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1、KimberlyCollins,MSIIIGillianLieberman,MDMarch2007APatientwithLowBackPainKimberlyCollins,HarvardMedicalSchoolYearIIIGillianLieberman,MDKimberlyCollins,MSIIIGillianLieberman,MDCasePresentationMJisa48year-oldmalewithafivemonthhistoryofincreasedlowbackpainthatradiatesdownhisleftleg,leftle
2、gweakness,newonsetconstipation,andslowurination.slowurination.2KimberlyCollins,MSIIIGillianLieberman,MDLowBackPain°About70%ofadultshavelowbackpainatsometime°Lowbackpainissecondonlytoupperrespiratoryillnessasasymptom-relatedreasonsforvisitstothephysician3Deyo,1992KimberlyCollins,MSIIIG
3、illianLieberman,MDDifferentialforBackPainMechanicalLowBackPain97%•Lumbarstrain,sprain70%•Degenerativeprocessesofdisksandfacets10%•Herniateddisk4%•Spinalstenosis3%•Spondylolisthesis2%Non-MechanicalSpinalConditions~1%•Neoplasia0.7%•Infection0.01%•Inflammatoryarthritis0.3%VisceralDisease
4、2%•Diseaseofpelvicorgans•Renaldisease•Aorticaneurysm•Gastrointestinaldisease4Deyo,2001KimberlyCollins,MSIIIGillianLieberman,MDDecidingwhethertoimage°Backpaininapatient<50withnoneurologicaldeficitsshouldbefollowedconservativelywithfollow-upin6weeks°Patientswithbackpainassociatedwithneu
5、rologicalsignsshouldhaveimaging°Backpainlastingmorethan3monthsisconsideredchronicandshouldbeimaged5Jarvik,2002KimberlyCollins,MSIIIGillianLieberman,MDDecidingwhethertoimageMJ’ssymptoms:lowbackpainthatradiatesdownhisleftleg,leftlegweakness,newonsetconstipation,andslowurination.Indicati
6、onsforimagingMJ:•Leftlegsciaticaandweakness•Changesinbowelandbladderfunction6KimberlyCollins,MSIIIGillianLieberman,MDImagingmodalitiesforpatientswithlowbackpainwithlowbackpainIMAGINGADVANTAGESDISADVANTAGESMODALITYPlainfilmAllowsvisualizationofSofttissueisnotwellbonystructures,lowcostv
7、isualized,radiationexposureCTDetailedvisualizationofNotgreatforevaluatingsoftbonystructures,sometissue,radiationexposure,visualizationofsofttissueexpensivestructuresMRIBestmodalityforsoftDifficulttoevaluatecorticaltissuevisualization,noboneandcalcifications,veryradiationexposure.Testo
8、fexpe
