MSCT多平面重建技术对胸椎黄韧带骨化的相关性研究

发布时间：2018-06-27 07:49

本文选题：胸椎黄韧带骨化 + MSCT　；参考：《泰山医学院》2013年硕士论文

【摘要】：背景与目的黄韧带骨化（ossification of ligament flavum，OLF）在亚洲国家中发病率较高，日本居首位，发病率约占脊柱疾病的2%，占脊柱手术患者的2.3%[1]，在年手术总量中占0.9/10万[2]。该病属退行性变范畴，中老年人发病率较高。OLF在颈、胸、腰段均可发生，但以胸椎特别是下胸椎最为多见，目前被临床上认为是引起胸椎管狭窄的主要原因。传统的影像学检查为X线平片，但由于胸椎正、侧位片胸椎与多个结构重叠显示，漏误诊率较高。螺旋（computed tomography）CT可以清晰的显示横断面图像，由于OLF呈高密度，观察较为直观、明显。但由于轴位图像的局限性，仅对部分类型的黄韧带骨化显示较好。而且难以确切判断韧带骨化的范围，对多发病变及跳跃性病变也难以观察。磁共振成像（Magnetic Resonance Imaging MRI）可较大范围的显示病灶，，对多发病变及跳跃性病变显示较好。但是OLF在T1WI及T2WI图像中均为低信号，不易观察。多层螺旋CT(multislice spiral computed tomography MSCT)多平面重建技术（multiplanar reformation MPR）可对扫描所得图像进行任意角度的重建，选择合适的角度，可以较好的观察胸椎黄韧带骨化的形态特点及其对脊髓的影响，对多节段同时受累及跳跃性病变的观察也较为方便。利用MRCT多平面重建技术研究胸椎黄韧带骨化（thoracic ossification of ligamentflavum，TOLF）与年龄、性别的相关性，分析说明这些因素与胸椎黄韧带骨化的关系。材料与方法观察性研究1244例行胸部CT受检者，其中男性771例，女性473例，年龄0-96岁，平均年龄48.48±23.44岁。所有受检者胸部CT扫描图像均行MPR，由三名影像科医生观察每个受检者12个胸椎左右双侧黄韧带，选择最佳角度、最佳层面判断其骨化情况及程度并记录。利用SPSS13.0统计软件对数据进行统计学分析，方法如下：（1）年龄与左右双侧胸椎黄韧带骨化程度作Spearman相关分析；（2）对不同年龄组黄韧带骨化级别作非参数的Kruskal-Wallis H检验；（3）男女之间黄韧带骨化级别作非参数相关检验；（4）左右双侧黄韧带骨化级别作非参数相关检验。结果 1.左右双侧胸椎黄韧带骨化程度程度随年龄的增加而相应增加； 2.黄韧带骨化程度与年龄呈高度相关； 3.男女之间左右两侧黄韧带骨化程度均无差异； 4.左右双侧黄韧带骨化程度在T2、T3、T4、T5、T7等5个椎体中存在差异，其他胸椎黄韧带骨化程度在左右双侧无差异。结论胸椎黄韧带骨化程度最年龄增加而相应增加，与年龄有显著的相关性；性别与胸椎黄韧带骨化没有相关性；左右双侧部分黄韧带骨化程度存在差异，右侧较左侧发生率高。
[Abstract]:Background & objective the incidence of ossification of ligamentum flavum (ossification of ligament flavum OLF) is relatively high in Asian countries, with Japan being the first country, accounting for 2% of spinal diseases, accounting for 2.3% of the total number of patients undergoing spinal surgery, accounting for 0.9% -100 000 of the total number of surgeries per year [2]. The disease belongs to the category of degenerative change. The incidence of OLF in middle and old people is higher. OLF can occur in cervical, thoracic and lumbar segments, but the thoracic vertebrae, especially the lower thoracic vertebra, are the most common, which is clinically considered to be the main cause of thoracic spinal canal stenosis. The traditional radiographic examination was X-ray plain film, but the misdiagnosis rate of leakage was higher because the thoracic vertebrae were positive and the lateral position of thoracic vertebrae were overlapped with multiple structures. Spiral (computed tomography) CT can clearly display cross-sectional images, because of its high density, the observation is intuitionistic and obvious. However, due to the limitation of axial images, only partial ossification of ligamentum flavum is shown. Furthermore, it is difficult to determine the extent of ossification of ligaments, and to observe frequently-occurring lesions and leaping lesions. Magnetic Resonance Imaging (MRI) can show the lesion in a wide range, and it can show the leaping lesion well. However, OLF is low signal on T 1 WI and T 2 WI, so it is difficult to observe. Multi-slice spiral CT (multislice spiral computed tomography MSCT multiplanar reconstruction technique (multiplanar reformation MPR) can reconstruct the images at any angle and select a suitable angle to observe the morphological characteristics of ossification of ligamentum flavum in thoracic vertebrae and its effect on spinal cord. It is also convenient to observe multiple segmental involvement and leaping lesions at the same time. The relationship between (thoracic ossification of ligamentum flavum ossification (thoracic ossification of ligamentum flavum TOLF) and age and sex was studied by MRCT multiplanar reconstruction, and the relationship between these factors and ossification of ligamentum flavum in thoracic vertebrae was analyzed. Materials and methods 1244 patients (male 771, female 473, aged 0-96 years, mean age 48.48 卤23.44 years) underwent chest CT examination. MPRR was performed on all chest CT images. The left and right ligamentum flavum of 12 thoracic vertebrae were observed by three imaging doctors, and the best angle was selected to judge the ossification and the degree of ossification on the best plane and to record the ossification. The data were analyzed by SPSS 13.0 software. The methods were as follows: (1) Spearman correlation analysis between age and ossification of ligamentum flavum in left and right thoracic vertebrae, (2) nonparametric Kruskal-Wallis H test for ossification of ligamentum flavum in different age groups; (3) the ossification grade of ligamentum flavum was tested by nonparametric correlation test between men and women, and (4) the ossification grade of ligamentum flavum on both sides was tested by nonparametric correlation test. Result 1. The ossification degree of ligamentum flavum of left and right thoracic vertebrae increased with the increase of age; 2. Ossification degree of ligamentum flavum was highly correlated with age. There was no significant difference in ossification of ligamentum flavum between male and female. The degree of ossification of right and left ligamentum flavum was different in 5 vertebrae such as T _ 2T _ 3, T _ 4, T _ 5 and T _ 7, while the ossification of other thoracic ligamentum flavum had no difference in left and right sides. Conclusion the degree of ossification of ligamentum flavum in thoracic vertebrae increases with age, and there is a significant correlation between sex and ossification of ligamentum flavum in thoracic vertebrae, the ossification degree of ligamentum flavum in both sides of thoracic vertebrae is different. The incidence was higher on the right side than on the left.
【学位授予单位】：泰山医学院
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R686;R816.8

【参考文献】