摘要
目的：探讨CT导引下椎间盘造影在椎间盘源性疼痛中的诊断价值。方法：55例疑似椎间盘源性疼痛的患者行CT导引下椎间盘造影，根据达拉斯CT椎间盘造影评价系统（Dallas Discogram Description， DDD）对造影阳性椎间盘的形态分型，明确诊断阳性椎间盘及相应椎间盘纤维环退变和破裂程度。结果：经椎间盘造影确诊为阳性者33例（60.0%），高龄组（>50岁）中造影阳性率为35.7%；而低龄组（<50岁）中造影阳性率为68.3%。应用DDD评估纤维环的退变、破裂程度和级别，其中纤维环退变1，2，3级比例分别为26.3%，34.2%，39.5%；纤维环破裂1，2，3级比例分别为23.7%，73.7%，2.6%。所有阳性椎间盘MRI表现均有不同程度的退行性改变。MRI椎间盘纤维环后缘高信号区（HIZ）的11例患者中有10例椎间盘造影为阳性；阳性率达90.9%。结论：①年轻的慢性腰痛患者中椎间盘造影阳性率较高。②椎间盘造影形态异常（纤维环内破裂）是诱发疼痛阳性的基础。③MRI诊断椎间盘源性疼痛敏感性高但缺乏特异性，需要椎间盘造影来确定责任椎间盘。④HIZ对于诊断椎间盘源性疼痛特异性较高。⑤造影剂在椎间盘内的弥散因素。
Abstract
Objective: To discuss the values of CT-guided discography in diagnosing intervertebral disc pain. Methods: CT-guided discography was performed in 55 cases of the suspicious intervertebral disc pain, the positive discs were classified according to Dallas Discogram Description(DDD), then diagnosed definitely positive discs and the degree of degeneration and rupture of corresponding annulus fibrosus. Result: Thirty-three cases were positive by CT-guided discography, the positive rate in the elder group(>50 year) was 35.7%, that in the younger group was 68.3%. To evaluate the degree and level of disc degeneration and rupture according to DDD, 1, 2, 3 degree of disc degeneration was 26.3%, 34.2%, 39.5% respectively； 1, 2, 3 degree of disc rupture was 23.7%, 73.7%, 2.6% respectively. Degenerative changes on MR image existed in all positive discs. 10 cases were positive in 11 cases existing HIZ on MR, the positive rate of which was 90.9%. Conclusion: ①The positive rate of discography was higher in the younger group of chronic lumbar pain. ②Abnormal morphology of discography(rupture within annulus fibrosus) was the basis of the positive inducing pain. ③It had high sensitivity but low specificity to diagnose intervertebral disc pain by MR, so we have to utilize discography to identify the responsible disc. ④HIZ on MRI has higher specificity to diagnose intervertebral disc pain. ⑤Diffuse factor of contrast media within intervertebral disc.
关键词
椎间盘 /
腰痛 /
体层摄影术 /
X线计算机
Key words
intervertebral disc /
low back pain /
tomography /
X-ray computed
郭 林;王林森;蔡跃增;张继东;孙鼎元.
CT导引下椎间盘造影诊断椎间盘源性疼痛的价值[J]. 中国临床医学影像杂志. 2007, 18(10): 726-728
GUO Lin;WANG Lin-sen;CAI Yue-zeng;ZHANG Ji-dong;SUN Ding-yuan.
Values of CT-guided discography in diagnosing intervertebral disc pain[J]. Journal of China Clinic Medical Imaging. 2007, 18(10): 726-728
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