膝关节周围神经多层螺旋CT、磁共振成像对照

[目的]探讨膝关节周围神经MSCT、MRI表现及解剖学特点。[方法]观察37例正常成年人膝关节周围神经在MSCT及磁共振图像上的表现,并对CT图像及磁共振3D-BRAVO T1WI图像在GE公司AW4.6工作站上进行多平面重组,取膝关节周围神经其同层显示层面,观察其影像学解剖特点。[结果]膝关节周围神经影像表现为索条样结构,内含脂肪组织。在MSCT图像与MRI测量并对比胫神经不同水平层面轴截面面积,二者无显著性差异。对照观察多平面重组图像与常规图像,测量胫神经与腓总神经单支显示最大长度、二者走行夹角及同层时神经长度,二者有显著性差异。主要神经走行方向、形态、粗细、张力及毗邻关系通过多平面重组同层能清晰显示。[结论]膝关节周围神经在MSCT与磁共振成像表现基本一致,其解剖特征能利用多平面重建同层理想地显示,3DBRAVO T1WI序列可以应用于外周神经的显示,为膝关节周围神经相关病变的影像学诊断奠定基础。     

16排螺旋CTMPR技术在腰椎峡部裂诊断中的价值

目的：探讨多排螺旋CT多平面重建技术在腰椎峡部裂诊断中的应用价值。方法：对临床怀疑腰椎间盘突出症1170例病人进行多层螺旋CT薄层横断面扫描，扫描完成后进行多平面重建，包括椎间盘横断面、腰椎矢状面及腰椎峡部平面。结果：椎间盘病变可以在横断面及矢状面得到更加准确的定位，而且矢状面对椎弓峡部显示清晰，并发现66例椎弓峡部裂。结论：多排螺旋CT多平面重建技术一次扫描可同时对椎间盘病变和椎弓峡部裂诊断提供精确可靠依据，避免腰椎峡部裂漏诊，对指导临床治疗方法选择有重要的价值。     

基于中国数字化人体的肩袖间隙薄层断面解剖与MRI对照研究

目的探讨基于中国数字化人体(CVH)和MRI对照,观察肩袖间隙(RI)薄层断面解剖特点,为临床应用提供影像解剖学依据。方法获取5个CVH肩关节解剖数据集,以斜冠状位、斜矢状位虚拟重建显示RI连续薄层断面解剖,并与20侧肩关节MR平扫T1WI,5侧肩关节MR造影(MRA)对照,用PhotoShop CS2软件观察RI。结果 3种显示方法中,CVH显示RI各边界最佳,优于MRI平扫T1WI和MRA。3个显示平面中,斜矢状位显示RI各边界结构及内容物最佳。在RI各边界显示中,其下界肩胛下肌腱、内界喙突在轴位、斜矢状位及斜冠状位3个平面中及CVH、平扫T1WI、MRA 3种显示方法中最易清楚显示。结论基于CVH的数据集研究RI边界及毗邻关系是较好的方法,以其斜矢状位显示肩袖间隙边界、内容物及毗邻关系为最佳,为肩袖间隙疾病影像诊断提供了重要的识别标志。     

CT神经同层显示技术对腰骶神经根变异的诊断价值

目的 :探讨CT神经同层显示技术对腰骶神经根变异(lumbosacral nerve root anomalies,LSNRA)的诊断价值。方法:顺序选取2015年10月~2016年5月在我院医学影像科因腰腿痛(除外腰椎术后、肿瘤或炎症引起疼痛者)而行腰椎CT检查的100例患者,男54例,女46例,年龄27~88岁(65.0±15.6岁)。采用Philips(Ingenuity CT)64排螺旋CT机行常规腰椎容积扫描,同时进行常规图像重组和神经重组(重组双侧L2神经根至S2神经根),并分别观察腰骶神经根形态。变异的神经根按坎贝尔骨科手术学的标准分为6型。结果:97例图像显示满意。常规图像(轴位、冠状位、矢状位)与神经重组图像各发现LSNRA 3例和13例,显示率分别为3.09%和13.40%,两者之间存在显著性差异(P=0.002)。在13例变异神经根中,Ⅱ型变异11例(84.62%),Ⅴ型变异2例(15.38%)。结论:CT神经同层显示技术可以完整、直观地显示神经根变异形态、走行及与相邻神经根的关系,是诊断LSNRA的一种较理想方法。     

