MSCT多平面重组技术在观察PKP术后骨水泥渗漏中的应用价值

摘要

目的：探讨多层螺旋CT（MSCT）多平面重组技术（MPR）在观察经皮穿刺椎体后凸成形术（PKP）后骨水泥渗漏中的应用价值。方法对PKP术后存在骨水泥渗漏的21个椎体的MSCT多平面重组图像和脊柱数字化X线摄影（DR）检查的影像学资料进行回顾性对比分析，其中胸椎6个，腰椎15个。结果21个椎体MSCT多平面重组的图像均发现骨水泥渗漏现象，其中椎体静脉渗漏4处，椎间盘渗漏4处，椎管内渗漏6处，椎旁软组织内渗漏7例，其中有2个椎体为多部位渗漏，检出率为100%。21个椎体中脊柱DR检查发现15个椎体有骨水泥渗漏现象，其中椎体静脉渗漏3例，椎间盘渗漏4例，椎管渗漏2例，椎旁软组织内渗漏6例，可疑椎管渗漏1例，检出率为71.42%。结论MSCT多平面重组技术在观察PKP术后骨水泥渗漏Ⅰ、Ⅳ、Ⅴ型与DR平片无明显差异，但在Ⅱ和Ⅲ型渗漏上较脊柱DR检查更加全面、直观，敏感性更高，特别是可以观察到椎管内骨水泥的数量，占据椎管内的空间、位置，对判断渗漏的骨水泥是否会造成神经根或脊髓的损伤具有重要的临床应用价值。%Objective To explore the application value of multi-slice spiral CT (MSCT) multiplanar reformation (MPR) in observing the leakage of bone cement after percutaneous kyphoplasty (PKP). Methods The multiplanar reformation images of MSCT and images of digital radiography of 21 vertebrae with bone cement leakage after PKP were retrospectively analyzed, including 6 thoracic vertebrae and 15 lumbar vertebrae. Results 21 vertebrae were determined as bone cement leakage with MSCT MPR, including 4 cases located in vertebral vein, 4 cases located in intervertebral disc, 6 cases located in spinal canal, 7 cases located in paravertebral tissue. Among the 21 leakage of bone cement, 2 cases located in multi-site. The detection rate of MSCT MPR was 100﹪. At the same time, 15 vertebrae were determined as bone cement leakage with DR examination, including 3 cases located in vertebral venous, 4 cases located in intervertebral disc, 2 cases located in spinal canal, 6 cases located in paravertebral tissue, and 1 case located in spinal canal was diagnosed as suspected leakage of bone cement. The detection rate of DR examination was 71.42﹪. Conclusion These were no significant differences in observingⅠ, Ⅳ and Ⅴ types of bone cement leakage between MSCT MPR and DR. However, MSCT MPR was more comprehensive, intuitive and sensitive than DR in the observation ofⅡandⅢtypes of bone cement leakage. MSCT MPR which can show the amount, space and location of bone cement in spinal canal has an important clinical application value in estimating whether the leakage of bone cement can cause the injury of nerve root or spinal cord.