【作者】 李昊；

【导师】 刘勇；

【作者基本信息】 新乡医学院 ， 外科学， 2013， 硕士

【副题名】附病例对照

【摘要】 目的：利用Photo shop像素法在胸椎MRI上测量脊髓、脑脊液柱、椎管的横截面面积,得到一组正常成人胸椎脊髓、脑脊液柱、椎管的横截面面积数据,为临床评价相关胸椎脊髓疾病提供量化参考。方法：1.入选标准：在MRI室随机选择无不适主诉的健康查体人群的胸椎MRI做为正常组。2.选取健康查体人群45例做为正常组,其中男24例,女21例,年龄22--72岁,平均48.4岁。同时选取确诊为结核性脑膜炎(TBM)后脊髓蛛网膜粘连患者10例(均行奎肯试验,符合部分梗阻或完全梗阻,且脑脊液蛋白均有不同程度的增高),作为病例对照组进行讨论,其中男6例,女4例,年龄23--54岁,平均38.1岁。3.MRI测量：将正常组胸椎MRI片通过纷腾9800XL型扫描仪输入计算机。正常组每例均测量T1-12十二个节段,每节段于椎体后高中点处、与脊髓纵轴垂直进行扫描,得到十二幅有关脊髓、脑脊液柱、椎管的横截面图像,用Photo shop软件中的多边形套索工具对有效椎管及相应节段脊髓、脑脊液柱进行划界测量,每幅图像均测量3次,取其平均值,分别得出脊髓、脑脊液柱、椎管的横截面面积,并计算脊髓/椎管、脊髓/脑脊液柱、脑脊液柱/椎管的比值。用同样方法测量10例病例对照组术前术后脊髓、脑脊液柱横截面面积,对照组中,每个病例术前术后测量的层面相同,均测量3次,取其平均值。4.探讨正常人胸椎脊髓、脑脊液柱、椎管的横截面面积的临床意义。病例对照组在实施椎管扩大成形术后同一节段脑脊液柱横截面积的变化情况。结果：1.采用Photo shop像素法测量脊髓、脑脊液柱、椎管横截面面是一种实用、准确、可靠的方法。2.得到一组正常人胸椎脊髓、脑脊液柱、椎管的面积数据,及其两两比值。从T1-T8,脊髓、脑脊液柱、椎管横截面面积均逐渐减小,而从T8-T12逐渐增大,与解剖上脊髓形态变化一致。(详见表1；表2)3.结果表明,脊髓蛛网膜粘连后,脊髓、脑脊液柱面积较正常时减小。通过测量10例病例对照组粘连节段脊髓、脑脊液柱横截面面积发现,术前粘连节段脊髓、脑脊液柱横截面面积均小于所测正常人相应节段脊髓、脑脊液柱横截面面积。(详见表3)4.测量10例病例对照组术前、术后粘连节段脑脊液柱横截面面积发现,术后相应节段脑脊液柱面积高于术前。(详见表4)结论：1. Photo shop可以统计出任意形状的像素数,从而计算出该形状的面积,且由于具有多种选择方法,Photo shop软件在二维面积测量上具有较大的优势,因此采用Photo shop像素法测量脊髓、脑脊液柱、椎管横截面面是一种实用、准确、可靠的方法。2.脊髓蛛网膜粘连后,可引发脊髓、脑脊液柱面积的改变。因蛛网膜粘连主要影响脑脊液循环(脑脊液柱面积减小),通过实施椎管扩大成形术发现,术后相应节段脑脊液柱面积均较术前扩大,但扩大量还需进一步量化,避免扩大量不足或过大。3.脊髓、脑脊液柱、椎管横截面面积的测量有临床意义,通过测量45例正常成人胸椎脊髓、脑脊液柱、椎管横截面面积可发现,从T1-T8,脊髓、脑脊液柱、椎管横截面面积均逐渐减小,而从T8-T12逐渐增大,与解剖上脊髓形态变化一致。这一组正常数据的获得,期望为今后相关的脊髓脊柱疾病治疗提供参考对照。更多还原