骶丛、坐骨神经盆腔段在磁共振神经成像术的解剖特征

[目的]应用磁共振神经成像序列,探讨骶丛、坐骨神经盆腔段MRI表现及解剖学特点。[方法]观察40例(80侧)健康成年志愿者骶丛、坐骨神经盆腔段在磁共振图像上的表现,并利用GE公司AW4.6工作站对磁共振3D-BRAVO序列、3D-FIESTA序列图像进行多平面重建(MPR),取得最佳显示层面,观察其影像学解剖特点。[结果] 3D-BRAVO序列、3D-FIESTA序列能够完成骶丛、坐骨神经盆腔段的显示,并且可以通过多平面重建清晰显示其与周围结构的毗邻关系。在MRI神经成像序列上测量双侧骶丛神经的长度,二者差异无统计学意义(P0.05)。测量双侧坐骨神经、梨状肌下孔的前后径、左右径,二者差异无统计学意义(P0.05)。[结论]利用MRI神经成像及多平面重建同层显示技术可以理想地显示骶丛、坐骨神经盆腔段的解剖特征,清晰地描述梨状肌下孔的形态及其毗邻结构组成。3D-BRAVO序列结合3D-FIESTA序列可以应用于外周神经的显示,对骶丛、坐骨神经正常解剖、相关病变的影像学诊断具有重要意义。     

高分辨率CT整体重建坐骨神经的应用研究

36侧(87.80%)、粘连34侧(82.92%)、萎缩30侧(73.17%)、增粗6侧(14.63%). 结论 16层螺旋CT多平面重建同层显示技术是坐骨神经各构成支起点至出骨盆壁整体解剖学特征及病变基本表现的理想检查方法,它对SN相关疾病的诊断具有极其重要的应用价值.     

成人腹股沟区CT影像解剖

目的 探讨多层螺旋CT(multi-detector row spiral CT,MDCT)及多平面重建(multi-planer reconstruction,MPR)技术对显示正常成人腹股沟区解剖结构的价值.方法 回顾性收集2009年7～12月期间于我院行腹股沟区CT薄层扫描检查腹股沟区结构正常的成年受检者50例(男30例,女20例),并使用MPR获得冠状位及矢状位图像,观察轴位、冠状位及矢状位影像对腹股沟区主要解剖结构的显示.结果 各平面均可显示所有受检者的双侧腹壁下动脉(100/100,100%)、双侧精索(60/60,100%)及双侧子宫圆韧带(40/40,100%).冠状位图像上可显示所有受检者双侧的"影像学股三角"(100/100,100%).双侧腹股沟韧带在所有受检者(100/100,100%)的冠状位图像及34例受检者(68/100,68%)的矢状位图像上显示,但轴位图像上仅3例男性受检者(6/100,6%)可显示.双侧腹股沟管及腹股沟深环可在所有受检者(100/100,100%)的冠状位及46例受检者(92/100,92%)的矢状位图像上显示.冠状位腹股沟管宽度: 男性左侧(0.97±0.35) cm,右侧(0.89±0.23) cm;女性左侧(0.62±0.11) cm,右侧(0.71±0.11) cm,双侧间差异无统计学意义(男P=0.059,女P=0.067),但性别间差异有统计学意义(左侧P=0.007,右侧P=0.009).腹股沟深环横径: 男性左侧(1.32±0.31) cm,右侧(1.31±0.36) cm;女性左侧(1.07±0.35) cm,右侧(1.07±0.30) cm,双侧间差异无统计学意义(男P=0.344,女P=0.638),性别间差异有统计学意义(左侧P=0.001,右侧P=0.002).结论 MDCT可以清楚显示腹股沟区解剖结构,其中冠状位重建图像对解剖结构的显示价值最大.     

