腰椎间盘疾患诊治中腰椎间盘造影后计算机体层摄影术与磁共振显像的对比研究

Comparison between CT-discography and magnetic resonance imaging in lumbar disc diseases

目的分析腰椎间盘造影及间盘造影后计算机体层摄影术(CTD)在腰椎间盘疾患的诊治中的应用并与磁共振显像(MRI)进行比较。方法回顾性分析256例患者298例间盘造影及CTD的结果并与MRI结果进行比较,其中男177例,女79例,年龄(39±16)岁,均有腰腿痛病史。根据间盘造影及CTD的表现将间盘分为7种类型。237例患者(257间盘)有完整MRI资料,也按MRI结果进行分型并与前面的分型进行分组对比。结果245例患者行手术治疗,术中可直视的间盘共247个,238例(96．4％)间盘造影及CTD准确提示了间盘异常的情况。CTD与MRI的分组对比中,两种诊断方法判断间盘结构改变的阳性率间的差异有统计学意义(P<0．01)。MRI对间盘阴性间盘造影结果的预测能力有限。结论腰椎间盘造影术是一个有效、可靠和安全的辅助诊断方法。加上造影术后的CT平扫,可以获得一些其他的方法所不能获得的有关间盘情况的临床资料。多组对比研究表明MRI与CTD之间不能相互替代。MRI可作为间盘病变诊断的筛选方法,但是,MRI对间盘病变的阴性预测能力有限,对脊柱内固定融合术前相邻间盘结构是否完整的判断仍需采用椎间盘造影及CTD。

Objective To investigate the clinical importance of discography and CT after discography （CTD） in the lumbar disc diseases, and make a comparison between CTD and magnetic resonance imaging （MRI）. Methods 265 patients with back and leg pain 177 males and 79 females, age 39 ＋ 16, underwent discography and CT 2 hours later on 298 discs. All the patients＇ discs were classified into 7 types according to the findings by discography and CTD. Comprehensive MRI pictures were available in 237 of the 265 patients （with 257 discs）; they accepted the MRI classification and were compared with the CT-discographie findings. Results 245 patients underwent operation, among which 247 discs showed visual lesions during the procedure and 238 eases （96. 4% ） had their disc diseases diagnosed accurately through discography and CTD. Considering the positive screening rate for the discogenie abnormality, the difference was of statistical significance between the CTD and MRI groups, （P 〈 0. 01 ） MRI was considered to have limited value in the disc diseases with passive diseographie finding, Conclusion Discography is an efficient, sound and safe assistant diagnostic tool, which can get some special information about disc. The matched-group study shows that the MRI and CTD can not be re placed by each other. MRI may act as the screening tool for disc diseases, but is inferior to CTD, especially for the contiguous disc structure in the spinal fixation procedure.