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目的前瞻性研究64层 CT 的脊髓造影(CTM)多平面重组(MPR)在颈神经根损伤中的诊断价值及其替代直接扫描横断面图像及常规 X 线脊髓造影的可能性。方法对26例临床诊断为颈神经损伤患者进行 X 线脊髓造影和64层 CT 各向同性扫描,然后进行 MPR 成像,并进行 MPR 多方向调整,使病变显示于冠状、矢状和横断面上。其中26例(54个神经根)进行了手术探查并有术后诊断结果,就其冠状、矢状断面 MPR 图像、直接扫描 CT 横断面图像、脊髓造影平片对病变的诊断符合率进行对比,并比较横断面 MPR 与直接扫描横断而 CT 的图像数量。结果以患侧蛛网膜下腔内颈神经根前后支走行区和神经孔处充盈缺损消失,连续性无神经根显示为直接征象,CTM 发现神经根损伤31个。间接征象表现为:(1)创伤性脊膜膨出:椎管内患侧硬膜囊膨大、变形,呈柱形高密度影,并可沿椎间孔向外延伸,形成神经根鞘膜囊肿,与蛛网膜下腔间有低密度的细线状分隔,在撕裂水平可见29个膨出。(2)蛛网膜囊肿:硬膜囊一侧膨大变形,呈囊样扩张,病变未经椎间孔向外延伸,与蛛网膜下腔间有细线状分隔26个。(3)蛛网膜下腔不对称:一侧腔变窄,脊髓有不同程度的移位,多层面显示各神经根走行区未见连续性充盈缺损17个。64层 CT 多向调整的冠状面 MPR 对病变的诊断符合率为92.6%(50/54个),高于直接扫描 CT 横断图像(77.8%,42/54个)及平片(68.5%,37/54个),3种影像方法与术后诊断结果进行 Kappa 一致性检验比较,X 线平片、CTM 横断面和曲面冠状 MPR 的 Kappa 值分别为0.686、0.772、0.920,P 值均<0.05。可见曲面冠状 MPR 与手术诊断结果高度一致。而图像数量明显少于横断面 CT(MPR 50幅图像,横断面 CT 400幅图像)。结论多向调整的冠状面 MPR 解决了多层 CT 图像数量庞大的问题,该方法省时、易行,可直观清晰显示颈神经根损伤范围,提高了诊断符合率。
Objective To prospectively study the diagnostic value of multiplanar reconstruction (MPR) of 64-slice CT in cervical nerve root injury and its potential to replace direct scan cross-sectional images and conventional radiography. Methods 26 cases of cervical nerve injury were diagnosed by X-ray myelography and 64-slice CT isotropic scanning. Then MPR imaging was performed and the MPR was adjusted in different directions to show the lesions in coronal, sagittal and transverse sections. Among them, 26 cases (54 nerve roots) underwent surgical exploration and postoperative diagnosis. The coronal and sagittal MPR images, direct scan CT cross-sectional images and myelography films were used to compare the diagnostic accuracy of the lesions. And compare the cross-sectional MPR with the direct scan of the CT scan and the number of images. Results The filling defect of anterior and posterior branch of the cervical nerve root in the ipsilateral subarachnoid space and the nerve hole disappeared, and no nerve root was found as a direct sign. 31 nerve root lesions were found in the CTM. Indirect signs as follows: (1) traumatic meningocele: the ipsilateral dural sac dilated, deformity, cylindrical high-density shadow, and can be extended along the intervertebral foramen, the formation of nerve root sheath cyst , And between the subarachnoid space with a low density of fine line separation, visible at the tearing level of 29 bulging. (2) arachnoid cyst: dural sac enlargement deformation on one side, cyst-like dilatation, lesions without extending out of the foramina, with a fine line between the subarachnoid space 26. (3) Subarachnoid asymmetry: narrowing of the side cavity, varying degrees of displacement of the spinal cord, multi-level display of the root area of each nerve root continuous filling defect 17. The coincidence rate of 64-slice CT multi-directional coronal plane MPR in diagnosis of lesions was 92.6% (50/54), which was higher than that of direct scan CT transection (77.8%, 42/54) and plain film (68.5%, 37 / 54), Kappa agreement test showed that the Kappa values of X-ray, CTM cross section and curved coronal MPR were 0.686,0.772,0.920, P <0.05 respectively. Visible surface coronal MPR and surgical diagnosis results are highly consistent. The number of images was significantly less than the cross-sectional CT (MPR 50 images, cross-sectional CT 400 images). Conclusions Multi-directional coronal MPR solves the problem of huge number of multi-slice CT images. This method saves time and is easy to operate. It can clearly show the scope of cervical nerve root injury and improve the diagnostic coincidence rate.