腰椎间盘突出症的CT诊断

CT diagnosis of lumbar disc herniation

目的 :探讨腰椎间盘突出症的CT征象及其病理基础 ,提高对该病的诊断率。方法 :对 14 5例病人行腰椎间盘CT轴位扫描或螺旋薄层扫描后进行矢状位、冠状位的多平面重建。结果 :腰椎间盘突出好发于L4 L5、L5 S1两个节段 ,其主要CT征象 :①突入椎管内的髓核所形成的软组织块影 ;②硬脊膜囊受压、变形、移位 ;③神经根肿胀、受压移位或湮没 ;④碎块形成、滑移 ;⑤许莫氏结节形成 ;⑥突出的髓核部分钙化 ;⑦螺旋CT三维重建 (MPR)成像主要征象 :矢状位为椎体后缘突入椎管内呈半圆形卯钉状或乳头状的软组织块影 ,冠状位为突入椎管内的圆形或椭圆形软组织块影。结论 :CT是诊断腰椎间盘突出症的重要方法 ,其准确率在 91%以上 ,且能清楚显示局部伴随征象 。

Objective:To study CT features of intervertebral disc herniation and its pathomorphology,and to improve the accuracy of the diagnosis.Methods:Lumbar intervertebral disc herniation of 145 patients underwent axial CT or helical CT scanning with thin slice,which would be reconstructed in sagittal and coronary plane with MPR.Results:Herniation occurred frequently at the level of L 4 S 1 intervertebral space.The main CT features of the herniated intervertebral disc were as follows:①soft tissue mass formed by extrusion of the disc into the spinal canal;②compression,distortion and displacement of the dural sac;③swelling,compressing displacement and obliteration of nerve root;④formation and migration of disc fragments;⑤formation of Schmorl′s nodule;⑥partial calcification of herniated nucleus pulposus;⑦On the reconstructed images with MPR the herniated disc appeared as a rivet like or papillary soft tissue mass on sagittal plane and as a round or oval mass on coronary plane.Conclusion:CT is an important method in the diagnosis of lumbar disc herniation and its accuracy is over 91%.