16层螺旋CT三维和多平面重组对儿童先天性脊柱侧弯的评价

目的 运用16层螺旋CT三维（3D）和多平面重组技术对先天性脊柱侧弯患儿进行评估，探讨此技术的优势和临床指导意义。方法 搜集2004年4至10月司27例先天性脊柱侧弯患儿的影像学资料，男13例，女14例，中位年龄3岁。27例均进行了X线片、16层螺旋CT容积3D、标准和曲面多平面重组技术。结果 10例患者有分节异常，6例患者有形成异常，11例患者有复杂的、无法分类的畸形。15例肋骨畸形中，肋骨畸形的主要部分和脊柱旋转在同水平的有7例。8例合并脊髓纵裂，其中6例有完全或不完全的骨性隔。27例中的19例患者，多平面重组和3D图像显示出在常规X线片和常规轴面图像中未发现和认知的畸形并且全面评估了脊柱侧弯的程度，包括11例复杂畸形中7例归类为无法分类的脊柱畸形，4例为单侧未分节的骨桥合并同侧半椎体畸形；4例清晰显示出单侧未分节的骨桥（3例）和双侧骨桥融合（1例）；2例发现了掩蔽的半椎体畸形；2例重新评估了半椎体的类型和数目；27例曲面多平面重组图像更好的显示了椎管形态和脊髓弯曲情况，6例清晰显示椎管内骨性隔的生长方式和形态；4例患者标准多平面重组更好的显示了颅底-C1-C2的解剖和畸形，尤其是颅颈联合部畸形。结论 16层螺旋CT3D和标准或曲面多平面重组图像是诊断先天性脊柱侧弯、分析复杂多发或隐蔽脊柱和肋骨畸形的首选方法，在评价儿童脊柱侧弯的进展、修订手术方案较常规平片和（或）常规CT更具优势和指导意义。

16 multi-slice CT three-dimensional and multiplanar reconstruction for evaluation of pediatric congenital scoliosis

Objective Our study is to use of 16 MSCT three-dimensional images and multiplanar reconstruction images in the preoperative investigation of patients with congenital scoliosis,to study its technical advantage and work out surgical plan.Methods Twenty-seven pediatric patients with congenital scoliosis processing between April to October 2004 were reviewed, including 13 boys and 14 girls. X-ray plain film and sixteen multi-slice CT examination on curved/standard multiplanar reconstruction and three-dimensional computed tomographic imaging may offer many potential advantages for defining congenital spine anomalies liable to cause progression of scoliosis, including visualization of the deformity in any plane, from any angle, with the overlying structures subtracted. Results Ten patients had segmentation defects, 6 patients underwent formation defects, 11 patients had complex, unclassifiable anomalies. The patients of rib deformity were found in 15 patients,the most prominent part of the rib cage deformity was at the same level as the most rotated vertebra in 7 patients; 8 patients had vertebral anomalies accompanied with diastematomyelie, including 6 patients with uncompleted or completed bony spur. In 19 of 27 cases, the multiplanar reconstruction and three-dimensional images allowed identification of unrecognized malformations and completely evaluated the degree of scoliosis,during conventional X-ray images and axial CT images, including volume 3D imaging evaluated approximately classification and modality of complex anomalies in 11 cases ,which were unclassifiable malformation in 7 cases and unsegmented bar with contralateral hemivertebrae; 4 children had segmentation defects revealed unilateral unsegmented bar (3 cases) and bilateral block vertebra (1 case) in volume 3D reconstruction images; 2 children were found occultation hemivertebrae which were not been discovered during conventional X-ray images and axial CT images; and 2 children were revaluated the amount of hemivertebrae. The curved multiplanar reconstruction images in all cases were best for defining the spinal canal and spinal medulla, and showed clearly the modality and developed way of bony spur, even the relationship with spinal cord in 6 cases. The standard multiplanar reformatted images in 4 cases were helpful in showing occipital-C1-C2 anatomy and malformatiom, especially the junction of skull and cervix malformation. Conclusion Our data suggest that 16 MSCT three-dimensional images and multiplanar reconstruction images appears to be most useful tool in the patients with congenital scoliosis in which the anomalies are complex, multiple, or obscured by deformity and rib malformation. The reformatted images of MSCT is markedly superior to conventional X-ray images and axial CT images when used to evaluate the progressive spinal curvatures and work out surgical plan.