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胸椎黄韧带骨化（thoracic ossification of ligament flavum，TOLF）是胸椎黄韧带纤维组织转变为骨性组织的病理性异位骨化过程，是导致胸椎管狭窄症及胸脊髓病的最常见病因。影像学检查是定位、定性诊断TOLF的最常用手段。临床上根据骨化形态、分布、脊髓压迫程度及与周围组织的关系制订的TOLF分型系统有很多，但应用混乱，迄今尚无统一标准。本文对TOLF分型系统的临床应用进行综述，并评估分型系统的可靠性及影像学检查的诊断准确性。经文献检索，X线诊断TOLF的准确性低，相关分型较少，可靠性差；基于CT的Sato分型（外侧型、扩展型、扩大型、融合型、结节型）和Kuh分型（单侧型、双侧型、桥接型），基于MRI的Kuh分型（喙型、圆型）和陈仲强分型（局灶型、跳跃型、连续型），以及合并硬膜囊骨化的Muthukumar分型（Tram track征、Comma征）等从不同角度和维度阐述了TOLF的类型，在反映骨化机制、评估病情风险、指导治疗方案或判断预后等方面具有一定的临床价值，诊断的准确性及分型可靠性较高。结合CT和MRI的多维度、多层面影像学参数将在TOLF的精准化诊疗及新分型探索过程中扮演重要角色。“,”Thoracic ossification of ligament flavum (TOLF) is a pathological process of heterotopic bone formation from ligamentum flavum tissue, which is the most common cause of thoracic spinal stenosis and thoracic myelopathy. Imaging examination is the predominant measure for localization and qualitative diagnosis for TOLF. Various TOLF classification systems have been reported currently, based on its morphology, distribution, configuration of compressed spinal cord or its association with peripheral tissue structures. However, there has been no unified classification due to confusing clinical applications. Therefore, we conducted a review to summarize TOLF classification systems and to evaluate the reliability of these classification systems and the diagnostic accuracy of various imaging modalities. As demonstrated in literatures, the diagnostic accuracy of radiography and the reliability of related classification were low. CT-based Sato classification (lateral, extended, enlarged, fused, tuberous) and Kuh classification (unilateral, bilateral, bridging), MRI-based Kuh classification (round, beak) and Chen Zhongqiang classification (isolated, skipping, continuous), Muthukumar classification combined with dural ossification (Tram track sign, Comma sign) elaborated ossification characteristics from different angles and dimensions. These classification systems were clinically significant in pathogenesis implication, risk assessment, treatment guidance and prognosis judgement, which showed high diagnostic accuracy and reliability. Combining multi-dimension and multi-level parameters of CT and MRI will play an important role in the diagnosis, treatment and new classification research of TOLF.