多层螺旋CT显示肝圆韧带的初步研究

目的：探讨肝圆韧带的多层螺旋CT表现及其临床意义。方法：对130例无肝脏疾病的患者行16层CT腹部平扫及增强扫描,采用多平面重组（MPR）、层块最大密度投影（slab-MIP）和层块容积再现（slab-VR）等后处理技术重点观测肝圆韧带。结果：在斜矢状位MPR,slab-MIP,slab-VR图像上肝圆韧带表现为符合其解剖走行特点的密度稍高的光滑条索灶,显示率为90.8%（118/130）。裂隙段中点处直径为(5.44±0.96)mm（3.2～7.2 mm）,游离段中点处直径为(3.43±0.91)mm（1.6～6.0 mm）。结论：多层螺旋CT能清晰显示肝圆韧带,可为以肝圆韧带为自体修复材料的上腹部手术提供较为可靠的术前影像学判断。     

多层螺旋CT轴位薄层重建与斜矢状位多平面重建图像对腰椎峡部裂的诊断价值

腰椎峡部裂是指椎弓上下关节突之间的狭细部分断裂．是椎体滑脱的主要病因之一。传统X线平片是诊断腰椎峡部裂的常规检查方法，但其获得的信息有限。CT特别是多层螺旋CT及其图像后处理软件的开发和应用为诊断腰椎峡部裂提供了更多更全面的影像信息。笔者对40例腰椎峡部裂患者的多层螺旋CT扫描轴位薄层重建图像及斜矢状位多平面重建（MPR）图像的特点进行分析，旨在探讨该技术在腰椎峡部裂中的临床应用价值。     

薄层连续MRI扫描描记臂丛神经

目的 通过薄层连续MRI扫描显示臂丛神经形态。方法 采用1．5-T MRI(GE，Signa)对6例健康志愿者行双侧臂丛神经斜矢状位和冠状位扫描，确认其与周围组织解剖定位关系，并观察其走行和分支情况。结果 所有志愿者的臂丛神经均得到了较好的显示，斜矢状位T2加权压脂可明显显示臂丛神经及部分神经束，特别是神经根出口处可以得到很好的显示。结论 薄层连续MRI扫描可以显示臂丛神经的形态，可以提高其对臂丛损伤的诊断。     

CT重建对腰椎多节段峡部裂的诊断价值

目的 统计腰椎多节段峡部裂的患病率,评价CT重建对腰椎多节段峡部裂的诊断价值.方法 选取2004年1月至2012年3月间因腰椎峡部裂在北京积水潭医院骨科住院接受手术治疗的所有患者(312例),男147例(占47％),女165例(占53％);年龄12～76岁,平均44岁.对所有病例行腰椎正、侧位,过屈、过伸位、双斜位X线片和腰椎CT检查,统计入院手术患者中腰椎多节段峡部裂的患病率和患病节段,总结其临床表现和影像学特点.结果 所有腰椎峡部裂手术病例中共发现多节段峡部裂患者9例,占患者总人数的2.9％,男5例,女4例;年龄21～51岁,平均39岁.腰椎峡部裂节段分布,8例为L4、L5双侧峡部裂,1例为L4右侧峡部裂、L5双侧峡部裂同时合并L4左侧椎弓根基底处不连续和腰椎不稳定.9例患者中有3例可以通过腰椎正、侧位和双斜位X线获得正确的初步诊断,全部患者可以通过腰椎CT矢状位和峡部重建确诊.在CT峡部重建片可以观察腰椎峡部骨缺损的具体形态,及其周围骨赘、骨痂、纤维组织增生的情况;当单侧峡部裂时,能观察到健侧椎板反应性硬化的表现.结论 腰椎多节段峡部裂并不罕见,占全部手术病例的2.9％,受累节段均为L4、L5.腰椎CT矢状位和峡部重建能更有效地观察峡部裂的形态,以减少漏诊并指导治疗方案.     

