脊柱侧弯的多层螺旋CT后处理技术的临床应用  

Clinical Value of Muti--slice Spiral CT Post--processing Technique in Scoliosis

作　　者：王利[1] 刘团江[2] 连鹏[1] 杨军[1] 

机构地区：[1]西安市第四医院影像中心,陕西西安710004 [2]西安市红十字会医院脊柱外科

出　　处：《实用放射学杂志》2010年第9期1320-1322,1332,共4页Journal of Practical Radiology

摘　　要：目的 讨论多层螺旋CT后处理技术在脊柱侧弯治疗中的应用价值.方法 搜集脊柱侧弯患者25例影像资料,均行常规X线片,多层螺旋CT（MSCT）容积扫描,应用最大密度投影（maximum intensity projection,MIP）、多平面重组（multiplanar reformation,MPR）、曲面多层面重组（curved multiplanar reformation,CMPR）、表面遮盖显示（shaded surface display,SSD）、容积显示技术（volume rendering technique,VRT）、四维重建（four-dimension,4D）对所得容积数据进行后处理,观察各种后处理图像的优势和临床指导意义.结果 25例中,18例为特发性脊柱侧弯,6例为先天性脊柱侧弯,1例为后天性脊柱侧弯.①多平面重组和3D、4D图像显示出在常规X线片和常规横轴位图像中未发现和认知的畸形且全面评估了脊柱侧弯的程度,6例先天性脊柱侧弯中3例发现了掩蔽的半椎体畸形,并且评估了半椎体的类型和数目.② MPR/CMPR可以从各个角度重组畸形椎体的冠状、矢状影像,是最方便实用的显示方法 MIP因为层次不明,不适用脊柱侧弯的诊断 SSD可观察全脊柱影及侧弯的曲度,但缺乏对椎管内形态显示 VRT通过调节不同密度的阈值并辅以不同的伪彩依次可显示骨质及椎管的形态,尤其适用观察侧弯的分类和椎管情况 4D可清晰评价脊柱侧弯的所有相关表现.结论 多层螺旋CT横轴位结合其丰富的后处理图像为脊柱侧弯的诊断提供了有价值的空间结构信息,在临床医师选择治疗方案和制订手术路径上具有指导意义.Objective To evaluate the value of MSCT post processing technique in the diagnosis of scolisis. Methods 25 cases of scoliosis underwent X--ray plain film,of them, 16 cases underwent multi--slice spiral CT examination. The primary CT data were processed with maximum intensity projection（ MIP）, curved multiplanar reformation（ CMPR）, shaded surface display（ SSD）, volume rendering technique{VRT） and four--dimension（4D）. The advantages in diagnosing scoliosis were compared between these post-- processing techniques. Results In 15 cases of scoliosis, 18 cases were idiopathic scoliosis （IS）, 6 cases were congenital scoliosis, 1 case was acquired scoliosis. （1）The malformations of scoliosis were completely evaluated with MPR, 3D and 4D images, which were not detected by conventional X-- ray and axial CT images. In 3 of 6 cases with congenital scoliosis, the occultation hemivertebraes were discovered by MPR, 3D and 4D images. （2）MPR/CMPR techniques were easily used for scoliosis with coronal and sagittal images. But MIP was not available in diagnosing scoliosis. SSD was suitable to show the whole of the spine structure and the angle of scoliosis, but failed to display the content of vertebral canal. Through adjusting the density threshold, the osteal pathological changes and related condition about scoliosis could be showed by VRT,especially suitable for the classification of scoliosis and displaying the status of the vertebral canal. 4D was the best in use for evaluation of scoliosis. Conclusion The axial imaging of MSCT in eombina tion with various post--processing techniques can provide the space struction of scoliosis which is help for clinical administration.

关 键 词：脊椎 脊柱侧弯 体层摄影术 X线计算机 

分 类 号：R681.5[医药卫生—骨科学] R814.42[医药卫生—外科学]