64层螺旋CT扫描及重建方式对腰椎峡部裂的诊断价值

Value of 64 MSCT with reconstruction in diagnosing lumbar spondyloschisis

目的:探讨多层螺旋CT在腰椎峡部裂诊断中的扫描及重建方式。方法:26例腰椎峡部裂患者行椎间盘扫描,对L4～5及L5～S1椎间盘加大扫描范围,包括椎弓根层面;对其中10例行螺旋扫描,图像后处理采用平行于峡部的椎弓长轴最大密度投影(MIP)及多平面重建(MPR)。结果:包括椎弓根层面的轴位扫描均能显示峡部裂和其他伴发表现,包括椎管增大或变窄、侧隐窝狭窄、双边征、椎间盘变形、椎小关节退行性变和黄韧带肥厚。采用平行于峡部的椎弓长轴MPR、MIP斜矢状面重建能直观显示峡部裂的典型表现——猎狗项圈征,正中矢状面重建能显示椎体滑脱。结论:对常规椎间盘扫描采用对L4～5及L5～S1椎间盘加大扫描范围,包括椎弓根层面的方法,对于轴位扫描发现或可疑峡部裂的患者再做相应椎体螺旋扫描,行平行于峡部的椎弓长轴多平面斜矢状面和矢状面重建,是腰腿痛病人CT检查的简单、实用的有效方法。

Objective： To discuss the method of scanning and image reconstruction with MSCT in lumbar spondyloschisis. Methods： Twenty-six patients were scanned with CT for the intervertebral disc. The scan range were enlarged for L4-5, L5-S1 interverteral disc and including vertebral arch. Spiral scan were performed in 10 cases. The images were reconstructed with muhiplanar reformation（MPR） and maximum intensity projection（MIP） along the direction of vertebral arch. Results： Axial scanning including vertebral arch can show spondyloschisis and other signs. These contained widened or stenosis of the spinal canal, stenosis of the lateral recess, the double margin sign, deformity of the intervertebral disc, denegeration of the joint facet and thickening of the ligamentum flavum. Scotty dog sign were showed in images reconstructed along the direction of vertebral arch. Spondylolysis were showed in sagittal images. Conclusion： The scan range were increased for the fourth lumbar to first sacroiliac interverteral disc and contained vertebral arch for conventional intervertebral disc. The spiral scanning were performed for lumbar spondyloschisis and with MPR along the direction of vertebral arch. The method is simple and useful for the patients suffered low-back pain.