CT椎间盘造影对腰椎间盘内破裂的诊断价值.DOC

青年士兵盘源性下腰痛的CT椎间盘造影与MRI相关性研究 刘淼 陈兴灿 费军 邹庆 张文丹 摘要 目的 基于CT腰椎间盘造影术（CTD）诱发的一致性疼痛，研究青年士兵盘源性下腰痛与腰椎间盘MRI改变的相关性。方法 对54例盘源性下腰痛的青年士兵行MRI检查后实施CT腰椎间盘造影术，共计造影152个腰椎间盘，分析CTD分型、对比剂注射剂量、诱发的一致性疼痛与MRI改变的相关性。结果 CTD显示青年士兵慢性下腰痛的椎间盘内破裂主要为Ⅱ型和Ⅳ型，其分型、对比剂注射剂量与诱发一致性疼痛具有相关性，腰椎间盘的MRI改变与造影诱发的一致性疼痛有明显的相关性。结论 CT腰椎间盘造影术能定性诊断腰椎间盘内破裂，进一步确定责任椎间盘。青年士兵盘源性下腰痛的病因可能与MRI改变（Ⅳ~Ⅴ级退变、HIZ的出现、终板的modic变性）相关。 关键词 士兵；盘源性下腰痛；椎间盘造影术；体层摄影术，X线计算机 Correlation Between MR Imaging and CT Discography With Provocative Concordant Pain in Young Soldiers With Discogenic Low Back Pain LIU Miao CHEN Xing-can FEI Jun ZHOU Qin ZHANG Wen-dan The Department of Radiology of the PLA 117 Hospital in Hangzhou 310013,China Abstract Objective This study aimed to correlate magnetic resonance (MR) findings and CT discography(CTD) with provocative concordant pain in patients with discogenic low back pain（DLBP）of young soldiers. Methods Based on MR findings,CT discography was successfully carried out on 152 discs in 54 young soldiers with DLBP,We evaluated correlation among the CTD group 、dose of contrast medium、concordant pain by discography and MR findings.Results Internal disc disruption(IDD) of young soldiers with DLBP included CTD Ⅱand Ⅳ mainly.The CTD groups、the numbers of contrast medium from positive and negative discs have significant difference,MR findings of discs and provocative concordant pain by CTD have significant difference.Conclusion CTD can show the sign of internal disc disruption directly,identified the symptomatic disc.Grade IV-V disc on MR images, the presence of HIZ,and endplate abnormalities might indicate discogenic pain in patients with DLBP of young soldiers. Key Words Solder；Discogenic low back pain；Discography；Tomography，X-ray computed 慢性下腰痛是初级保健医生遇到的一种常见临床症状，它的一个显著特征是由椎间盘源性疼痛引起的，也有人称之为盘源性下腰痛[1]。青年士兵的慢性下腰痛多是由于高强度的军事训练,导致椎间盘内的压力急剧增高几倍或几十倍,从而使纤维环急性破裂所导致。MRI在评价椎间盘的形态学改变方面具有较大的优势，但是它在确定责任椎间盘方面并不可靠。本研究试图通过基于CT引导下的椎间盘造影（CTD）诱发的一致性疼痛，研究青年士兵慢性下腰痛是否与MRI腰椎间盘形态学改变（其中包括椎间盘变性、T2加权像中椎间盘后方的弧形高信号区、椎体终板的modic变性等）有相关性。 材料与方法