下腰痛影像诊断的临床综合评估.doc

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1、下腰痛影像诊断的临床综合评估作者：谢幼专，侯筱魁，朱振安，张蒲，史定伟，李华【摘要】［目的］探索下腰痛各种影像学检查方法的合理选择，避免资源浪费，减少病人支出，使其发挥互补作用。［方法］对61例下腰痛患者包括腰椎间盘突出症（38例）、椎管狭窄（4例）、滑脱（10例）、感染（4例）和肿瘤（5例）的影像学资料进行分析。［结果］临床症状和体征是引导正确诊断的基础，影像学检查结果只有建立于其上才有意义。常规X线摄片对骨性结构具有较高的分辨率，可为进一步影像学检查提供依据。脊髓造影根据硬膜囊及神经根管的影像学改变来判断下腰段的病变，对较

2、小的L5S1椎间盘突出和极外侧椎间盘突出不易诊断。计算机体层摄影（CT）从横断面观察脊柱的病变，但较局限，不易观察椎管内CT值相似的软组织病变。脊髓造影后CT扫描（CTM）则提高了诊断的阳性率。磁共振成像（MRI）从多平面显示多节段的病变，对软组织具有很高的分辨率，但对骨性结构的分辨率较CT差。［结论］常规X线摄片是最基础且重要的常规检查方法，脊髓造影、CT、CTM、MRI对下腰痛的诊断各有其特点，不能相互替代，而是起相互补充的作用。【关键词】下腰痛；常规X线摄片；脊髓造影；计算机体层摄影；磁共振成像Abstract：［Obj

3、ective］Topursuetheappropriateselectionofradiographicexaminationsoflowbackpainandtoreducetheexpenses.［Method］Inthisstudy,61casesofimagingtestswerestudied,including38casesoflumbardischerniation,10casesoflumbarspondylolisthesis,4lumbarstenosis,4lumbarinfectionand5lumba

4、rneoplasm.［Result］Correctdiagnosiswasbasedontheclinicalsignsandsymptoms.Imagingfindingshaditsvalueonlywhenbasingonthem.Conventionalroentgenogramofferedacheapevaluationandhighspatialresolutionofbonystructures.Anditcouldgiveacluetotakefurtherimagingstudies.Lowbackdiso

5、rderscouldbeinferredfromthecontrastcolumndefectofdurasacandnerverootsheathinthemyelography.Inthediagnosisofdischerniation,itslimitationsexistedatfarlacteralandL5S1discherniation.Computedtomography,across-sectionalimagingmodality,allowsdirectvisualizationofthebonystr

6、uctureofthespine.Butroutineimagingcouldonlycoveralimitednumberoflevers.AnotherlimitationwasthedifficultyindistinguishingthesofttissuechangesinthespinalcanalwiththesimilarCTvalues.CT-myelographywasperformedtodelineatemoreclearlythebonyandsofttissueanatomy,andcoulddet

7、erminewhetherlesionsweremedullary,intradualorextradualinlocation.MRimagingprovidedthelargeranatomicregioninmultipleplaneswithhighspatialresolution5ofsofttissue.OnelimitationofMRimagingwasrelativelylowspatialresolutionofbonystructure.［Conclusion］Ofallimagingstudiesco

8、nventionalroentgenogramisthemostimportantandthemostfundamental.Itcouldnotbesubstitutedbymyelography,CT,CT-myelography,andMRimaging,whichha