脊柱侧弯的多层螺旋CT后处理技术的临床应用

目的 讨论多层螺旋CT后处理技术在脊柱侧弯治疗中的应用价值.方法 搜集脊柱侧弯患者25例影像资料,均行常规X线片,多层螺旋CT(MSCT)容积扫描,应用最大密度投影(maximum intensity projection,MIP)、多平面重组(multiplanar reformation,MPR)、曲面多层面重组(curved multiplanar reformation,CMPR)、表面遮盖显示(shaded surface display,SSD)、容积显示技术(volume rendering technique,VRT)、四维重建(four-dimension,4D)对所得容积数据进行后处理,观察各种后处理图像的优势和临床指导意义.结果 25例中,18例为特发性脊柱侧弯,6例为先天性脊柱侧弯,1例为后天性脊柱侧弯.①多平面重组和3D、4D图像显示出在常规X线片和常规横轴位图像中未发现和认知的畸形且全面评估了脊柱侧弯的程度,6例先天性脊柱侧弯中3例发现了掩蔽的半椎体畸形,并且评估了半椎体的类型和数目.② MPR/CMPR可以从各个角度重组畸形椎体的冠状、矢状影像,是最方便实用的显示方法;MIP因为层次不明,不适用脊柱侧弯的诊断;SSD可观察全脊柱影及侧弯的曲度,但缺乏对椎管内形态显示;VRT通过调节不同密度的阈值并辅以不同的伪彩依次可显示骨质及椎管的形态,尤其适用观察侧弯的分类和椎管情况;4D可清晰评价脊柱侧弯的所有相关表现.结论 多层螺旋CT横轴位结合其丰富的后处理图像为脊柱侧弯的诊断提供了有价值的空间结构信息,在临床医师选择治疗方案和制订手术路径上具有指导意义.     

螺旋CT在先天性脊柱侧弯诊断中的应用

目的 探讨16层螺旋CT对先天性脊柱侧弯的诊断价值.方法 收集自2007-06-2010-04经放射学检查和临床诊治的先天性脊柱侧弯患者40例.术前均行16层螺旋CT扫描,然后在工作站完成多平面和曲面重组(MPR/CPR)、表面最大密度投影(SurMIP)和容积重建(VR),评价不同后处理图像的应用价值.结果 VR可以清晰评价先天性脊柱侧弯的所有相关表现,尤其适用于脊柱侧弯的分类.MPR/CPR重建图像能清晰显示椎弓根层面,显示畸形椎体、椎管并进行椎体旋转角度测量.40例先天性脊柱侧弯中,脊柱侧弯越重则顶椎的旋转度数越大,各椎体椎弓根矢状径均大于横径且凹侧椎弓根横径均小于凸侧,相邻椎体有类似表现.SurMIP可以用来测量脊柱侧弯角度,类似于X线片.结论 MSCT的后处理技术对矫形手术方法的制定有重要价值.     

多层螺旋CT后处理技术在脊柱检查中的应用价值

目的:探讨多层螺旋CT在脊柱检查中的应用价值。方法:对35例脊柱病变进行多层螺旋CT容积扫描,应用多平面重组(multiplanar reformation,MPR)、曲面多层面重组(curved multiplanar reformation,CMPR)、表面遮盖显示(shaded sur-face displays,SSD)、容积显示技术(volume rendering technique,VRT)、切面VRT(slab VRT)对所得容积数据进行后处理,观察各种后处理方法在显示脊柱结构或病变中的效果。结果:MPR在观察椎间盘、椎体骨质增生、椎间隙和脊柱曲度方面具有优势,CMPR在观察椎间隙及脊柱侧弯方面具有优势,SSD和VRT在观察椎体骨质增生、脊柱曲度、椎体附件小关节、椎间孔、脊柱侧弯和脊柱整体形态具有优势,切面VRT在观察椎间隙、脊柱曲度、椎体附件小关节和椎间孔方面具有优势。结论:多层螺旋CT在脊柱的检查中有着独特的优势,应该根据不同的疾病选择不同的后处理方式。     

