螺旋CT三维成像在颈椎损伤病变中的应用

Application of Spiral CT 3D Reconstruction in the Trauma of Cervical Vertebrae

目的 探讨螺旋CT三维成像 (MPR、SSD)在颈椎损伤中的应用价值。材料与方法 经X线和 /或螺旋CT证实的颈椎损伤 15例 ,行螺旋CT扫描 ,并作MPR和SSD成像 ,13例扫描参数为层厚 3mm ,床速 4.5mm/s ,重建间距 1.5mm ;2例为层厚 5mm ,床速5mm/s ,重建间距 2mm。SSD最低阈值选择 15 0～ 180。结果 椎体及附件骨折 10例 ,其中 6例伴环齿关节脱位 ,1例椎体滑脱。椎体旋转脱位 4例 ,成角滑脱 1例。 15例中 3例椎管狭窄并硬脊膜受压。MPR结合轴位图像可完全明确骨折、脱位及椎管情况。SSD对颈椎表面骨折、椎体旋转及成角脱位显示良好 ,立体感强 ,但对椎体内骨裂或骨折、椎管内病变显示差。结论 颈椎损伤应首选CT检查。轴位图像、MPR及SSD联合应用 ,能明确病变性质 ,立体、直观、多方位提供临床医师所需信息 ,有利于治疗方案的选择。

Objective To evaluate spiral CT 3 D imaging (MPR and SSD) in the diagnosis of cervical trauma.Materials and Methods In this study, 15 patients with cervical trauma, confirmed by radiography and/or Spiral CT scans, were collected. The scanning parameters used in 13 patients were as follows: collimation 3 mm, table speed 4.5 mm/s, reconstruction interval 1.5 mm. For the remaining two patients the collimation was 5 mm, table speed 5 mm/s and reconstruction interval 2 mm. MPR and SSD was obtained. The lower value of SSD threshold was 150～180.Results Fractures of vertebral body and appendix were seen in 10 cases, of which atlantoaxial dislocation was accompanied in 6, vertebral olisthy in 1, rotatory dislocation in 4 and angled olisthy in one. Of the total 15 cases, spinal canal stenosis and oppression of dura was seen in 3. MPR combined with axial images could well display the whole picture of fracture, dislocation and spinal canal. SSD could stereoscopically demonstrate the shallow cervical fractures, the rotatory and angled dislocation, although it had limitations in showing fractures within vertebral body and lesions within spinal canal.Conclusion CT scanning is the choice of examination for patients with cervical injury. A combination of axial images and MPR, SSD provides valuable diagnostic and anatomic information helpful for the surgeon to decide clinical management.