographic examination rationally by using a two-dimensional fluorescent display.     

Reliability of ultrasonography in the follow-up of hip dysplasia in children above 2 years of age

PURPOSE: The aim of the present study was to assess whether ultrasonography (US) was reliable in the follow-up of children above 2 years of age who had previously been treated for congenital or developmental hip dislocation or dysplasia (HD). MATERIAL AND METHODS: As part of the routine follow-up, we examined 53 children (106 hips), aged 2-12 years (mean 6 years). Using US, the coverage of the femoral head was assessed by the distance from the lateral tangent of the ossified femoral head to the lateral bony acetabular rim (lateral head distance, LHD). The corresponding distance was measured on radiographs (LHDR). The radiographic femoral head coverage was assessed by the migration percentage (MP) and the center-edge (CE) angle. RESULTS: We found a good accordance between sonographic LHD and the radiographic parameters MP and CE in all age groups, indicating that femoral head coverage was reliably assessed by US. There was also a high correlation between LHD and LHDR (r=0.85). All hips with subluxation were detected by US. In 11 hips that appeared normal on US, but with dysplasia or uncertain findings by radiography, the condition spontaneously normalized in 9 out of 9 examined hips with further follow-up. CONCLUSION: Because a reliable assessment of the hip is obtained, we recommend that US should be used as the primary imaging technique in the routine follow-up of children above 2 years of age with previous HD. Radiography should be omitted when US shows normal findings and is only needed when the US LHD is above the upper normal limit or the hip looks abnormal or suspicious by subjective evaluation.     

Abnormalities of the axial and proximal appendicular skeleton in adults with Laron syndrome (growth hormone insensitivity)

Objective To investigate abnormalities in the skeleton (with the exclusion of the skull, cervical spine, hands and feet) in patients with Laron syndrome, who have an inborn growth hormone resistance and congenital insulin-like growth factor-1 (IGF-1) deficiency. Design and patients The study group was composed of 15 untreated patients with Laron syndrome (seven male and eight female) aged 21–68 years. Plain films of the axial and appendicular skeleton were evaluated retrospectively for abnormalities in structure and shape. The cortical width of the long bones was evaluated qualitatively and quantitatively (in the upper humerus and mid-femur), and the cortical index was calculated and compared with published references. Measurements were taken of the mid-anteroposterior and cranio-caudal diameters of the vertebral body and spinous process at L3, the interpedicular distance at L1 and L5, and the sacral slope. Thoracic and lumbar osteophytes were graded on a 5-point scale. Values were compared with a control group of 20 healthy persons matched for age. Results The skeleton appeared small in all patients. No signs of osteopenia were visible. The cortex of the long bones appeared thick in the upper limbs in 11 patients and in the lower limbs in four. Compared with the reference values, the cortical width was thicker than average in the humerus and thinner in the femur. The vertebral diameters at L3 and the interpedicular distances at L1 and L5 were significantly smaller in the patients than in the control subjects (P < 0.001); however, at L5 the canal was wider, relative to the vertebral body. The study group had a higher rate of anterior osteophytes in the lumbar spine than the controls had, and their osteophytes were also significantly larger. In the six patients for whom radiographs of the upper extremity in its entirety were available on one film, the ulna appeared to be rotated. In one 22-year-old man, multiple epiphyses were still open. Conclusion Congenital IGF-1 deficiency leads to skeletal abnormalities characterized by small bones, narrow spinal canal, and delayed bone age. The limitation in elbow distensibility common to patients with Laron syndrome may be related to a marked retroversion of the humeral head.     

Relationship between bone mineral density and tooth loss in elderly Japanese women.

OBJECTIVE: To evaluate the relationship between vertebral bone mass and tooth loss and jaw bone mass in elderly Japanese women. METHODS: Mandibular cortical bone mass, alveolar bone height and number of teeth present (total, anterior, and posterior) were compared with the 3rd lumbar vertebral bone mineral density (L3BMD), measured by dual energy computed tomography (DEQCT), in 90 Japanese women by means of multiple regression analysis, controlling for body mass index, menopausal status, years since menopause and self-reported periodontal condition. RESULTS: Mandibular cortical bone mass and number of posterior teeth were associated with both alveolar bone height and L3BMD, but there was no association between alveolar bone height, number of anterior teeth present and L3BMD. CONCLUSION: Our results suggest that the loss of posterior teeth may be associated with a decrease not only in alveolar bone height, but also alveolar bone mineral density (BMD). The latter may be related to a decrease of lumbar vertebral BMD.     