X线平片与螺旋CT对先天性脊柱侧弯的应用价值

目的探讨多层螺旋CT(MSCT)和X线平片对于先天性脊柱侧弯的诊断价值。方法对临床诊断为先天性脊柱侧弯的40例患者行脊柱CT扫描,经最大密度投影(MIP)、多平面图像重组(MPR)、表面容积遮盖(SVR)及表现遮盖图像(SSD)后处理,并对照X线平片分析不同的处理后图像的应用价值。结果术前X线平片诊断脊椎形成障碍18例,脊椎分节障碍15例,混合型7例。MSCT诊断脊椎形成障碍13例,脊椎分节障碍12例,混合型15例,伴有脊柱纵裂6例,肋骨畸形8例,椎管内纵行骨嵴4例。SVR图像可较全面地评价先天性脊柱侧弯的所有相关表现。结论MSCT的多种后处理图像较X线平片更具优势,能准确和全面判断脊柱畸形的类型和范围。     

64层螺旋CT对先天性脊柱侧弯的术前评估及测量价值

目的 探讨螺旋CT对脊柱侧弯术前评估的价值.方法 脊柱侧弯患者90例,行64层螺旋CT扫描,根据侧弯程度确定扫描范围,并对所取得的数据进行重组.螺距0.75、扫描层厚5 mm或10 mm、重组层厚1 mm,间隔0.5 mm.重组方法为MPR法,在SSD或VRT图像上调整重组出每一椎体的最佳椎弓根横断位图像.逐一测量椎弓根横径、椎弓根深度、椎管横径、椎弓根轴线与椎体、棘突纵轴夹角.结果 90例脊柱侧弯患者的MPR重组图像均能清晰显示椎弓根层面,并能同时显示椎体本身、椎管、椎旁组织的情况.以上参数均能准确测量.结论 螺旋CT多平面重组技术对脊柱侧弯患者术前评估有着极其重要的作用.     

多层螺旋CT在肋骨微细骨折诊断中的应用价值

目的 探讨多层螺旋CT薄层重建及曲面重组技术在诊断肋骨微细骨折中的实用价值。方法 对38例临床怀疑肋骨骨折而常规X线平片显示阴性的病例，应用多层螺旋CT扫描并行薄层重建及曲面重组观察。由CT室3组医师分别对常规5mm层厚、1mm层厚横断图像及曲面重组图像进行分析。结果 （1）3组医师应用1mm层厚横断图像及曲面重组图像均确诊26例59根肋骨骨折，另12例未见骨折。3组医师对常规5mm层厚图像的肋骨骨折诊断准确度分别为86．4％、89．8％、94．9％。（2）26例肋骨骨折中单纯左侧肋骨骨折12例、右侧肋骨骨折11例，双侧肋骨骨折3例。（3）按骨折程度分为完全性肋骨骨折18根和不完全性肋骨骨折41根。在18根完全性肋骨骨折中断端错位均不超过2个皮质宽度。结论 不完全性肋骨骨折及无明显移位的完全性肋骨骨折应用X线平片准确诊断困难，薄层重建及曲面重组技术可及时、准确诊断不同程度的肋骨骨折，曲面重组图像清晰、直观地完整显示了肋骨结构及肋骨骨折的位置、形态及程度。     

16层螺旋CT诊断胸腰椎创伤性骨折临床分析

目的 探讨16层螺旋CT应用于胸腰椎创伤性骨折诊断中的价值.方法 分析在我院接受治疗的胸腰椎创伤性骨折62例患者的CT影像学资料,并对比分析这62例患者的多平面重组图像（MPR）、横轴位图像、表面遮盖法三维立体重建（SSD）图像的优缺点.结果 在对于椎体部位的骨折以及脱位、轴向线的骨折、椎管狭窄、成角畸形的显示上多平面重组及表面遮盖法三维立体重建图像的显示效果较好,而在附件骨折脱位以及非轴向线上的骨折横轴位图像显示效果较好.结论 16层螺旋CT具有多平面重组图像、横轴位图像、表面遮盖法三维立体重建图像等优点.     

