腰椎管内椎间盘游离髓核核磁共振诊断.docxVIP

腰椎管内椎间盘游离髓核核磁共振诊断 中图分类号:R445. 2 文献标识码：A 文章编号：1005-0019 (2009) 05-0009-03 【摘要】目的观察腰椎管内椎间盘游离髓核的MRI表 现及诊断价值。方法回顾性分析28例经手术后病理证实的 腰椎管内椎间盘游离髓核患者MRI征像。结果31例腰椎管 内游离髓核均位于硬膜外间隙前部。游离髓核在椎管内向上 游走6例，向下游走20例，向后水平游走5例；占据右隔区15 例，左隔区11例，中线隔区5例。游离髓核与供体椎间盘髓 核呈等或稍低信号,6例见班点状钙化呈更低信号。其形态呈 圆形、卵圆形及片带状不规则形。其中6例行GD-DTPA对比 剂增强扫描，病灶中心均无强化表现，边缘均有环形中、高度 强化。结论正确的扫描方法能准确显示腰椎管内游离髓 核,MRI是确诊的首选方法。 【关键词】椎间盘游离髓核;磁共振成像 MRI Diagnosis of Intervertebral Disc Free Pulpiform Nucleus in Intraspinal Lumbar HUANG Zu-ping, LI Qiu~yun. (1. Hea 1th Centre of Dangjiajie Subdisti\rict Office of Jinan, Jinan 250116； 2. QianfushanHospttal in shandong China.) [Abstract] Objective To observe the MRI findings and diagnosticvalue of lumbar intraspinal intervertebral disc free pulpiform nucleus ? Methods MR I findings of 31 cases with free pulpiform nucleus proved by surgery and pathology were retrospectively analyzed. Results Of the all cases, the free pulpiform nucleus located at extradural foreside. 6 cases dissociated upon in spinal, 20 cases moved down and 5 cases removed backwards. Of 31 patients, 15 cases inhabited right and 11 cases left and 5 cases midline? The free pulpiform nucleus had the same equal or low signal with provided intervertebral disc,56cases with flecky calcification showed lower signa1. They had round shape,or oval or anormaly form? Among these 6 cases there were injected GD-DTPA with no enhancement in the center ,but mild and high enhancement at periphery. Conclusion Correct sean technique can exactly show lumbar intervertebral disc free pulpiform nucleus intraspinal.MRI should be the first choice for diagnosis. 【Key words 】 Free pulpiform nucleus；Magnetic resonance imaging 椎间盘游离髓核是腰推间盘突出的一种类型，患者有较 严重的症状和体征，常需要手术治疗。笔者搜集28例患者的 MRI资料，并复习文献资料分析。 1材料方法 31例中男23例，女8例，年龄31?29岁，平均46岁。31 例均行手术后病理证实。病程5天至15年，平均4. 3年。临 床症状主要有腰腿痛，下肢麻木，下肢肌肉痉挛等，7例行走 困难。体查直腿抬高试验 3.2游离髓核的MRI诊断 矢状面T1WI、T2WI及脂肪抑制序列T2WI：能清楚地观察 到游离髓核的走向（向上、向下或者向后水平）。后纵韧带常 因髓核受压向后移位，可以观察到”尾状征”；部分游离髓 核导致后纵韧带断裂，后缘见不到受压的线状低信号，共上 下端可皱缩的后纵韧带残端。游离髓核与供体椎间盘可完