胸椎黄韧带骨化症合并硬脊膜粘连的影像学分析  

IMAGING ANALYSIS OF OSSIFICATION OF LIGAMENTUM FLAVUM ASSOCIATED WITH DURAL ADHESIONS

作　　者：神兴勤[1,2,3] 孙天威[2,3] 方钊[2,3] 孟德福[1] 胡炜[1,2,3] 张学利[2,3] 

机构地区：[1]天津医科大学研究生院,天津300070 [2]天津市人民医院 [3]南开大学人民医院脊柱外科

出　　处：《中国修复重建外科杂志》2013年第4期414-417,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的通过对胸椎黄韧带骨化症(ossification of the ligamentum flavum,OLF)合并硬脊膜粘连患者的影像学表现进行回顾性分析,总结OLF合并硬脊膜粘连的特征性影像学表现。方法回顾分析2010年1月-2012年9月行OLF手术的85例患者临床资料。按照患者术前MRI和CT检查结果是否同时存在"车轨征"及"锯齿状线征"将其分为研究组和对照组。研究组患者同时具有两种影像学表现,共34例;对照组不同时或不具有两种影像学表现,共51例。以术中剥离黄韧带时所见硬脊膜与黄韧带粘连作为诊断硬脊膜粘连的"金标准"。将术前影像学检查结果与"金标准"进行比较,并分别计算研究组和对照组术前影像学检查的敏感性、特异性和阳性似然比(阳性似然比>5表示具有参考价值,>10表示具有诊断价值),判断术前影像学检查有无参考或诊断价值。结果研究组患者中26例术中可见硬脊膜粘连,男10例,女16例;8例术中未见硬脊膜粘连,男6例,女2例。对照组中2例术中可见硬脊膜粘连,均为存在"锯齿状线征"女性患者;49例术中未见硬脊膜粘连,男14例,女35例。"车轨征"+"锯齿状线征"的敏感性为92.9%,特异性为86.0%,阳性似然比为6.6;单纯"车轨征"的敏感性为92.9%,特异性为64.9%,阳性似然比为2.6;单纯"锯齿状线征"的敏感性为100%,特异性为77.2%,阳性似然比为4.4。结论胸椎OLF患者术前CT和MRI检查提示为"车轨征"+"锯齿状线征"对术前OLF合并硬脊膜粘连的诊断具有参考价值。Objective To summarize the characteristic imaging signs of ossification of the ligamentum flavum （OLF） associated with dural adhesions by analyzing retrospectively the imaging signs of OLF associated with dural adhesions. Methods A retrospective analysis was made on clinical data of 85 patients undergoing OLF surgery between January 2010 and September 2012. The patients were assigned into the study group and the control group according to the preoperative imaging signs. Of 85 patients, 34 had both tram track sign and jagged line sign as the study group and 51 had either tram track sign or ＇jagged line sign and neither of them as the control group. Adherence between dura mater and ligamentum flavum was observed during operation as the gold standard for the diagnosis of dural adhesion. The imaging information of CT and MRI in sagittal and axial planes was analyzed. The typical characteristics of dural adhesions were found. Then the sensitivity, specificity, and positive likelihood ratio of the preoperative imaging examinations were calculated to estimate the reference value and diagnostic value （〉 5 having reference value, and 〉 10 having diagnostic value）. Results In the study group, dural adhesion was observed in 26 patients （10 males and 16 females）, and the other 8 patients （6 males and 2 females） had no dural adhesion. In the control group, dural adhesion was found in 2 female patients who had jagged line sign, and 49 patients had no dural adhesion （14 males and 35 females）. In patients having both tram track sign and ＇jagged line sign, the sensitivity was 92.9%; the specificity was 86.0%; and the positive likelihood ratio was 6.6. In patients having tram track sign, the sensitivity was 92.9%; the specificity was 64.9%; and the positive likelihood ratio was 2.6. In patients having jagged line sign, the sensitivity was 100%; the specificity was 77.2%0; and the positive likelihood ratio was 4.4. Conclusion For patients with OLF having both tram track sign and jagged line sign, preoper

关 键 词：黄韧带骨化症 硬脊膜粘连 车轨征 锯齿状线征 影像学分析 

分 类 号：R816.8[医药卫生—放射医学]