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目的探讨腰神经根(LNR)16层螺旋 CT 多平面重组同层显示的解剖学特征及临床价值。方法选55例腰椎正常者和23例经手术病理证实的 LNR 病变者(腰椎椎间盘突出症8例、椎管狭窄症5例、恶性肿瘤4例、创伤5例及结核1例)。使用美国 GE 公司生产的 Light Speed 16层螺旋 CT 扫描,在工作站(ADW4.1)上利用 UNIX 操作系统进行 LNR 多平面重组,选取 LNR 走行清晰的同层显示层面,观察其解剖学特征。对病变者重点分析其异常表现。结果在斜冠状面上双侧LNR 可对称显示:55例(100%)L1～5的 LNR 均可分别单节段显示;55例(100%)L1～2或 L2～3,以及 L3～4的 LNR 均可同时显示2个节段;49例(88%)L1～3、46例(84%)L2～4、20例(36%)L3～5可同时显示3个节段;15例(27%)L1～4的 LNR 同时显示4个节段;8例(15%)同时显示5个节段LNR。每条 LNR 均能显示走行的起止点、方向、大小、形态、张力状态及毗邻关系。除斜冠状面外 LNR均不能对称显示,但显示的长度相对增加而数目减少,单根重组时 LNR 均显示的最长。LNR 异常主要表现受压23例,同时伴粘连20例,移位14例,萎缩13例,增粗9例。结论 16层螺旋 CT 的多平面重组同层显示技术是整体显示 LNR 解剖学特征极为理想的方法,它对 LNR 病变的影像学诊断奠定了基础。LNR 走行“同层显示”及“路标”的新概念,可能为其进一步影像学研究奠定基础。
Objective To investigate the anatomical characteristics and clinical value of multiplanar reconstruction of 16-slice spiral CT in lumbar nerve root (LNR). Methods 55 cases of normal lumbar and 23 cases of pathologically confirmed LNR lesions (lumbar disc herniation in 8 cases, 5 cases of spinal stenosis, 4 cases of malignant tumors, 5 cases of trauma and 1 case of tuberculosis). Using the Light Speed 16-slice spiral CT scanner manufactured by GE Company of USA, the LNR multiplanar reorganization was performed on the workstation (ADW4.1) by using the UNIX operating system. A clear LNR display layer was selected to observe its anatomical features. Focus on the abnormalities of patients with abnormal performance. Results The bilateral LNR symmetry in the oblique coronal plane showed that LNR of 55 cases (100%) L1 ~ 5 could be displayed in single segment, 55 cases (100%) L1 ~ 2 or L2 ~ 3, and L3 ~ 4 LNR of two cases showed two segments at the same time; three segments were found in 49 cases (88%) L1 ~ 3,46 cases (84%) L2 ~ 4 and 20 cases (36% (27%) LNR of L1 ~ 4 showed 4 segments at the same time; 8 cases (15%) showed LNR of 5 segments at the same time. Each LNR can show the starting and ending points, direction, size, shape, tension and adjacent relationship. In addition to oblique coronal LNR are not symmetrical display, but the relative increase in the length of the display and reduce the number of single-stage LNR showed the longest. The main manifestations of abnormal LNR pressure in 23 cases, accompanied by adhesions in 20 cases, 14 cases of shift, atrophy in 13 cases, 9 cases of thickening. Conclusion The multiplanar reconstruction of 16-slice spiral CT is an ideal method to display the anatomic features of LNR as a whole, which lays the foundation for the imaging diagnosis of LNR lesions. The new concept of LNR running “same level display ” and “road sign ” may lay the foundation for further imaging studies.