CAJ | 학술논문

目的：探讨第5腰椎水平椎管前后径增宽(宽管征)在 MRI诊断椎弓峡部不连中的意义。方法随机收集经 X线平片和/或CT证实的 L5双侧椎弓峡部不连100例,同时收集年龄、性别匹配的无椎弓峡部不连组100例作为对照组,在 T1 WI 正中矢状位 MRI图像上测量 L1、L5椎体的正中水平椎管矢状径,并计算 L5椎体平面的椎管正中矢状径与 L1椎体平面正中矢状径的比率,比较不连组和对照组的 L5/L1椎体平面椎管矢状径率,并进行 ROC曲线分析。结果椎弓峡部不连组 L5椎体平面的平均正中矢状径为(22.3±1.34)mm,平均正中椎管矢状径比率平均为1.32；而对照组平均正中椎管矢状径为(18.8±1.57)mm,平均正中椎管矢状径比率平均为1.12；经统计学检验,两者有显著差异(P 值为0.000)；ROC曲线下面积为0.964,当截断点选择为1.25时,灵敏度为88%,特异度为90%,两者之和值最大(1.78)。结论正中椎管矢状比率超过1.25定义为宽管征阳性,是诊断 L5双侧椎弓峡部不连的特异性征象,且直观、容易掌握,能有效地减少断椎弓峡部不连的漏误诊。
목적：탐토제5요추수평추관전후경증관(관관정)재 MRI진단추궁협부불련중적의의。방법수궤수집경 X선평편화/혹CT증실적 L5쌍측추궁협부불련100례,동시수집년령、성별필배적무추궁협부불련조100례작위대조조,재 T1 WI 정중시상위 MRI도상상측량 L1、L5추체적정중수평추관시상경,병계산 L5추체평면적추관정중시상경여 L1추체평면정중시상경적비솔,비교불련조화대조조적 L5/L1추체평면추관시상경솔,병진행 ROC곡선분석。결과추궁협부불련조 L5추체평면적평균정중시상경위(22.3±1.34)mm,평균정중추관시상경비솔평균위1.32；이대조조평균정중추관시상경위(18.8±1.57)mm,평균정중추관시상경비솔평균위1.12；경통계학검험,량자유현저차이(P 치위0.000)；ROC곡선하면적위0.964,당절단점선택위1.25시,령민도위88%,특이도위90%,량자지화치최대(1.78)。결론정중추관시상비솔초과1.25정의위관관정양성,시진단 L5쌍측추궁협부불련적특이성정상,차직관、용역장악,능유효지감소단추궁협부불련적루오진。
Objective To evaluate the importance of wide canal sign (increased anteroposterior diameter of the spinal canal at L5) in the MR diagnosis of lumbar isthmic spondylolisthesis.Methods One hundred cases of bilateral isthmic spondylolisthesis at L5 confirmed with conventional radiography and/or CT were randomly collected.Another age and sex matched 100 cases without spon-dylolisthesis were collected as control group.The sagittal canal diameters at the L1 and L5 levels were measured and analyzed for all 100 cases of bilateral isthmic spondylolisthesis and 100 control subjects.For each group,the sagittal canal ratio(defined as the maxi-mum anteroposterior diameter of the canal at L5 level divided by the diameter of the canal at L1 )was calculated and compared be-tween the two groups ,and anylyzed with ROC curve.Results The mean midline sagittal anteroposterior diameter was (22.3 ± 1.34)mm at L5 in patients with lumbar isthmic spondylolisthesis,and (18.8±1.57)mm in the control subjects.The sagittal canal ratio was 1.32 in the isthmic spondylolisthesis group and 1.12 in the control subjects,which was different significantly.ROC curve illustrated that the sagittal canal ratio 1.25 was a most meanful point with 88% sensitivity and 90% specificity.Conclusion The sag-ittal canal ratio at L5 is bigger than 1.25 meaning abnormally increased sagittal canal diameter (wide canal sign),which specifically indicates the presence of bilateral pars interarticularis defects.Using this sign can help to make correct MR diagnosis and differential diagnosis of isthmic spondylolisthesis .