Dietemann J L, Romero C, Allal R, Gangi A, Tajahmady T
Service de Radiologie, Clovis Vincent CHRU, Hôpital Civil, Strasbourg, France.
J Neuroradiol. 1992 Sep;19(3):167-76.
The CT technique used to explore intervertebral discs and foramina is described, as are the CT signs of nucleus pulposus (NP) herniation and cervical degenerative lesions. CT with intravenous contrast injection is the most efficient and easiest method to diagnose a radicular compression of discal or degenerative origin. The advent of high-resolution contrast CT will probably make obsolete the use of contrast media. CT measures the width of the vertebral canal, but it does not evaluate the repercussions on the spinal cord of compression caused by NP herniation or osteophytosis: only CT-myelography or, better, MRI can make this evaluation. Conventional CT scans are sometimes inadequate when exploration is hampered by superimposition of the shoulders (C6-C7 and more often C7-T1), when the scanner is of poor quality or when it is misused. Myelography and CT-myelography can then be utilized to resolve the problem posed by C7 or C8 cervicobrachial neuralgia (CBN). CT makes it possible to exclude most of the causes of non-discal CBN in the extradural spaces (e.g. bone tumour, neurinoma, vertebral vascular malformation, paravertebral expansive process, apical lung tumour). The search for an intradural cause (extra- or intramedullary tumour) rests on myelography, CT-myelography and MRI.
本文描述了用于探查椎间盘和椎间孔的CT技术，以及髓核（NP）突出和颈椎退行性病变的CT征象。静脉注射造影剂的CT是诊断椎间盘源性或退行性神经根受压最有效、最简单的方法。高分辨率对比CT的出现可能会使造影剂的使用过时。CT可测量椎管宽度，但无法评估NP突出或骨赘形成所致压迫对脊髓的影响：只有CT脊髓造影，或者更好的MRI才能进行此项评估。当肩部重叠（C6-C7，更常见于C7-T1）、扫描仪质量差或使用不当而妨碍探查时，传统CT扫描有时并不充分。此时可利用脊髓造影和CT脊髓造影来解决C7或C8型颈臂神经痛（CBN）所带来的问题。CT能够排除硬膜外间隙非椎间盘源性CBN的大多数病因（如骨肿瘤、神经鞘瘤、椎体血管畸形、椎旁扩张性病变、肺尖肿瘤）。对硬膜内病因（髓外或髓内肿瘤）的排查依赖于脊髓造影、CT脊髓造影和MRI。
