腰椎峡部裂的CT重建技术诊断价值及其病因探讨

摘要

Objective To explore the value of multi-slice spiral computed tomography (MSCT) reconstruction technique in the diagnosis of lumbar spondylolysis (LS), and analyze the causes of LS. Methods Twenty-eight patients diagnosed as LS by MSCT during 2011-2014 were retrospectively analyzed. Multiplanar reconstruction (MPR), maxi-mum intensity projection (MIP) and volume representation (VR) technology of MSCT were used for post-processing of the images. All-round, multi-angle observation of the patients was performed, and comparisons in MPR, MIP and VR im-ages were conducted. Results The 28 cases were detected with 53 spondylolysis and 17 cases of slippage, including 46 bilateral spondylolysis in 21 cases (16 cases with slippage) and 7 unilateral spondylolysis in 7 cases (1 case with slip-page). The diagnostic rate of LS with MPR technology was 100% (53/53). The spondylolysis fracture can be clearly showed on oblique sagittal (along with the vertebral isthmus) and oblique (parallel to the vertebral isthmus) plane, as"dog collar"and"double joints", respectively. The mediansagittal position can clearly show the vertebral slippage. MIP images can also reveal all lesions, but observation of the surrounding soft tissue was not as good as MPR images. The di-agnostic rate of LS with VR technology was 79.24%(42/53). VR technology can observe spondylolysis stereoscopically. Conclusion MSCT with MPR, MIP and VR technology can comprehensively evaluate the situation of LS, and MPR images on oblique sagittal (along with the vertebral isthmus) and oblique (parallel to the vertebral isthmus) plane are pre-ferred for the reconstruction. Acquired factors (fatigue or stress fractures) are the major causes of LS.%目的 探讨多层螺旋CT重建技术对腰椎峡部裂(LS)的诊断价值,并分析LS的病因.方法 回顾性分析我院2011-2014年经多层螺旋CT诊断为腰椎峡部裂的患者共28例.利用多层螺旋CT的多平面重建(MPR)、最大密度投影(MIP)、容积再现(VR)技术对图像进行后处理,全方位、多角度观察患者腰椎峡部裂情况,并综合对比MPR图像、MIP图像及VR图像.结果 28例患者中共检出峡部裂53处,滑脱17例;其中双侧峡部裂21例,46处,16例伴滑脱;单侧峡部裂7例,7处,1例伴滑脱.MPR图像LS诊断率为100%(53/53),斜矢状(沿椎弓峡部走向)位及斜轴(平行于椎弓)位可清楚的显示峡部断裂情况,分别表现为"狗项圈征"和"双关节征",正中矢状位可清楚的显示椎体滑脱情况.MIP图像也可显示全部病变,但对周边软组织的观察不如MPR图像.VR图像LS诊断率为79.24%(42/53),可立体观察峡部情况.结论 多层螺旋CT-MPR、MIP、VR技术可以全方位的评价腰椎峡部情况,其中斜矢状(沿椎弓峡部走向)位及斜轴(平行于椎弓)位的MPR图像可作为首选的重建方法;后天性因素(疲劳或应力骨折)可能是LS主要病因之一.