MSCT多种测量方法在上颈椎椎弓根测量中的应用价值

摘要

目的:探讨MSCT不同测量方法在上颈椎椎弓根测量中的应用价值.方法:选择51例怀疑或确诊为上颈椎病变患者行颈部CT检查.通过MIP、MPR和VR等后处理方式分别显示椎体、椎弓根及周围的解剖结构.在MPR、MIP和VR图像上分别测量C2椎弓根宽度(PW),椎弓根的长度(PL),椎弓根高度(PH),头倾角(PSA)和内倾角(PMA). 由1名主管技师独立对3种方法测量的数值差异、可操作性及显示能力进行比较分析. 结果:MPR、MIP和VR 3种方式均能很好地显示椎体、椎弓根及周围的解剖结构和彼此的空间位置关系. MPR、MIP和VR 3种方法测定的C2椎弓根数据是:①MPR:PW(右/左)为(5.43±1.62)mm/(5.43±1.53)mm,PL(右/左)为(25.66±3.79)mm/(26.57±3.76)mm,PH(右/左)为(9.18±2.20)mm/(9.08±2.34)mm,PSA(右/左)为(31.79° ±9.57° )/(32.13° ±9.96° ),PMA (右/左)为(31.14° ±10.22° )/(32.69° ±10.57° ). ②MIP:PW (右/左)为(6.04 ±1.62)mm/(6.11±1.66)mm,PL(右/左)为(28.59±3.76)mm/(28.95±3.79)mm,PH(右/左)为(9.52±2.13)mm/(9.19±2.10)mm,PSA(右/左)为(28.73°±11.00°)/(29.88°±2.82°),PMA(右/左)为(35.78°±11.84°)/(35.68°±12.30°). ③VR:PW(右/左)为(6.82±1.75)mm/(6.52±1.92)mm,PL(右/左)为(28.28±3.93)mm/(28.40±3.76)mm,PH(右/左)为(9.64±1.73)mm/(9.33±2.13)mm,PSA(右/左)为(31.82°±8.81°)/(29.12°±2.33°),PMA(右/左)为(34.00°±11.28°)/(36.43°±11.90°). 左右椎弓根数据间差异均无统计学意义.3种测量方法两两之间行配对t检验,MPR与MIP在评价PL、PW和PMA(右)上差异均有统计学意义(均P<0.05),MPR与VR在评价PL、PW 和PSA(右)上差异均有统计学意义(均P<0.05),MIP 与 VR 在评价 PW 和 PSA(右)上差异均有统计学意义(均P<0.05);其余数据差异无统计学意义(P>0.05). 结论:MSCT 3种测量方法均可以用于上颈椎椎弓根数据的测量,为上颈椎后路内固定置钉提供参考,在实际工作中,可根据需要采用不同的测量方法.%Objective:To explore the application value of multi-slice CT (MSCT) different measuring methods in the measure-ment of C2 cervical vertebral pedicle. Methods:51 patients suspected or confirmed upper cervical disease were collected and performed cervical CTA examination,all the primary data. Multi-planar reformation (MPR),maximum intensity projection (MIP) and volume render (VR)were used to show the structure of vertebra,vertebrae pedicle,the relationship between the cervical vertebra and adjacent structure. Measure the pedicle data of C2 in MPR,MIP and VR images,including pedicle width (PW), pedicle length (PL),pedicle height (PH),pedicle superior angle (PSA),pedicle median angle (PMA). Comparative analysis about the data difference,the operability and the display ability of post-processing image were accomplished by one technician in charge independently. Pair sample t-test statistical analysis was used for the difference of two sides and the consistency of C2 data of three methods. Results:MPR,MIP and VR could show the anatomy structure and nearby space relationship of cervi-cal pedicle vertebral. The records of pedicle were as follow:(1)MPR:C2-PW(R/L) (5.43±1.62)mm/(5.43±1.53)mm,C2-PL(R/L) (25.66±3.79)mm/(26.57±3.76)mm,C2-PH(R/L) (9.18±2.20)mm/(9.08±2.34)mm,C2-PSA(R/L) (31.79°±9.57°)/(32.13°±9.96°), C2-PMA(R/L) (31.14°±10.22°)/(32.69°±10.57°). (2)MIP:C2-PW(R/L) (6.04±1.62)mm/(6.11±1.66)mm,C2-PL(R/L) (28.59± 3.76)mm/(28.95±3.79)mm,C2-PH(R/L) (9.52±2.13)mm/(9.19±2.10)mm,C2-PSA(R/L) (28.73°±11.00°)/(29.88°± 2.82°),C2-PMA(R/L) (35.78°±11.84°)/(35.68°±12.30°). (3)VR:C2-PW(R/L) (6.82±1.75)mm/(6.52±1.92)mm,C2-PL(R/L) (28.28±3.93)mm/(28.40±3.76)mm,C2-PH(R/L) (9.64±1.73)mm/(9.33±2.13)mm,C2-PSA(R/L) (31.82°±8.81°)/(29.12°± 2.33°),C2-PMA(R/L) (34.00°±11.28°)/(36.43°±11.90°). With pair sample t-test statistical analysis,there was no significant difference between the left and right pedicle. Most of data had significant deviation ,which means there was significant differ-ence between three methods. MPR and MIP had advantage in operability and display ability of post-processing image,compared with VR. Conclusion:Three methods which can be used for the measurement of cervical vertebral pedicle and an accurate ref-erence for clinical screw placement,had provincial difference in pedicle data,operability and display ability of post-processing image. Different methods can be selected according to actual needs in clinic work.