原发性颅底凹陷症的CT、CTM、MR特征及检查方法的选择

A Study on CT, CTM and MR Feature of Basilar Impression and Investigation Program

目的 探讨原发性颅底凹陷症的影像学表现及最佳检查程序。方法 观察平片、CT、CTM、MR表现 ,比较各种检查方法在显示该病的骨关节改变、神经组织受压情况及各种合并症的优势。结果 CT在显示骨结构变化方面优于平片及MR ,CT骨测量的准确性 (10 0 % )高于平片 (75 % ) ;各种影像检查方法在显示寰枢椎脱位方面无差异 ;CTM、MR在显示延脑的形态及受压程度方面优于常规CT ,CTM (2 0 / 2 0 ,10 0 % ) ,MR(2 7/ 2 7,10 0 % ) ,常规CT(15 / 78,19% ) ;5例MR +CTM检查者 3例合并脊髓空洞症 ,MR全部检出 ,CTM仅检出 1例。结论 认识颅底凹陷症的CT、CTM、MR表现将有助于做出准确、全面的诊断和选择恰当的检查程序 ,对术前选择手术方式具有很高的价值。

Objective To investigate the CT, CTM and MR features of basilar impression (BI) and find the best investigation program. Methods The CT, CTM and MR sign of BI were observed, and the ability of CT, CTM and MR to show the pathologic changes of bone and joint, ligament, neurotissue, and other accompanying disease were compared. Results CT is superior to simple X ray film and MR in showing bony structures. For accuracy of diagnosis of BI, CT (100%) is superior to simple X ray film (75%, P< 0 5). For showing the compression of medulla oblongata, either CTM (20/20, 100%) or MR (27/27,100%) is superior to CT (15/78, 19% P <0 01). Heowever, for showing atlanto axial subluxation, all the methods above were the same. In 5 cases, in which both MR and CTM were performed, syringomyelia was present on MR in 3 cases and on CTM only in one. Conclusion The recognition of CT, CTM and MR features of BI is helpful in making accurate and comprebensive diagnosis, and working out the proper investigation and therapeutic plan. [