动力位MRI对颈椎椎间盘突出症诊断价值.docVIP

动力位MRI对颈椎椎间盘突出症诊断价值 　　摘要：目的：探讨颈椎动力位MRI检查在椎间盘突出症的诊断价值。方法：临床疑有颈椎椎间盘突出症并行颈椎常规中立位和动力位MRI检查的60例患者。利用计算机软件对各个节段颈椎间盘突出程度进行对比分析并行统计学处理。结果：在动力位上，各节段颈椎椎间盘突出同中立位相比均有显著增加。在中立位正常或椎间盘突出3 mm，15.44%患者在过伸位椎间盘突出进展到3 mm。在中立位椎间盘突出3 mm 且5 mm，7.14%患者在过伸位椎间盘突出进展到5 mm。结论：与中立位相比，动力位 MRI 上颈椎椎间盘突出更加准确。动力位 MRI 对颈椎间盘突出症的评估有其重要价值，是常规中立位的重要补充。 　　关键词： MRI；动力位；颈椎病 　　Abstract： objective：To investigate the diagnostic value of cervical kinematic MRI for the disc herniation. Methods：60 patients who were clinically suspected the cervical disc herniation were examined with the neutral， flexion and extension position of MRI. The images were analyzed using computer software to objectively quantify the amount of disc herniation. Results ： Compared to neutral position， cervical disc herniations were significantly increased in extension MRI. For patients with normal or 3 mm of disc bulge in neutral， 2.46% demonstrated an increase in herniation to 3 mm bulge in flexion， and 17.25% demonstrated an increase to 3 mm bulge in extension. For patients in the neutral view that had a baseline disc bulge of 3 to 5 mm， 3.61% had increased herniations to 5mm in flexion and 11.65% had increased herniations to 5 mm in extension. Conclusion accurate increase in the degree of cervical disc herniation is found by examining flexion and extension views when compared with neutral views alone. Kinematic MRI views provide valuable added information and it is an important complement to the neutral position. 　　Keywords ：Magnetic resonance imaging；Dynamic position scan； 　　1 资料与方法 　　1.1 临床一般资料 　　本研究选取 2013年 5月至 2014 年 1 月期间临床疑有颈椎椎间盘突出症并行颈椎常规中立位和动力位MRI检查的60例患者做为研究对象。男性40例，女性20例，年龄 18～65 岁，平均（43.8±11.7）岁，均自愿接受动态 MRI 检查。动力位MRI检查均先用中立位MRI检查排除有颈椎动力位检查禁忌的患者。 　　1.2 方法 　　1.2.1 检查方法：采用PHILIPS ACHIEVA 1.5T超导型磁共振，所有研究对象均先用颈椎中立位MRI检查，再行动力位MRI检查。扫描范围：头起自小脑，尾止于上胸椎，分别在中立位、过屈位、过伸位连续完成。中立位：常规扫描体位，枕部垫取薄枕，使患者感觉颈部处于自然曲度位置。过屈位：枕部垫取高枕，使患者感觉颈部处于能承受的最大前屈位置（角度30°）。过伸位：肩背部垫取高枕，使患者感觉颈部处于能承受的最大后伸位置（角度15°）。 　　1.2.2 椎间盘突出的诊断：先由2名有经验的医师分别对颈椎是否椎间盘突出和突出的分级