三维质子密度加权MRI对儿童寰枢关节半脱位的诊断及疗效评价的意义研究  

Research on the Significance of Three-Dimensional Proton Density Weighted MRI in the Diagnosis and Treatment Evaluation of Atlantoaxial Subluxation in Children

作　　者：陈岩[1] 徐士象[2] 高希法 CHEN Yan;XU Shixiang;GAO Xifa(Department of Radiology,Jiangsu Province Hospital of Chinese Medicine,Nanjing Jiangsu 210029,China;Department of Massage,Jiangsu Province Hospital of Chinese Medicine,Nanjing Jiangsu 210029,China)

机构地区：[1]江苏省中医院放射科,江苏南京210029 [2]江苏省中医院推拿科,江苏南京210029

出　　处：《中国医疗设备》2021年第2期61-64,76,共5页China Medical Devices

基　　金：江苏省中医药局国家中医临床研究基地开放课题(JD201811)。

摘　　要：目的探讨MR成像技术对寰枢关节半脱位诊断及疗效评价的价值。方法收集23例临床怀疑寰枢关节半脱位的儿童患者,采用三维可变翻转角空间优化对比度完善技术(3D Sampling Perfection with Application optimized Contrast using differentflip angle Evolution,3D-SPACE)的质子加权成像(3D-PD-SPACE)联合常规扫描,牵引治疗2~4周后进行复查,对3D-PDSPACE抑脂序列的图像进行多平面重组(Multiple Planar Reformation,MPR),两名医生对图像质量进行主观评价,对MR诊断结果进行统计,对寰枢关节治疗前后的MR征象进行对比分析。结果所有MR图像质量评价全部为优或良,两名医师评价一致性较高(Kappa值=0.646)。23例患者中,寰枢关节及颈椎无明显异常(7例);寰枢关节半脱位16例;半脱位的影像学异常表现诊断为齿突侧块间距差值大于3 mm(7例)、寰齿前间隙大于5 mm(9例)、横韧带损伤(2例)、翼状韧带损伤(10例)。其他影像学异常表现包括颈椎侧弯(4例)、齿突先天畸形(1例)。MR诊断阳性的寰枢关节半脱位行牵引治疗后,MR复查结果:16例寰枢关节半脱位患者中11例MR表现恢复正常,3例有所缓解。结论MR 3D-PD-SPACE抑脂序列联合常规MR成像对寰枢关节半脱位诊断及疗效评价具有很高的价值。Objective To evaluate the value of MR imaging in the diagnosis and treatment of atlantoaxial subluxation.Methods 23 children suspected to be atlantoaxial subluxation were scanned with 3 D-Pd-SPACE.After 2-4 weeks of traction treatment,the images were reexamined.The images of 3 D-Pd-SPACE sequence were reconstructed with multiplanar reconstruction(MPR).Two doctors evaluated the image quality subjectively,counted the results of MR diagnosis,and compared the MR signs before and after the treatment of atlantoaxial joint.Results The quality of all MR images was excellent or fine,and the consistency between the two doctors was high(Kappa value=0.646).Among the 23 patients,there were no obvious abnormalities of atlantoaxial joint and cervical vertebra(7 cases);16 cases of atlantoaxial subluxation;the imaging abnormalities of subluxation were diagnosed as vblads greater than 3 mm(7 cases),ADI greater than 5 mm(9 cases),transverse ligament injury(2 cases),pterygoid ligament injury(10 cases).Other imaging abnormalities included scoliosis(4 cases)and congenital odontoid process deformity(1 case).After traction treatment for atlantoaxial subluxation with MR diagnosis positive,MR reexamination results:in 16 cases of atlantoaxial subluxation,11 cases of MR feature returned to normal,3 cases were relieved.Conclusion MR 3 D-Pd-SPACE sequence combined with conventional MR imaging is of great value in the diagnosis and evaluation of atlantoaxial subluxation.

关 键 词：寰枢关节半脱位 磁共振成像 质子密度加权成像 

分 类 号：R726.8[医药卫生—儿科]