磁共振椎管水成像在腰椎管内疾患的影像特点及其与手术诊断符合率

Characteristics and evaluation of MR myelography in the diagnosis of lumbar spinal disorders

中文关键词:  腰椎管内疾患  磁共振椎管水成像  诊断

英文关键词:Lumbar spinal disorders  MR myelography  Diagnosis

中文摘要:

  【摘要】 目的：探讨磁共振椎管水成像（magnetic resonance myelography，MRM）在腰椎管内疾患的成像特点及诊断价值。方法：根据132例行手术治疗的腰椎疾患患者术前MRM检查做出诊断，对比术中所见，总结腰椎管内疾患的MRM成像特点及其诊断符合率。结果：MRM上表现为胡须型者9例（27节段），术前诊断为发育型腰椎管狭窄症，术中见椎板夹角减小，椎板肥厚，小关节内聚，本组共27节段，诊断符合率100%；表现为幕帘型、不全阻断型以及完全阻断型共56例（150节段），术前诊断为获得性腰椎管狭窄症的中央椎管狭窄，术中见小关节增生内聚，黄韧带弥漫性增生肥厚，三型分别为44、72、29节段，诊断符合率分别为89.8%（44/49）、100%及100%；表现为残根型、单侧压迹型共28例（80节段），术前诊断为单侧侧方椎管狭窄，术中见黄韧带形成侧方韧带卷入侧方椎管，两型分别为30、50节段，诊断符合率均为100%；表现为喇叭口型、束腰型共39例（98节段），术前诊断为双侧侧方椎管狭窄，术中见黄韧带外侧部肥厚、上关节突骨赘增生，两型各29、62节段，诊断符合率为80.6%（29/36）、100%。表现为根须型共3例，术前诊断为中央型椎间盘突出症，术中见突出椎间盘属中央或中央偏旁型；表现为残根型及单侧压迹型共16例，术前诊断为侧方型椎间盘突出症，术中见突出椎间盘偏侧方，波及神经根肩部或者腋部，诊断符合率均为100%。14例Tarlov囊肿MRM表现有硬膜囊周围型、神经根中央型及神经根周围型，术中完全证实囊肿与硬膜囊、神经根关系，诊断符合率100%。6例腰段椎管内肿瘤MRM表现为椎管内硬膜下肿瘤，对比术中所见符合率为100%。结论：MRM能真实、准确诊断腰椎管内病患，为腰椎疾患的术前评估提供了新的检查手段。

英文摘要:

  【Abstract】 Objective：To investigate the MR myelography（MRM） findings and its value in determining lumbar spinal disorders.Method：MRM and surgical findings of 132 cases diagnosed as lumbar spinal disorders were analyzed comparatively，and their characteristics and diagnostic accuracy were reviewed either.Result：Beard shape was showed in 9 cases（27 segments） on MRM，which were diagnosed as development lumbar spinal stenosis preoperatively and had intraoperative findings of decreasing laminar included angle，thick laminar and remarkably degenerated facet joint，which were completely coincidence to preoperative diagnosis.56 cases（150 segments） showed curtain shape，partial blockage shape and complete blockage shape on MRM，which were diagnosed as acquired central lumbar spinal stenosis preoperatively and had intraoperative findings of degenerated facet joint and thick ligamentum flavum，with the diagnostic accuracy of those three shapes 89.8％（44/49），100% and 100% respectively.28 cases（80 segments） showed nub shape and unilateral print shape on MRM，which were diagnosed as acquired lateral recess stenosis preoperatively and had intraoperative findings of infolding of the ligamentum flavum in lateral recess，with the diagnostic accuracy of 100% for both.39 cases（98 segments） showed horn shape and corset shape，which were diagnosed as acquired bilateral recess stenosis preoperatively and had intraoperative findings of thicken the lateral ligamentum flavum in lateral recess and degenerated upper facet joint，with the diagnostic accuracy of 80.6%（29/36） and 100% respectively.3 cases showed root beard，which were diagnosed as central disc hernia preoperatively and had intraoperative findings of disrupt disc bulged into the central side of spinal canal，with the diagnostic accuracy of 100%.16 cases showed nub shape and unilateral print shape，which were diagnosed as lateral disc herniation preoperatively and had intraoperative findings of disrupt disc bulged into the lateral side of spinal canal，with the diagnostic accuracy of 100% for both.14 cases were diagnosed as Tarlov cyst，their MRM showed circumferential dural sac type，central nerve root sheath type and circumferential nerve root sheath type，whose correlation with dural matter and nerve root were verified through operation with the diagnostic accuracy of 100%.6 cases were diagnosed as lumbar intradural tumor on MRM，which were confirmed by surgery.Conclusion：MRM is capable of determining intradural tumor accurately，which is an alternative to preoperative evaluation of lumbar spine disorders.