CR全脊柱拼接摄影与MRI在诊断脊柱侧弯畸形中的应用价值

Clinical Value of CR Total Spine Radiography and MRI in the Diagnosis of Scoliosis Deformities

目的 探讨CR全脊柱拼接摄影与MRI在诊断脊柱侧弯畸形中的应用价值.方法 收集2013年广州市番禺区高考体检DR胸部照片中发现的23例青少年特发性脊柱侧弯畸形患者,其中男10例,女13例,年龄17～19岁,平均18岁,男女比例为1∶1.3.所有病例均作CR全脊柱拼接摄影,其中7例进一步作MRI检查.结果 用Cobb角测量：10°～19°有13例（56.52％）;≥20°～39°有9例（39.13％）;≥40°有1例（4.35％）.不同节段侧弯情况：腰段侧弯（9例）＞胸段侧弯（8例）＞胸腰段侧弯（5例）＞双弯（1例）.23例中,CR摄影诊断：16例以脊柱侧弯为主要,未发现有脊髓及椎体畸形;5例发现脊柱侧弯伴有椎体畸形,2例可疑脊柱侧弯伴有椎管内病变.7例MRI诊断病例中,脊柱侧弯伴椎体畸形4例,伴脊髓空洞1例,伴中央管扩大1例,伴Chiari氏畸形1例.对脊髓异常的显示MRI检出率为100％,明显优于CR摄影.结论 青少年是特发性脊柱侧弯的多发群体,CR全脊柱拼接摄影可作为临床常规的普查手段,而MRI能提高对脊柱侧弯相关病变的检出率,是矫形或手术治疗前综合评估的重要补充,能更准确地指导临床诊治工作.

Objective To explore the clinical value of CR total spine radiography and MRI in the diagnosis of adolescent idiopathic scoliosis. Methods Twenty-three teenagers （10 males and 13 females, age ranged from 17 to 19 years, average age 18 years, proportion of male and female was 1 ： 1.3） with idiopathic scoliosis were enrolled in the study, and were examined at DR chest radiography physical examination of 2013 College Entrance Examination in Panyu District, Guangzhou. CR total spine radiography was carried out in all the cases, MRI scanning was performed in 7 cases. Results The Cobb＇s angle was used for measurement： thirteen cases （56.52%） of scoliosis with the Cobb＇s angle of 10~ - 19~; nine cases （39.13%） with more than 20~ - 39~; one case （4.35%） with more than 40~. Scoliosis of different segments： lumbar segment （nine cases） 〉 thoracal segment （eight cases） 〉 thoracolumbar segment （five cases） 〉double bend （one cases）. Among twenty three cases diagnosed by CR, sixteen cases were particularly in scoliosis, without spinal and vertebral deformity, five cases with vertebral deformity, two cases with suspected intraspinal canal disease. Among seven cases diagnosed by MRI, four cases were with vertebral deformity, one case with syringomyelia, one case with central tunnel expanding, one case with Chiari malformation. For spinal cord abnormalities, the detection rate of MRI was 100%, significantly higher than CR radiography. Conclusions Adolescents are prone to idiopathic scoliosis. CR total spine radiography can be used as a clinical egular scanning means, and MRI can be used as an important complement to integrated assessment before orthopedic or surgical treatment, which will improve the detection rate of related scoliosis lesions and guide the clinical diagnosis and treatment more accurately.