峡部裂及腰椎滑脱症的磁共振成像课件

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1、MagneticresonanceimagingofspondylolysisandisthmicspondylolisthesisPascalNiggemann–JohannesKuchta–DieterGrosskurth–Hans-KonradBeyerJanineHöffer–KarlStefanDelankXIXSymposiumNeuroradiologicump.niggemann@mrt-koeln.deiWiZPartI:StaticmagneticresonanceimagingIncidenceofvertebralhypoplasiaImpactofverte

2、bralhypoplasiaonmeasurementandclassificationPartII:PositionalmagneticresonanceimagingPositionalMRIfindingsClinicalimplicationofpositionalMRfindingsStaticmagneticresonanceimagingSpondylolysisandisthmicspondylolisthesis:multi-factorialcommondisorder(prevalence2.5to10.5%)highprevalenceinspecificpop

3、ulationsandincertainfamiliesaquireddisorder=>acquireddisorderwithageneticpredispositionPathogenesis:factureoftheparsinterarticularis=>spondylolysisVertebraloosesdorsal“hock”=>isthmicspondylolisthesisHypoplasiaiscommoninpatientswithspondylolysisandisthmicspondylolisthesisMaterial:181patientswith1

4、84levelsofspondylolysis-53women/128men176bilateral/8unilateralmeanage:50.5±13.5yearsLevelofspondylolysis:-L5/S1:157patients85%-L4/L5:20patients11%-L3/L4:6patients3%-L2/3:1patient1%PositionalMRIusingtheFonarUprightMRIScansinflexion,extension,supineandsittingpositionMethodsI:SagittalT2weightedscan

5、ofthemidlineABCLineA:dorsalmarginofL5LineB:paralleltolineAatthedorsaledgeofS1LineC:distancebetweenAandBMethodsII:MRIinseatedpositionusingtheFONARUprightMRI=>sagittalT2weightedscanDELineD:lowermarginofL5LineE:uppermarginofS1DifferenceinsizebetweenLineAandlineBinmmMethodsIII:CEGradeMeyerding:Cdivi

6、dedbyEin%Hypoplasia:EminusDinmmRealSpondylolisthesis:C–HypoplasiaRealSlip(Meyerding):C-Hypoplasia/EControl:Groupof526patientswithoutspondylolysisorspondylolisthesis=>IsL4smallerthanL5orL5smallerthanS1?=>Dorsalalignment?DResultsI:Hypoplasiawasfoundin62levelsoutof184(L5:61,L4:1)Rangeofhypoplasia:3

7、to13mm(5+/-2mm)Hypoplasia(classic):Grade0:0Adjusted:Grade0:24GradeI:37GradeI:31GradeII:24GradeII:7GradeIII:1In41patientsthegradeofsliphadtobeadjusted!24patientswerereclassifiedasspondylolysis!ResultsII:Hypoplasiawasfoundin10