腰神经根CT多平面重组同层显示的解剖学特征及临床价值探讨

Features and clinic values of normal lumbar nerve root anatomy with CT on multiple plane reconstruction techniques at the same slice

目的探讨腰神经根(LNR)16层螺旋 CT 多平面重组同层显示的解剖学特征及临床价值。方法选55例腰椎正常者和23例经手术病理证实的 LNR 病变者(腰椎椎间盘突出症8例、椎管狭窄症5例、恶性肿瘤4例、创伤5例及结核1例)。使用美国 GE 公司生产的 Light Speed 16层螺旋 CT 扫描,在工作站(ADW4.1)上利用 UNIX 操作系统进行 LNR 多平面重组,选取 LNR 走行清晰的同层显示层面,观察其解剖学特征。对病变者重点分析其异常表现。结果在斜冠状面上双侧LNR 可对称显示:55例(100%)L1～5的 LNR 均可分别单节段显示;55例(100%)L1～2或 L2～3,以及 L3～4的 LNR 均可同时显示2个节段;49例(88%)L1～3、46例(84%)L2～4、20例(36%)L3～5可同时显示3个节段;15例(27%)L1～4的 LNR 同时显示4个节段;8例(15%)同时显示5个节段LNR。每条 LNR 均能显示走行的起止点、方向、大小、形态、张力状态及毗邻关系。除斜冠状面外 LNR均不能对称显示,但显示的长度相对增加而数目减少,单根重组时 LNR 均显示的最长。LNR 异常主要表现受压23例,同时伴粘连20例,移位14例,萎缩13例,增粗9例。结论 16层螺旋 CT 的多平面重组同层显示技术是整体显示 LNR 解剖学特征极为理想的方法,它对 LNR 病变的影像学诊断奠定了基础。LNR 走行"同层显示"及"路标"的新概念,可能为其进一步影像学研究奠定基础。

Objective To explore features and clinic values of LNR anatomy with multiple planar reconstruction techniques with 16-slice spiral CT at the same slice. Methods The lumbar vertebrae with normal adults of 55 cases and 23 cases with abnormal LNR caused by 8 cases with protrusion of lumbar disc, 5 cases with spinal stenosis,4 cases with malignant tumor ,5 cases with trauma and 1 case with lumbar TB confirmed by operation were scanned with 16-slice spiral CT made in American GE company in routine posture of the lumbar vertebrae, reconstructed LNR with UNIX system in workstation （ ADW 4. 1 ）, and analyzed their normal and abnormal anatomic manifestations at the same slice. Results All of LNR can symmetrically showed on oblique and coronal planes according to different segments ： one segment from L1 to L5（ 55,100% ）, two segments： from L1 to L2, L2 to L3 and L3 to IA（55,100% ）, three segments： from L1 to L3 （49,88%）, from L2to IA（46,84% ）and from L3 to L5（20,36% ） ,four segments： from L1 to L4 （ 15,27% ） and five segments ： （ 8,15% ）, respectively. Each LNR, including their whole shapes of passage from starting to end, direction, size, shape, tension and peripheral relationship and so on can showed clearly on oblique and coronal planes and on other planes. However, the later planes can increase LNR but decreasing numbers of LNR and especially increase very long one LNR reconstruction. Primary manifestation of all diseases can be showed on oppressing along its walking line, meanwhile, 20 cases with adhesion, 14 cases with displacement, 13 cases atrophy and 9 cases with increasing diameter. Conclusions Image anatomy features of full LNR with 16-slice spiral CT with the multiple plane reconstruction techniques is very ideal ways at the same slice. It is a very valuable way to make diagnosis and treatment of LNR diseases. The concept of ＂road sing＂ and showing ＂at the same slice＂ of LNR are tried to rise from in order to make foundation for studying their image.