旋转DSA的软组织断层重建技术在经皮椎体成形术后并发症诊断中的价值  

The application value of soft-tissue reconstructed imaging with rotational DSA in the diagnosis of the complication after percutaneous vertebroplasty

作　　者：顾一峰[1] 吴春根[1] 程永德[2] 李敏[1] 王珏[1] 张培蕾[1] 杜倬婴[1] 李明华[1] 

机构地区：[1]上海交通大学附属第六人民医院放射科,200233 [2]南京军区介入放射中心

出　　处：《介入放射学杂志》2006年第9期547-551,共5页Journal of Interventional Radiology

摘　　要：目的探讨旋转DSA的软组织断层重建技术(DynaCT)在经皮椎体成形术后并发症诊断中的应用价值。方法对30例中36个胸椎和腰椎行经皮椎体成形术(PVP),术后经X线摄片、DynaCT和螺旋CT扫描,对聚甲基丙烯酸甲酯(PMMA)的椎体外渗漏和胸膜腔的图像和临床情况进行分析。结果所有病例的手术都获得成功。所有病例术中和术后未出现严重的并发症。在经PVP术后的36个椎体中,30个椎体的无椎体外渗漏,都经X线正侧位、DynaCT和CT确诊。6个椎体出现椎体外渗漏,经X线正侧位、DynaCT和CT检查确诊,其中2例中2个椎体出现椎间盘渗漏;2例2个椎体出现椎旁软组织渗漏;1例1个椎体出现静脉丛渗漏。1例椎弓根渗漏在侧位X线片怀疑为椎体后缘硬膜外渗漏,但在DynaCT重建图像和螺旋CT显示,PMMA位于两侧椎弓根内,椎管内并无PMMA。X线摄片和DynaCT、CT都未发现气胸和胸腔积液。结论DynaCT对PVP术后并发症的迅速判断提供了有益的信息。Objective To discuss the application value of soft-tissue reconstructed imaging with rotational DSA in the diagnosis of the complication after percutaneous vertebroplasty （PVP）. Methods Polymethylmethacrylate （PMMA）was injected into the vertebrae of 30 cases （36 thoracic and lumbar vertebrae） guided by fluoroscopy. Radiography, soft-tissue reconstructed imaging with rotational DSA（Dyna CT）scan and spiral CT scan were performed in all patients postoperatively. The images and clinical data of 30 cases after PVP were analyzed to evaluate the presence of cement leakage and pleural lesion. Results The operations were successful in all cases without severe complications during and after procedure. Distribution of cement in 30 vertebrae of 30 cases was satisfactory. The other 6 vertebrae of 5 cases showed leakages of cement outside the vertebral body including cement leakage into the adjacent intervertebral discs in 2 vertebrae of 2 cases, into the paravertebral soft tissue in 2 vertebrae of 2 cases, and into the paravertebral venous plexus in 1 vertebrae of 1 case. Another vertebrae in 1 case on lateral radiographic film showed small amount of cement at the posterior vertebral margin suggesting leakage into the spinal canal. But Dyna CT and CT scans demonstrated that this small amount of cement was actually located inside the bilateral pedicles with no cement leakage into the spinal canal. All of 30 cases showed no occurrences of pneumothorax and pleural effusion under radiography, Dyna CT and spiral CT. Conclusion The soft-tissue reconstructed imaging with Dyna CTcan immediately display the signs of cement leakage and pleural lesion. It plays an important role in diagnosing the PVP complications. （J Intervent Radiol, 2006, 15： 547-551）

关 键 词：经皮椎体成形术 并发症 血管造影术 数字减影 图像处理 计算机辅助 

分 类 号：R816.8[医药卫生—放射医学]