螺旋CT多平面三维重建技术在脊柱侧弯术前扫描的应用

Application of Three-dimensional Multi-planar Reconstruction Technique with Spiral CT in Scoliosis During Its Pre-operative Scanning

【目的】探讨螺旋CT多平面三维重建在脊柱侧弯术前的应用价值、成像方法及成像扫描参数 ;为临床提供与手术密切相关的椎弓根层面的各种准确参数。【方法】确诊为不同类型的脊柱侧弯患者 98例 ,应用Philips Mx 80 0 0型多层螺旋CT机 ,根据侧弯程度及类型确定扫描范围 ,并对所取得的数据进行重建。重建方法为MPR法 ,在矢状位和冠状位图像上调整重建出每一椎体的最佳椎弓根横断位图像。逐一测量双侧椎板宽度、椎弓根的宽度、椎体前缘至双侧横突距离、椎管宽度、椎体旋转角度及椎体前后径等数值。【结果】98例脊柱侧弯患者的MPR重建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、椎旁组织及其脊髓的情况。测量椎弓根、椎体、椎管、椎体旋转角度等各种参数并标注在图像旁提供给临床医生。【结论】螺旋CT多平面三维重建技术能准确提供脊柱侧弯特别是严重脊柱侧弯患者脊柱、椎体、椎弓根层面、椎管等各种参数 ,对提高矫形手术的成功率有着极其重要的作用。电压 12 0KV ,毫安秒为 35 0mAs、螺距 0 .75～1.2 5mm、层厚 3.2mm、层间距 1.6mm时扫描为最理想的扫描参数。

Objectives]To evaluate the three-dimensional (3-D) multi-planar reconstruction technique (MPRT) with spiral CT in scoliosis during its pre-operative scanning and to explore the best scan method for creation of high quality image and accurate scanning parameters.Ninety-eight cases with different types of scoliosis were involved in this study using Philips-Mx 8000 multi-slice spiral CT scanner. The scanning range was determined by the type and severity of disease. All data obtained were reconstructed to create the best image. MPRT was used to reconstruct the best transverse plane image for every pedicle of vertebral arch at the vector and coronary planes. The width of bilateral laminae and pedicles ,the distance between anterior edge of the vertebrae and the transverse process, the width of spinal canal ,the rotation angles of vertebrae as well as the antero-posterior longitude of vertebrae were measured.The MPRT reconstructed images in 98 cases of scoliosis displayed a clear pedicle plane, at the same time it also could distinguish the conditions of the vertebrae , spinal canal , spinal cord and the soft tissues around vertebrae. All the parameters relevant to pedicle, vertebrae , spinal canal and the rotation angles of vertebrae were labeled on the films, providing reliable reference for the physicians.[Conclusion]3-D MPRT with spiral CT can offer various parameters of the vertebrae concerning spine, spinal canal and the pedicle plane that will play very important role in the rectifying operation of scoliosis, especially in the severe cases. Voltage 120kV, current 350mAs, pitch 0.75～1.25 mm, slice width 3.2mm and the scan interval of 1.6mm are the most appropriate scanning parameters during pre-operative CT scan in scoliosis.