多层螺旋CT三维成像在急性肋骨骨折诊断中的应用

目的:探讨多层螺旋CT三维重组在急性肋骨骨折诊断中的价值。方法:利用GE Lightspeed 16多层螺旋CT机对胸部外伤患者在外伤后10d内进行多层螺旋CT肋骨扫描,并进行薄层重建,于工作站上进行VR、MIP三维图像重组,由2位医师对后处理图像进行观察,并与肋骨平片结果对照分析。结果:66例中总肋骨骨折数为200根,CT横断图像直接显示骨折线63例198根,检出率99%。三维容积重组图像显示骨折197根,检出率98.5%。其中2根三维重组图像显示而横断面图像未能显示,3根横断面显示而三维图像未能显示。肋软骨骨折1例1根。平片诊断骨折152根,检出率76%;可疑骨折6例12根,CT确诊10根,排除2例;平片未见骨折5例,CT扫描发现10根骨折;另有4例确诊10根,可疑5根,CT确诊16根骨折,排除3根骨折。结论:多层螺旋CT三维成像对肋骨骨折的检出率、诊断符合率明显高于普通肋骨平片,结合横断面CT图像可准确定位,发现合并症,是胸部外伤后常规肋骨平片的重要补充检查。     

64层螺旋CT后处理技术对不确定性肋骨骨折的诊断价值

目的探讨64层螺旋CT后处理技术对不确定性肋骨骨折的诊断价值。方法回顾分析64层螺旋CT容积扫描胸部外伤患者386例,筛选出26例患者,共32处不确定性肋骨骨折,将原始图像导入工作站进行多种后处理,包括薄层多平面重组、薄层曲面重组、表面遮盖、容积再现,进行诊断分析。结果薄层曲面重组发现肋骨骨折30处,排除2处,薄层多平面重组发现肋骨骨折30处,排除2处,表面遮盖发现骨折16处,容积再现发现骨折23处。表面遮盖、容积再现在显示骨折的空间解剖结构上有优势,薄层多平面重组、薄层曲面重组在显示肋骨骨折微细的变化上效果良好。结论薄层多平面重组、薄层曲面重组对不确定性肋骨骨折的显示较表面遮盖和容积再现图像更明确。薄层多平面重组、薄层曲面重组结合表面遮盖、容积再现三维重组图像对不确定性肋骨骨折的具体部位能准确定位。     

螺旋CT及MRI对先天性脊柱侧弯的应用价值

目的 探讨CT及MRI对先天性脊柱侧弯患者全脊柱畸形的应用价值.方法 比较3组共59例先天性脊柱侧弯患者在脊柱全貌、顶椎及脊髓3方面的显示率,第1组25例于脊髓造影后5～6 h后行全脊柱三维CT重建,第2组20例仅行全脊柱三维CT重建,第3组14例仅行MRI检查.结果 第1组25例在脊柱全貌、顶椎及脊髓显示方面满意度均为100%;第2组20例在显示脊柱全貌、顶椎方面满意度为100%,脊髓显示的满意度为40%;第3组14例脊柱全貌显示满意度为21.4%、顶椎显示满意度为42.8%,脊髓显示满意度为71.4%.结论 对先天性脊柱侧弯患者术前影像学检查中,与磁共振及单纯CT检查相比较,CT全脊柱重建结合CTM能更全面了解脊柱畸形及脊髓异常.     

Three-dimensional computed tomography in the assessment of congenital scoliosis

Objective. Patients with congenital vertebral anomalies frequently are afflicted with kyphoscoliosis, with the curvatures often being severe and progressive. Spinal fusion almost always is the treatment of choice in such patients. This report examines the use of three-dimensional computed tomography (3D CT) in the preoperative investigation of patients with congenital scoliosis. Design and patients. Twelve spinal CT examinations on 11 pediatric patients with congenital scoliosis underwent image processing to produce 3D images. The 3D images were compared with both the axial sections from the CT examinations and multiplanar reformations with regard to the detection of malformations liable to cause progression of scoliosis (i. e., hemivertebrae and unsegmented bars). Results and conclusions.In six of the 12 cases, the 3D images provided improved depiction of the congenital anomalies and their interrelationships compared with planar CT images. This work suggests that 3D CT can be a useful tool in the assessment of patients with congenital scoliosis. Received: 16 February 1999 Revision requested: 19 May 1999 Revision received: 10 June 1999 Accepted: 11 June 1999     