磁共振波谱技术在腰椎原发性骨质疏松中的诊断价值

目的探讨磁共振(MR)波谱脂肪测量技术评估腰椎原发性骨质疏松的价值。方法利用1.5T MR波谱(MRS)及双能X线吸收法(DXA)对56例研究对象进行检查,收集腰椎L3椎体脂肪比(FF)及L1~4椎体骨密度(BMD)值,以T值-2.5为临界点分为2组,将T值>-2.5定为阴性组和T值≤-2.5定为阳性组,采用Pearson法对FF-MRS与BMD作相关性分析。结果阴性组与阳性组之间的FF及BMD差异均有统计学意义(P<0.01),FF与BMD平均值存在高度负相关关系(r=-0.806,P<0.01)。结论MR波谱因其在评估骨质量方面有较好的优势,可为原发性骨质疏松评估提供一个有效的辅助方法。     

“Tower vertebra”: a new observation in sickle cell disease

Background. Skeletal abnormalities are common in sickle cell anemia. Ischemia, infarction, and growth disturbance of the thoracic and lumbar vertebral bodies are among the most common abnormalities, and can suggest the diagnosis radiographically. Design and patients. We recently encountered two adult patients in whom vertebrae had grown abnormally in height adjacent to infarcted short vertebrae. We then reviewed the thoracic and lumbar spine radiographs of 54 more adult patients with sickle cell anemia. Results and conclusion. A total of eight patients (14%) displayed infarcted vertebrae with compensatory vertical growth of at least one adjacent vertebrae. These resemble the elongated vertebral bodies associated with other conditions. We can find no prior report of this finding in association with sickle cell anemia.     

Importance of thyroid abnormalities detected at US screening: a 5-year follow-up

PURPOSE: To clarify the natural history and frequency of thyroid echo abnormalities in a random adult population by performing a 5-year follow-up study of subjects of a previous thyroid ultrasonographic (US) screening study. MATERIALS AND METHODS: In the original survey, 253 randomly selected adults were screened by means of thyroid US. US abnormalities were detected in 69 subjects (27%). In the follow-up study, 57 (83%) of those 69 subjects who had abnormalities were reexamined by means of thyroid US, fine-needle aspiration biopsy (FNAB), blood tests, and clinical examination. RESULTS: Of 34 individual nodules, 12 (35%) had grown. Biopsy was performed in 10 of them. Nine were benign. One was equivocal, was excised, and proved to be an adenomatous nodule. Eight nodules (24%) had diminished or disappeared. Seven new focal lesions were found in seven subjects (12%). Biopsy was performed in five of these lesions, and they were benign. At 5-year follow-up, no thyroid malignancies were detected among subjects with echo abnormalities at the primary US screening. CONCLUSION: Thyroid US abnormalities occurring in a random adult population are predominantly benign and clinically unimportant.     

椎弓切除对腰椎稳定性影响的三维运动研究

用８具新鲜成人男性尸体标本腰椎功能单位，通过脊柱三维运动实验机施加最大载荷为１０．０Ｎ．ｍ的６种力偶，使脊柱前生前屈／后伸，左／右侧弯和左／右轴向旋转运动。经立体摄像计算机图像处理得到Ｌ１～２节段的运动范围（ＲＯＭ），中性区（ＮＺ）和弹性区（ＥＮ）等参数。后在同一节段切除小关节和椎弓。将完整标本测量的结果为自身对照组，根据节段间的变化定量分析小关节和椎弓切除对腰椎三维运动的影响。结果：全椎弓和全小关节切除后６种力矩的ＲＯＭ均增加非常显著，脊柱失稳。     

骨质疏松成骨治疗后腰椎骨区域骨密度变化

运用区域骨密度测量,探讨骨质疏松治疗后腰椎骨密度改变.材料和方法:对38例骨质疏松患者128个维生素D和钙剂治疗前后腰椎骨进行前后位DEXA椎骨平均骨密度测量和区域骨密度测量对照.椎骨平均骨密度测量区包括L1～4上下终板之间的椎骨部分,区域骨密度测量区选择椎体上终板下方水平、椎体中部水平、椎体下终板上方水平和双侧椎弓根.结果:治疗后椎骨平均骨密度增高,治疗前后平均骨密度值比较相差显著(P＜0.05),L1～4各椎骨平均骨密度提高率相差不显著(P＞0.05),治疗后各区域骨密度增高,同部位区域骨密度治疗前后相差显著(P＜0.05),水平区域骨密度提高率之间相差显著(P＜0.05),椎体下终板上方水平区域增幅最大(P＜0.05),左侧椎弓根和右侧椎弓根提高率之间相差不显著(P＞0.05).椎骨平均骨密度增加与下终板区域上方水平、上终板下方水平区域骨密度相关系数最大,关系最密切.结论:骨质疏松成骨治疗后区域骨密度的提高是不均匀的.     