Lumbar spinal canal morphometry from computed tomography scans: reproducibility,results and clinical implications

Summary The reproducibility of measurements of the lumbar spine taken from computed tomography (CT) scans was assessed. The overall variaton in 53 patients scanned on more than one occasion was only 2.8%. Factors which reduced the reproducibility were increasing angle of scan from the mid-discal plane, measurement of oblique structures and measurement of dimensions with soft-tissue boundaries. Measurements from 142 patients are presented and compared with both other published series and the results from 17 patients with spinal stenosis. Whereas the sagittal diameter of the bony canal and the interpedicular distance of the patients with spinal stenosis did not differ from the control group, a new measurement described in this paper, the oblique sub-facet distance, demonstrated significant differences between the two groups.     

A long-term follow-up study of anterior tibial allografting and instrumentation in the management of thoracolumbar tuberculous spondylitis

OBJECT: The purpose of this study was to determine the efficacy of anterior instrumentation following radical debridement and tibial allografting and its long-term progression in patients with multilevel spinal tuberculosis. METHODS: This prospective observational study was undertaken to analyze 22 patients with multilevel spinal tuberculosis (Pott disease) who underwent anterior radical debridement, decompression, and fusion using anterior spinal instrumentation and tibial allograft replacement between 1999 and 2001. Clinical outcomes were assessed using the American Spinal Injury Association (ASIA) Impairment Scale and a visual analog scale (VAS). Preoperative and postoperative plain radiographs were obtained, and the focal kyphotic angle of the surgically treated spinal segments and the overall sagittal and coronal contours of the thoracic and lumbar spine were evaluated in all patients. RESULTS: The mean follow-up time was 84 months (range 36-96 months). All patients demonstrated clinical healing of the tuberculosis infection. All patients showed evidence of successful bone fusion. The mean late postoperative kyphosis correction was 74% (range 63-91%). On average, 2 degrees (range 0-5 degrees ) of loss of correction was noted in the local kyphotic angle postoperatively in late follow-up findings. Evaluation of the surgical effect on sagittal global contours showed a significant correction rate in thoracic, thoracolumbar, and lumbar regions. The mean late postoperative coronal plane alignment correction was 99%. The ASIA Impairment Scale scores demonstrated significant improvement in late follow-up results in our series. Surgical decompression also resulted in a dramatic reduction of overall pain in all patients (late postoperative VAS score 1.61 +/- 0.81). CONCLUSIONS: Anterior tibial allografting and instrumentation provide correction of the curvature, prevention of further deformation, improvement of sagittal and coronal balance, and restoration of neurological function in patients with spinal tuberculosis.     

Efficacy and safety of the use of titanium mesh cages and anterior cervical plates for interbody fusion after anterior cervical corpectomy

BACKGROUND: To determine the safety and effectiveness of the use of titanium mesh cages (TMCs) and anterior cervical plates (ACPs) for interbody fusion after anterior cervical corpectomy. METHODS: From June 2001 to June 2003, 15 patients underwent reconstruction with TMCs and ACPs for interbody fusion after anterior cervical corpectomy in our hospital. The mean follow-up is 13.6 months (range, 9-24 months). Subjects included those with cervical degenerative, traumatic, or pathological diseases. Titanium mesh cages were filled with autologous bone grafts taken from the corpectomy and iliac crest bone chips and were all filled with triosite (calcium phosphate ceramics). The patients' observable signs, neurological reconstruction results, and complications were fully and explicitly recorded throughout the procedure. Radiological imaging studies for measurements of coronal and sagittal angles, sagittal displacements, and settling ratio changes were performed to evaluate spinal stability. We used axial cervical computed tomography (CT) and reconstructive sagittal cervical CT to demonstrate interbody fusion within titanium mesh. RESULTS: The alleviation and frequent disappearance of the subjects' original symptoms and the significant neurological recovery obvious in most patients indicated that postoperative spinal stability could be well maintained. No significant differences in mean cage height-related settling rates, mean sagittal displacements, and mean coronal and sagittal angle changes were observed between 1-level and multilevel corpectomy. All patients who received axial and reconstructive sagittal cervical CT scan could demonstrate true interbody fusion within TMC, and no nonunions were present. Cage malplacement was observed in one subject who had neck pain and neck stiffness, rather than from radiculopathy or myelopathy. One subject died of acute myocardial infarction. There were no ceramic-related complications. CONCLUSIONS: Based on preliminary findings from this study, reconstruction involving TMC interbody fusion with ACP fixation after anterior cervical corpectomy serves as an effective and safe method for the treatment of cervical disease.     