Multidetector CT virtual bronchoscopy to grade tracheobronchial stenosis

OBJECTIVE: The purpose of this study was to compare the efficacy of noninvasive multidetector CT (virtual bronchoscopic images, axial CT slices, coronal reformatted images, and sagittal reformatted images) in depicting and allowing accurate grading of tracheobronchial stenosis with that of flexible bronchoscopy. MATERIALS AND METHODS: Multidetector CT and flexible bronchoscopy were used to examine 200 bronchial sections obtained from 20 patients (15 patients with bronchial carcinoma and five without central airways disease). Multidetector CT was performed using the following parameters: collimation, 4 x 2 mm, pitch, 1.375; and reconstruction intervals, 2 mm. Postprocessing was performed using surface rendering and multiplanar reformatted images. CT images were independently interpreted by two radiologists. The tracheobronchial stenoses revealed on flexible bronchoscopy were graded by a pulmonologist. RESULTS: Virtual bronchoscopic findings, axial CT scans, and multiplanar reformatted images were highly accurate (98% accuracy for virtual bronchoscopic images, 96% for axial slices and coronal reformatted images, and 96.5% for sagittal reformatted images) in revealing tracheobronchial stenosis. In allowing accurate grading of tracheobronchial stenosis, images from virtual bronchoscopy correlated closely (r = 0.91) with those of flexible bronchoscopy. Because use of virtual bronchoscopic images reduced the overestimation of stenosis, these images allowed better assessment of stenosis than did axial CT slices (r = 0.84) or multiplanar reformatted images (r = 0.84) alone. CONCLUSION: Multidetector CT virtual bronchoscopy is a reliable noninvasive method that allows accurate grading of tracheobronchial stenosis. However, it should be combined with the interpretation of axial CT images and multiplanar reformatted images for evaluation of surrounding structures and optimal spatial orientation.     

Diagnostic value of 3 D CT surface reconstruction in spinal fractures

Our purpose was to evaluate the diagnostic value of three-dimensional (3 D) CT surface reconstruction in spinal fractures in comparison with axial and reformatted images. A total of 50 patients with different CT-proven spinal fractures were analysed retrospectively. Based on axial scans and reformatted images, the spinal fractures were classified according to several classifications as Magerl for the thoraco-lumbar and lower cervical spine by one radiologist. Another radiologist performed 3 D CT surface reconstructions with the aim of characterizing the different types of spinal fractures. A third radiologist classified the 3 D CT surface reconstruction according to the Magerl classification. The results of the blinded reading process were compared. It was checked to see in which type and subgroup 3 D surface reconstructions were helpful. Readers one and two obtained the same results in the classification. The 3 D surface reconstruction did not yield any additional diagnostic information concerning type A and B injuries. Indeed, the full extent of the fracture could be easier recognized with axial and reformatted images in all cases. In 10 cases of C injuries, the dislocation of parts of vertebrae could be better recognized with the help of 3 D reconstructions. A 3 D CT surface reconstruction is only useful in rotational and shear vertebral injuries (Magerl type C injury). Received: 29 May 1995; Accepted: 11 January 1996     

螺旋 CT 容积扫描方法诊断胸廓骨及肋骨骨折的价值探讨

目的：探讨螺旋CT容积扫描诊断胸廓骨骨折的临床价值。方法笔者回顾性分析2011年1月～2014年6月拟诊断为胸廓骨及肋骨骨折患者80例的临床资料,男性49例,女性31例;年龄22～76岁,平均（40．2±2．3）岁。均具有完整X线片、3D图像和CT轴位扫描图像资料,并对X线、3D图像和CT轴位扫描图像的诊断结果进行对比分析。结果排除可疑骨折,以CT轴位扫描图像作为金标准,X线诊断的灵敏度为61．54％,特异度为66．67％;3D容积重建（ VR）诊断的灵敏度为98．59％,特异度为87．50％。结论螺旋CT可快速确诊胸廓骨及肋骨骨折,容积扫描中的容积再现法（ VR）、最大密度投影法（ MIP）和多平面重组法（ MPR）技术能较好显示细微骨折,在解剖空间结构上有较强优势。     