【Abstract】 ObjectiveBy using Photoshop a method of measure pixels of the spinal cord, cerebrospinal fluid column, cross-sectional area of the spinal canal in the thoracic spine MRI was use to get a group of normal adults metes and it’s practicality was confirmed. The purpose of it is to provide quantitative reference for the clinical evaluation of the thoracic spinal cord disease.Method1. The subject inclusion criteria:The thoracic MRI of the health checkup crowd who had no complaints was randomly selected as the normal group in the MRI room.2.45cases in the health checkup crowd were selected as a normal group:male24cases,21females, aged22-72years, an average of48.4years.10patients of the spinal arachnoids adhesions caused by the tuberculosis meningitis (TBM) select as the case discussion object (Under went the Queckenstedt test, in line with the partial obstruction or complete obstruction, and the CSF protein increased in varying degrees):6males and4females, aged23-54years old, with an average of38.1years old.3. Measurement by using MRI images:Acquisition normal human thora’cic MRI slices were input computer through divergent Tung9800XL scanner. Applied Photo shop software to carry out the image proportion correction and edge enhancement processing. Each case of the normal group were measured T1-12twelve segments, the location of each image was in the vertebral body back high middle point, perpendicular to the longitudinal axis of the spinal cord a picture was scanned, twelve images of the spinal cord, CSF column, the spinal canal cross-sectional was obtained. Photoshop software Polygonal Lasso Tool demarcation was used to measure the area of effective cross-sectional spinal canal and spinal cord, CSF column. Then the ratio of the spinal cord/spinal, and spinal cord/CSF column, and CSF column/spinal canal were calculated.4. Investigate the clinical significance of normal human thoracic spinal cord, cerebrospinal fluid column, the cross-sectional area of the spinal canal. Compare the area change of the same cross-section of spinal cord, cerebrospinal fluid column, the cross-sectional of the spinal canal before and after the expand implementation of the spinal canal operation.Results1. A method of measure pixels of the spinal cord, cerebrospinal fluid column, cross-sectional area of the spinal canal in the thoracic spine MRI by using Photoshop prove to be an effective and reliable method.2. This study gets a group of normal human thoracic spinal cord, CSF column, spinal canal area and ratio of pair wise comparison.(See Table1; Table2)3. Spinal arachnoids adhesions can lead to the change of the area of the spinal cord, CSF column. By measuring the10cases of the control group adhesions segments of the spinal cord, CSF column cross-sectional area found that preoperative adhesions segmental spinal cord, cerebrospinal fluid column cross-sectional area less than the normal person.(See Table3)4. By measuring the adhesions segment the CSF column cross-sectional area of10cases of the control group patients before and after the operative, this study found that the postoperative corresponding segments of the CSF column area is larger than preoperative.(See Table4)Conclusion1. Photo shop can be counted the number of pixels of the arbitrary shape, thereby calculating the area of the shape, and with a variety of selection methods, Photo Shop software has a large advantage in the two-dimensional area measurement, so using Photo shop pixel method measurement of the spinal cord, cerebrospinal fluid column, spinal canal cross-section area prove to be an effective and reliable method.2. The spinal arachnoids adhesions can lead to the change of the area of the spinal cord, CSF column. A result of the arachnoids adhesions is that it can impact the circulation of cerebrospinal fluid (CSF column area is reduced), through the implementation of the laminoplasty the corresponding segments CSF column area can be expanded but the amount of expansion needed to further quantify in order to avoid expanding insufficient or too large.3. The measurement of the spinal cord, the CSF column and the spinal canal area has clinical significance. By measuring the45normal adult thoracic spinal cord, CSF column, spinal canal cross-sectional area this study found that from T1to T8spinal cord, CSF column and cross-sectional spinal canal area decreases gradually, while from T8to T12the area gradually increase, which morphological consistent with the anatomy of the spinal cord. The change of the spinal cord/CSF column, spinal cord/spinal canal, CSF column/spinal canal ratio also shows the same tendency. And these results founded a basis reference for the further study of the measurement among disease populations.更多还原