【作者】 李健；

【导师】 刘吉华；

【作者基本信息】 青岛大学 ， 影像医学与核医学（影像医学）， 2017， 硕士

【摘要】 目的:探讨腰椎退行性变核素骨显像与CT退变程度和部位的相关性,加深腰椎退变核素骨显像特点理解。材料与方法:回顾性分析120例腰椎退行性变病人核素骨显像与CT表现,对CT显示腰椎退行性变程度进行分度:(1)椎体骨质增生:根据椎体边缘最大骨赘长度大小分为3度。Ⅰ度,椎体无骨质增生;Ⅱ度,最大骨赘长度<3mm;Ⅲ度,最大骨赘长度≥3mm。(2)椎小关节增生硬化:根据椎小关节边缘最大骨赘长度大小分3度。Ⅰ度,椎小关节无骨质增生和硬化;Ⅱ度,椎小关节增生边缘最大骨赘长度<2mm;Ⅲ度,椎小关节增生边缘最大骨赘长度≥2mm,或椎小关节肥大。(3)椎体终板硬化:根据椎体终板骨质硬化有无和部位分为3度。Ⅰ度,无终板硬化;Ⅱ度,椎体一侧终板硬化;Ⅲ度,椎体两侧终板硬化。(4)椎间盘膨出或突出:根据椎间盘向周围膨出大小和有无突出分3度。Ⅰ度,椎间盘未见膨出或突出;Ⅱ度,椎间盘向周围膨出3mm以内;Ⅲ度,椎间盘向周围膨出超过3mm,或者椎间盘局部突出。对腰椎退行性变核素浓聚程度分度:按核素异常浓聚灶大小分3度。Ⅰ度,无异常浓聚灶;Ⅱ度,异常浓聚灶面积<1/2椎体面积;Ⅲ度,异常浓聚灶面积≥1/2椎体面积。腰椎核素浓聚形态:包括倒“八”字形或“眼形”浓聚(从核素扫描后前位图像上可看到椎体后下方两侧异常浓聚灶,类似倒写的汉字“八”的形态或两只眼睛)、全椎体浓聚(整个椎体均匀浓聚)、不规则形浓聚(浓聚形态不规则)。记录CT不同退变程度的腰椎数量及腰椎退变核素浓聚形态。用统计学方法分析腰椎退行性变核素浓聚程度、形态与CT腰椎退变程度和部位的相关性。结果:采用Spearman秩相关分析统计学方法显示,腰椎退行性变核素骨显像异常浓聚程度与椎体骨质增生程度、椎小关节增生硬化程度、椎体终板硬化程度、椎间盘膨出或突出程度的秩相关系数r分别为0.588、0.465、0.152、0.305,并作相关系数的t检验,t值分别为17.777(P<0.05)、12.844(P<0.05)、3.761(P<0.05)、7.832(P<0.05),相关性有统计学意义。腰椎核素骨显像异常浓聚灶呈特定形态“倒八字征”的脊椎有8个,“眼征”有7个,皆有双侧椎小关节Ⅲ度增生硬化的CT表现。结论:腰椎退行性变核素骨显像浓聚程度分别与椎体骨质增生程度、椎小关节增生硬化程度、椎体终板硬化程度、椎间盘膨出或突出程度呈正相关,“倒八字征”或“眼征”是腰椎小关节退变核素骨显像一种特定表现形态,对临床具有重要提示作用,因此,在核素骨扫描转移瘤筛查中,要特别警惕由腰椎退行性变所致椎体异常浓聚的情况,必要时结合CT或MR综合评价,避免误诊。更多还原

【Abstract】 Objective: To investigate the correlation between the image features of lumbar spine degeneration on radionuclide bone imaging and the location or severity of LSD on CT.Understanding the characteristics of RBI for LSD.Materials and Methods: Review the imaging signs of 120 patients with LSD on RBI and CT,then record the location or severity of LSD on CT and the shape or severity of nuclide accumulations on RBI,and find the correlation between the location or severity of LSD on CT and the shape or severity of nuclide accumulations on RBI by statistical analysis.(1)lumbar hyperosteogeny:Ⅰ,none of vertebral hyperplasia;Ⅱ,the maximum length of the osteophyte is less than 3mm;Ⅲ,the maximum length of the osteophyte is more than 3mm.(2)facet joint hyperplasia and sclerosis:Ⅰ,none of the facet joint hyperplasia and sclerosis;Ⅱ,the maximum length of the osteophyte of the facet joint hyperplasia is less than 2mm;Ⅲ,the maximum length of the osteophyte of the facet joint hyperplasia is more than 2mm,or facet joint hypertrophy.(3)vertebral endplate sclerosis:Ⅰ,without endplate sclerosis;Ⅱ,the sclerosis of one side of vertebral plate;Ⅲ,the sclerosis of both sides of vertebral plate.(4)disc bulge or herniation:Ⅰ,none of disc bulge or herniation;Ⅱ,the intervertebral disc is bulging less than 3mm;Ⅲ,the intervertebral disc is bulging more than 3mm,or the local protrusion of the intervertebral disc.Severity of nuclide accumulations on RBI:Ⅰ,none of abnormal nuclide accumulations;Ⅱ,the range area of the abnormal nuclide accumulations is less than half of the vertebral area;Ⅲ,the range area of the abnormal nuclide accumulations is more than half of the vertebral area.The forms of nuclide accumulations including: “a reversed syndrome” or "eye sign" nuclide accumulations,holovertebral nuclide accumulations and irregular nuclide accumulations.Results: Positive correlation was detected between severity of nuclide accumulations on RBI and severity of lumbar hyperosteogeny,facet joint hyperplasia or sclerosis,endplate sclerosis and disc bulge or herniation by Spearman correlation analysis respectively(r= 0.588,0.465,0.152 and 0.305).The t value was 17.777,12.844,3.761 and 7.832 respectively(P<0.05).There were statistical positive correlations between severity of nuclide accumulations on RBI and severity of lumbar hyperosteogeny,facet joint hyperplasia or sclerosis,endplate sclerosis and disc bulge or herniation on CT respectively.The special sign “a reversed syndrome” was only found in 8 vertebral bodies and “eye sign”was only found in 7 vertebral bodies on RBI,all of which have 3 degree facet joint hyperplasia or hypertrophy on CT.Conclusion: Severity of nuclide accumulations of LSD on RBI is correlated with severity of of lumbar hyperosteogeny,facet joint hyperplasia or sclerosis,endplate sclerosis and disc bulge or herniation on CT.“A reversed syndrome”or “eye sign”on RBI plays an important role in clinical diagnosis as a special performance of facet joint degeneration.Therefore,special attention should be paid to the abnormal nuclide accumulations of the vertebral body caused by LSD.If necessary,combined with CT or MR to avoid misdiagnosis.更多还原