MSCT多模式重组诊断脊髓分裂畸形的临床应用

The clinical application of MSCT multiple mode reformation in diagnosing split cord malformations

目的总结多层螺旋CT在诊断脊髓分裂畸形中的临床应用。方法13例脊髓分裂畸形的病人均进行全脊柞CT扫描，后分别进行图像后处理，方法包括多平面重组（MPR）、容积再现（VR）、最大密度投影（MIP）、曲面重组（CPR），比较各种图像后处理方法在判断椎管内骨嵴的形态、范围、伴发椎体畸形以及相应脊髓改变等方面的各自优势。结果13例病人中PangⅠ型8例（61．5％），PangⅡ型5例（31．5％）。VR像对于6例椎管内骨性分隔及伴发椎体畸形的形态显示较好，立体感强；但2例纤维性分隔及所有病人脊髓的改变几乎不能显示。MIP对骨骼和脊髓的异常均能显示，但4例脊椎侧弯的病例难以显示脊椎全貌。CPR像对4例脊柱侧弯的病人可显示脊椎全貌，但脊髓改变在2例侧弯程度较重的病人中难以清晰蛀示。结论CT诊断脊髓分裂畸形准确、可靠，多种图像后处理方法结合使用可最大限度的对病变节段的椎体、脊髓状况做出判断，有利于临床治疗方案的确定。

Objective To summarize the clinical application of MSCT in diagnosing split cord of malformations （SCMs）. Methods Totally 13 cases of SCMs were underwent CT examination of whole vertebrae. The imaging postprocessing methods include multiple plane reformation （MPR）, volume render （VR）, maximum intensity projection （MIP） and curved plane reformation （CPR）. The advantages of each methods were compared concerning the shape and extent of intraspinal osseous septa, as well as the accompanied vertebral malformation and the spinal cord change. Results 8 cases （61.5%） were Pang Ⅰ type and 5 cases （31.5%） were Pang Ⅱ type. VR picture had advantage in showing intraspinal osseous septa and accompanied vertebral malformation in 6 cases. But fiber septa in 2 cases and all spinal cord change were hardly display on VR image. MIP images had the ability to display the osseous and spinal cord change, but hardly display the whole vertebrae of scoliolosis in 4 cases. CPR images could exhibit the whole verle- brae of scoliolosis patients, but the spinal cord changes were difficult to clearly display. Conclusion MSCT has the ability to accu- rately and reliably diagnose split cord of malformation. Combined multiple image post-processing methods may help surgeon to make the judgement about the affected vertebrae and spinal cord change.