Determination of vertebral fracture threshold by measuring bone mineral content in the lumbar vertebrae]

Bone mineral density (BMD) in the lumbar vertebrae (L2-L4) was assessed by dual energy X-ray absorptiometry (DEXA: QDR-1000), and the values obtained were compared with the frequency of vertebral fracture as assessed by spinal X-ray photographs. Patients with spondylosis or scoliosis, which affect BMD values, were excluded from the study. An essentially linear correlation was observed between the frequency of vertebral fracture and lumbar BMD values: no vertebral fractures were observed in those whose BMD more than 0.8 g/cm2, whereas the frequency of fracture was 100% in patients whose BMD was less than 0.45 g/cm2. Thus, measurement of lumbar vertebrae by DEXA would be very useful in predicting vertebral fractures.     

Normal and abnormal features of the lumbar spine observed in dual photon absorptiometry scans

Dual photon absorptiometry (DPA) is an extensively used technique for measuring the density of the lumbar spine. The presence of vertebral and extra-vertebral pathologies can lead to increased scatter of data and artifactual bias when constructing diagnostic reference value curves. The bone density of patients with such abnormalities cannot be compared with those of normals because it will appear artificially high. Furthermore, little effort has been made to identify and evaluate spinal abnormalities using the pictograms produced in this method. We have analyzed 60 DPA scans for morphologic changes, using x-rays for comparison, and have found practically complete concurrence between these two radiologic methods on features, though only the former is capable of accurately quantifying bone density. Examples of DPA presentation of anatomical morphology are shown to aid the user in interpreting DPA findings.     

Vertebral venous channels: CT appearance and differential considerations

A comprehensive study of the anatomy, radiologic images, and pathology of venous channels in the thoracic and lumbar vertebral bodies was performed using cadavers and patients. These structures may be mistaken for fractures, lytic lesions, or other abnormalities on high-resolution axial computed tomographic (CT) scans of the spine. A distinct osseous wall, absence of extension over multiple contiguous levels, lack of displacement, and predominant localization in the mid-axial plane of the vertebral body are characteristic features of venous channels. An understanding of the normal intraosseous venous anatomy should prevent misinterpretation of clinical CT studies in most instances.     

A case of paraspinal arteriovenous fistula in the lumbar spinal body assessed with time resolved three‐dimensional phase contrast MRI

A 93‐year‐old female with a paraspinal arteriovenous fistula (AVF) occurred within the lumbar spinal vertebral body was assessed with time resolved three‐dimensional (3D) phase‐contrast MRI (4D‐Flow) on 1.5 Tesla MR scanner (GE Healthcare). The 3D vector field, streamlines, and pathlines analyses demonstrated uni‐directional flow from the aorta to the large vascular cavity in the lumbar vertebral body by means of the lumbar artery as well as dilated paravertebral veins as drainers, which confirmed AVF, not aortic pseudoaneurysm. The 4D‐Flow also showed an added value in planned endovascular surgery concerning localization of the precise shunting point and the shunting volume quantification. J. Magn. Reson. Imaging 2012;36:1231–1233. © 2012 Wiley Periodicals, Inc.     

椎体软骨破裂症与椎体后缘软骨结节的CT诊断价值

目的:提出腰椎软骨板破裂与椎体后缘骨内软骨结节之间的关系。方法:对照32例腰椎软骨破裂及椎体后缘骨内软骨结节(LPMN)CT影像(32例均行手术治疗)进行分析。结果:CT可分为两型:Ⅰ型,软骨板连续型,即椎体后缘骨内软骨结节型(Schmorl’s结节),Ⅱ型,软骨板断裂型。结论:CT检查对腰椎软骨板破裂症及椎体后缘软骨结节有重要诊断价值,对制订手术方案具有指导意义。