螺旋CT后处理技术对青少年先天性脊柱畸形的诊断价值

目的：将先天性脊柱畸形的多层螺旋CT(MSCT)后处理图像与X线平片进行对比研究，探讨MSCT后处理技术的诊断价值。方法: 收集37例先天性脊柱侧凸畸形患者的X线平片、MSCT后处理图像，将3D CT、曲面重建(CPR)、多平面重建(MPR)图像与X线平片进行等级比较。MSCT重建图像能发现新病变、进一步证实X线平片上的模糊病变、没有新的发现分别为A、B、C级。其中20例怀疑合并神经系统异常行脊髓核磁共振(MRI)检查。结果: A级 25例（227处），B级5例（29处），C级7例（35处）。畸形位于颈椎、胸椎、腰椎、颈胸椎、胸腰椎、腰骶椎段，分别为2、12、8、4、7、2例，颈、胸、腰段均有病变2例。X线检出64处，MSCT检出291处，X线所见病变均可在MSCT图像上显示。同组患者行脊髓MRI检查20例，其中脊髓栓系、脊髓纵裂、脊髓空洞、Chiari-Ι畸形、脊膜膨出分别为5、5、3、1、2例，脊髓无明显异常4例。结论: 3D CT、MPR、CPR图像相结合可清晰显示先天性脊柱畸形的整体和细微结构，发现X线平片上不能显示的病变。CPR图像可使侧凸的脊柱整体显示在冠状和矢状位，有利于对复杂脊柱畸形的整体观察。

Post-processing techniques of spiral CT in adolescent congenital spinal deformity

Objective： To explore the diagnostic value of post-processing techniques of multi-slice spiral CT (MSCT) in congenital spinal deformity. Methods： Thirty-seven cases of adolescent congenital spinal deformity subjected to MSCT and plain radiography were retrospectively reviewed. They were classified into 3 grades based on the utility of the advanced MSCT reformatted images: the grade A group (substantial new information was obtained), the grade B group (confirmatory with improved visualization and understanding of the deformity), and the grade C group (no added useful information was obtained). Twenty cases expected to have nervous system abnormalities were determined by MRI. Results： There were 25 cases (227 deformities) in grade A, 5 cases (29 deformities) in grade B, and 7 cases (35 deformities) in grade C. Deformations were located in the cervical vertebrae in 2 cases, in the thoracic vertebrae in 12 cases, in the lumbar vertebrae in 8 cases, in the cervical-thoracic vertebrae in 4 cases, in the thoracic lumbar vertebrae in 7 cases, in the lumbar-sacral vertebrae in 2 cases, and in the cervical thoracic-lumbar in 2 cases. 64 deformities were shown by X-rays, and 291 deformities by MSCT. Of the 20 cases suspected of nervous system abnormalities, 5 cases had TCS, 5 cases had diastematomyelia, 3 cases had syringomyelia, 1 case had Chiari-Ι malformation, 2 cases had meningomyelocele, and 4 cases were normal. Conclusion： 3D CT combined with (Curved) multi-planar reformatted images can clearly reveal the whole and detail the anatomical structure of congenital spinal deformity and obtain more useful information not presented on plain radiographs. Curved planar reformatted images can describe the whole scoliotic spine in coronal and sagittal planes and have advantages in wholly observing congenital spinal deformity.