Curve correction effect of rigid spinal orthosis in different recumbent positions in adolescent idiopathic scoliosis (AIS): a pilot MRI study

In this pilot cross-sectional study, the effectiveness of rigid spinal orthoses in the correction of spinal curvature of 14 patients with moderate adolescent idiopathic scoliosis (AIS) at different recumbent positions (supine, prone, right and left decubitus) was investigated. Using magnetic resonance (MR) imaging and multi-planar reconstruction technique, evaluation of the scoliotic spine in the coronal, sagittal and axial planes and the effect of spinal orthosis on AIS at different recumbent positions was studied. There was significant reduction of coronal Cobb's angle (p < 0.05) with bracing at all four recumbent positions and the maximal reduction was found in the prone position (18% reduction). The sagittal Cobb's angle was only significantly reduced at the supine position while the axial rotation did not change significantly in all positions.     

The technique of direct multiplanar high resolution CT of the temporal bone

The technique of direct multiplanar high resolution CT opens new possibilities for detecting even the smallest lesions of the central nervous system and its coverings. The prerequisites are: Submillimetre spatial resolution. Thin slice thickness collimation. Sufficient radiation dose to keep the noise in the image around about 1%. No waiting time between scans other than short reconstruction times, or use of rapid sequence scan procedures. Possibility to position patients and immobilize them for direct scanning of coronal and sagittal planes without significantly reducing the patient's comfort. Possibility of using optional algorithms which improve spatial resolution further (MacroView) in order to bring out very fine details. This article describes the technique we have used in order to fulfil these prerequisites and also gives a few results relating to the imaging of the facial nerve canal.     

CT辅助腰椎终板形态学研究

目的：通过计算机断层扫描技术对健康成人腰椎终板结构进行解剖测量与研究,为腰椎假体的优化设计与临床应用提供有益指导。方法：有偿征集60名健康成人（男女均等）,签署知情同意书后于西安交通大学第二附属医院影像科行全腰段CT扫描。将扫描数据导入计算机辅助软件Mimics 16.0进行三维重建及测量。采集指标包括正中矢状径、最大冠状径,凹陷深度、正中矢状面凹陷角,冠状面凹陷角等共9项,最后利用统计学软件对采集数据进行统计学分析。结果：上下终板的正中矢状径与最大冠状径不但具有性别差异（P<0.05）,而且随着腰椎序列的增加呈增大趋势。上下终板凹陷深度无性别差异（P>0.05）,自L₁至L₅变化较小,分别在1.5~2.0 mm与2.2~3.9 mm波动;同一序列男性下终板凹陷深度大于上终板且差异有统计学意义（P<0.05）,而女性上下终板凹陷深度比较差异无统计学意义（P>0.05）。上下终板矢状面凹陷角与冠状面凹陷角随着椎体序数的增加整体变化较小而且绝大部分椎体序列上矢状面与冠状面凹陷角均无性别差异（P>0.05）。统计学显示靠近尾侧腰椎终板最大凹陷处位于终板平面偏背侧。结论：人体腰椎终板解剖结构比较复杂,熟悉掌握终板解剖参数以及术前充分利用CT辅助测量对于腰椎假体的研制及临床应用具有重要意义。     

Value of multidetector spiral CT in diagnosis of acute thoracolumbar spinal fracture and fracture-dislocation