EOS~(TM)在青少年脊柱侧凸中的应用

脊柱侧凸是青少年常见的脊柱畸形。传统的X线摄影只能从二维平面评估侧凸畸形,且辐射剂量高。近年来新出现的EOS影像采集系统采用低于传统X线及CT的辐射剂量即可同步获得人体站立位正侧位全脊柱影像,并能通过三维重建获得多种测量参数,从而量化评估脊柱轴面旋转,有助于脊柱侧凸的诊断、分级、手术方案制定及术后随访,尤其适用于青少年特发性脊柱侧凸病人。就EOS的原理、优势及在青少年脊柱侧凸中的应用予以综述。     

头颈部肿瘤多层螺旋CT冠状面多平面重建与常规扫描图像的对比研究

目的 分析头颈部肿瘤多层螺旋CT冠状面多平面重建(MPR)与常规扫描图像，探讨冠状面MPR能否替代常规冠状面扫描。方法 使用GE Lightspeed Ultra 8层螺旋CT扫描仪对90例头颈部肿瘤患者进行扫描，在横断面基础上行MPR。由3位资深放射科医生对冠状面MPR像与常规扫描图像进行对比分析。结果 90例冠状面MPR像对正常鼻咽、鼻腔、鼻窦、上颈部等部位软组织的显示与常规扫描冠状面像相似，图像质量好，均为1级。59例(65．6％)冠状面MPR像对骨质的显示优于常规扫描像，68例(75．6％)对颅底孔道的显示优于常规扫描像。增强CT扫描中，51例明显肿瘤病灶，46例(90．2％)对肿瘤的显示优于常规扫描冠状面像。结论 多层螺旋CT扫描MPR图像除对口腔、口咽的显示欠佳外，均近似或优于常规冠状面扫描像，多层螺旋CT扫描的冠状面MPR可以替代常规扫描。     

Evaluation of multiplanar reconstruction in CT recognition of lumbar disk disease

Axial computed tomographic (CT) images were compared with sagittal and coronal reformations and myelograms in 60 patients to evaluate the diagnostic usefulness of multiplanar reconstructions for the recognition of lumbar disk disease. The axial CT scans were most sensitive and specific. The sagittal scans were helpful in evaluating the neural foramina, the size of the disk bulge into the spinal canal, especially at L5-S1, and patients with spondylolisthesis. The coronal images were the least informative, although they contributed to the evaluation of lumbar nerve roots. The myelograms and the sagittal images were equally useful in the detection of herniated disk, but axial scans were superior to either. It was concluded that reformatted sagittal and coronal images are not required if all axial images are normal. However, when uncertainty exists or complex anatomy is being evaluated, reformatted images may be helpful, particularly for reassurance.     

Multiplanar and three-dimensional multi-detector row CT of thoracic vessels and airways in the pediatric population

Multi-detector row computed tomography (CT) has changed the approach to imaging of thoracic anatomy and disease in the pediatric population. At the author's institution, multi-detector row CT with multiplanar and three-dimensional reconstruction has become an important examination in the evaluation of systemic and pulmonary vasculature and the tracheobronchial tree. In some clinical situations, multi-detector row CT with reformatted images is obviating conventional angiography, which is associated with higher radiation doses and longer sedation times. Although multi-detector row CT with multiplanar and three-dimensional reconstruction is expanding the applications of CT of the thorax, its role as a diagnostic tool still needs to be better defined. The purposes of this article are to describe how to perform multi-detector row CT with multiplanar and three-dimensional reconstruction in young patients, to discuss various reconstruction techniques available, and to discuss applications in the evaluation of vascular and airways diseases.