下腰痛影像诊断的临床综合评估

Comprehensive clinical assessment on imaging diagnosis of low back pain

[目的]探索下腰痛各种影像学检查方法的合理选择,避免资源浪费,减少病人支出,使其发挥互补作用。[方法]对61例下腰痛患者包括腰椎间盘突出症(38例)、椎管狭窄(4例)、滑脱(10例)、感染(4例)和肿瘤(5例)的影像学资料进行分析。[结果]临床症状和体征是引导正确诊断的基础,影像学检查结果只有建立于其上才有意义。常规X线摄片对骨性结构具有较高的分辨率,可为进一步影像学检查提供依据。脊髓造影根据硬膜囊及神经根管的影像学改变来判断下腰段的病变,对较小的L5S1椎间盘突出和极外侧椎间盘突出不易诊断。计算机体层摄影(CT)从横断面观察脊柱的病变,但较局限,不易观察椎管内CT值相似的软组织病变。脊髓造影后CT扫描(CTM)则提高了诊断的阳性率。磁共振成像(MRI)从多平面显示多节段的病变,对软组织具有很高的分辨率,但对骨性结构的分辨率较CT差。[结论]常规X线摄片是最基础且重要的常规检查方法,脊髓造影、CT、CTM、MRI对下腰痛的诊断各有其特点,不能相互替代,而是起相互补充的作用。

[ Objective ] To pursue the appropriate selection of radiographic examinations of low back pain and to reduce the expenses. [ Method] In this study, 61 cases of imaging tests were studied, including 38 cases of lumbar disc herniation, 10 cases of lumbar spondylolisthesis, 4 lumbar stenosis, 4 lumbar infection and 5 lumbar neoplasm. [ Result] Correct diagnosis was based on the clinical signs and symptoms. Imaging findings had its value only when basing on them. Conventional roentgenogram offered a cheap evaluation and high spatial resolution of bony structures. And it could give a clue to take further imaging studies. Low back disorders could be inferred from the contrast column defect of dura sac and nerve root sheath in the myelography. In the diagnosis of disc herniation, its limitations existed at far lacteral and L5 S1 disc herniation. Computed tomography, a cross-sectional imaging modality, allows direct visualization of the bony structure of the spine. But routine imaging could only cover a limited number of levers. Another limitation was the difficulty in distinguishing the soft tissue changes in the spinal canal with the similar CT values. CT-myelography was performed to delineate more clearly the bony and soft tissue anatomy, and could determine whether lesions were medullary, intradual or extradual in location. MR imaging provided the larger anatomic region in multiple planes with high spatial resolution of soft tissue. One limitation of MR imaging was relatively low spatial resolution of bony structure. [ Conclusion] Of all imaging studies conventional roentgenogram is the most important and the most fundamen- tal. It could not be substituted by myelography, CT, CT-myelography, and MR imaging, which have their designated own roles respectively in the clinical decision-making process and in general were more complementary than competitive.