Objective: To investigate the diagnostic value of multidetector spiral CT (MSCT) in acute thoracolumbar spinal fracture and fracture-dislocation. Methods: CT imaging files of 152 consecutive traumatic patients with thoracolumbar fractures were retrospectively reviewed. MSCT scannings were performed with a collimation of 3-5 mm and a pitch of 5.5. The postprocessing included sagittal and coronal multiplannar reconstruction, and 3-D reconstruction. Results: There were 88 cases of compression fracture, 54 cases of burst fracture and 10 cases of fracture-dislocation. Transverse images of MSCT could visualize all fractures directly and determine whether spinal canal was intact. Postprocessing image was helpful in depicting the displacement of fragment and orientation of dislocation. Conclusions. MSCT plays an important role in diagnosis and management of acute thoracolumhar spinal fracture and fracture-dislocation.     

Three-dimensional computed tomography and multiplanar reformations in the assessment of pseudarthrosis in posterior lumbar fusion patients

Three-dimensional (3-D) surface reconstructions and multiplanar computed tomography (CT) reformations were obtained in 30 patients with clinically suspected spinal fusion pseudarthrosis. The imaging studies were blind-reviewed and the results were compared with the clinical and surgical findings. Sagittal, planar, and curved coronal two-dimensional (2-D) reformations were more useful in the detection of bony nonunion than were axial CT scans, as the latter required more extensive analysis. Three-dimensional surface "cuts" adequately demonstrated pseudarthrosis in most cases. In some instances, however, segmentation artifacts created artifactual clefts or implied solidity, which contrasted with the interpretation of the 2-D images. Sagittal 3-D cuts were helpful in demonstrating bony central and lateral stenosis. Three-dimensional surface reconstructions demonstrated superficial clefts and outlined the complex anatomy of the spinal fusions, thus facilitating pre- and intraoperative planning. The amount of bone stock available for pseudarthrosis repair at the fusion site and the need for additional harvesting of bone from the iliac crest also could be assessed easily. 3-D CT proved to be useful as an adjunctive imaging method in the evaluation of posterior lumbar fusion patients suspected of pseudarthrosis.     

Thoracal flat back is a risk factor for lumbar disc degeneration after scoliosis surgery

Background contextLumbar segments below fused scoliotic spines are thought to be exposed to extraordinary stress. Although positive sagittal imbalance has come into focus, reports about factors influencing the outcome of these segments remain inconclusive.PurposeOur study aimed at identifying spinal risk factors for the development of lumbar degenerative disc disease (DDD) in surgically treated patients with adolescent idiopathic scoliosis (AIS).Study design/settingRetrospective comparative prognostic study (Level III) was conducted. Thirty-three patients were seen at an average follow-up of 7.5 years after either isolated selective anterior (n=18) or long combined anterior-posterior fusion (n=15) for AIS.Outcome measuresSelf-reported Scoliosis Research Society 22 questionnaire, physical examination including the detection of segmental pain and unspecific back pain, preoperative and postoperative whole-spine standing radiographs, and magnetic resonance imaging were obtained.MethodsRadiographic evaluation included the measurement of regional, coronal, and sagittal curve parameters and the assessment of spinal balance. Magnetic resonance imaging evaluation was done for preoperative and postoperative lumbar discs, according to the classification of Pfirrmann.ResultsPatients with low DDD (Pfirrmann grading <3) had a significantly higher thoracal kyphosis angle (mean 28°) than patients with advanced DDD (mean 15°). There was a trend toward a more flat-type lumbar lordosis in patients with severe DDD. Positive sagittal imbalance was associated with advanced DDD. Follow-up coronal parameters, trunk imbalance, instrumentation length, and lowest instrumented vertebra selection had no influence on DDD. Specific segmental pain could be attributed to a significantly higher coronal trunk imbalance (21 vs. 11 mm).ConclusionsThis study establishes thoracal flat back as a risk factor for lumbar DDD after spinal fusion and supports the pathogenetic role of positive sagittal imbalance in this process.