【摘要】 目的进一步研究多层螺旋CT(MSCT)多种后处理技术在脊柱侧凸中的应用。方法我们回顾性地分析了2006年1月～2008年1月收治的26例手术矫正脊柱侧凸患者的影像学资料,术前行X线和MSCT检查、多平面和曲面重建(MPR/CPR)、最大密度投影(MIP)、三维表面遮盖重建(3D-SSD)、四维重建(4D-angio)和容积再现技术(VRT)。术后分析螺钉与椎弓根、椎体的位置。评价MSCT不同后处理技术的作用和优势。结果26例病人Cobb角(35°～128°),根据临床分型的不同,特发性17例,先天性5例,神经纤维瘤病型侧凸2例,其他2例。MPR/CPR可以从各个角度重组单个畸形椎体的冠状、矢状影像。是最方便实用的显示方法。3D-SSD可观察全脊柱影及侧弯的曲度,但缺乏对椎管内形态的显示;VRT可以全面显示,综合分析,对外科手术治疗很有价值;4D-angio可清晰评价脊柱侧凸的所有相关表现;MIP不适用对脊柱侧弯的评价。结论MSCT可一次性完成全脊柱扫描,后处理图像为脊柱侧凸患者准确、灵活制定个性化的手术方案和确定植入物情况提供非常有价值的空间结构信息,以便指导外科手术。更多还原

【Abstract】 Objective To study further clinical value of multi-slice spiral CT(MSCT) postprocessing technique in patients with scoliosis.Methods Radiological image data in 26 cases with scoliosis that have been performed operation to correct the defomity between January 2006 and January 2008 were studied retrospectively.All cases were performed with preoperative X-ray,multi-slice spiral CT scan.And all the images were reformed by Multiple Planar Reconstruction,Curved Planar Reconstruction(MRP/CPR),Maximum Intensity Projection(MIP),3D-Surface Shaded Display(3D-SSD),4D-angio and Volume Rendering Technique(VRT),which were used to evaluate the value of the various images.The postoperative relative position of the screw to the pedicle and vertebra was investigated and to evaluate the advantages and disadvantages of MSCT of different postprocessing in scoliosis.Results Among 26 cases,Cobb’ s angle range was from 35°to 128°.There were 17 idiopathic scoliosis and 5 congenital scoliosis,2 neuro fibromatosis scoliosis,and one other according to clinical classification.MRP/CPR techniques were easily used for scoliosis with coronary and sagittal image.It may offer many potential advantages for defining spine anomalies liable to cause progression of scoliosis,including visualization of the deformity in any plane,from any angle,with the overlying structures subtracted.3D-SSD was suitable to show the whole of the spinal structure and the angle of scoliosis,but failed to display the content of the vertebral canal.It was always useful if there is extensive bony tissue.VRT could directly and clearly show all of the anatomy of scoliosis through adjusting the density threshold,such as modality of complex anomalies, osteal pathological changes,and related condition about scoliosis,it was especially suitable for the classification of scoliosis and displaying the status of the vertebral canal.It was valuable for surgical operation.4D-angio was the best in use for evaluation all related signs in scoliosis.MIP technique could only provide poor effect and was not suitable for evaluation of scoliosis.Conclusion MSCT can be used for scanning of the whole spine in one time,and post-processing techniques can provide accurately the space structure of scoliosis which appears to be an effective modality to assess the pedicle screw position,and it is of important value for spine doctor to set down surgical plan in individual patient.更多还原