Jagannathan Devimeenal, Indiran Venkatraman, Hithaya Fouzal, Alamelu M, Padmanaban S
Department of Radiodiagnosis, Government Kilpauk Medical College, Chennai, India.
Department of Radiodiagnosis, Sree Balaji Medical College and Hospital Chromepet, Chennai, India.
Asian Spine J. 2017 Jun;11(3):365-379. doi: 10.4184/asj.2017.11.3.365. Epub 2017 Jun 15.
Retrospective study.
Identification of transitional vertebra is important in spine imaging, especially in presurgical planning. Pasted images of the whole spine obtained using high-field magnetic resonance imaging (MRI) are helpful in counting vertebrae and identifying transitional vertebrae. Counting vertebrae and identifying transitional vertebrae is challenging in isolated studies of lumbar spine and in studies conducted in low-field MRI. An incorrect evaluation may lead to wrong-level treatment. Here, we identify the location of different anatomical structures that can help in counting and identifying vertebrae.
Many studies have assessed the vertebral segments using various anatomical structures such as costal facets (CF), aortic bifurcation (AB), inferior vena cava confluence (IC), right renal artery (RRA), celiac trunk (CT), superior mesenteric artery root (SR), iliolumbar ligament (ILL) psoas muscle (PM) origin, and conus medullaris. However, none have yielded any consistent results.
We studied the locations of the anatomical structures CF, AB, IC, RRA, CT, SR, ILL, and PM in patients who underwent whole spine MRI at our department.
In our study, 81.4% patients had normal spinal segmentation, 14.7% had sacralization, and 3.8% had lumbarization. Vascular landmarks had variable origin. There were caudal and cranial shifts with respect to lumbarization and sacralization. In 93.8% of cases in the normal group, ILL emerged from either L5 alone or the adjacent disc. In the sacralization group, ILL was commonly seen in L5. In the lumbarization group, ILL emerged from L5 and the adjacent disc (66.6%). CFs were identified at D12 in 96.9% and 91.7% of patients in the normal and lumbarization groups, respectively. The PM origin was observed from D12 or D12-L1 in most patients in the normal and sacralization groups.
CF, PM, and ILL were good identification markers for D12 and L5, but none were 100% accurate.
回顾性研究。
在脊柱成像中，尤其是在术前规划中，识别过渡椎很重要。使用高场磁共振成像（MRI）获取的全脊柱粘贴图像有助于计数椎体和识别过渡椎。在腰椎的单独研究以及低场MRI研究中，计数椎体和识别过渡椎具有挑战性。错误的评估可能导致治疗节段错误。在此，我们确定了有助于计数和识别椎体的不同解剖结构的位置。
许多研究使用各种解剖结构评估椎骨节段，如肋小关节（CF）、主动脉分叉（AB）、下腔静脉汇合处（IC）、右肾动脉（RRA）、腹腔干（CT）、肠系膜上动脉根部（SR）、髂腰韧带（ILL）、腰大肌（PM）起点和脊髓圆锥。然而，没有一项研究得出任何一致的结果。
我们研究了在我院接受全脊柱MRI检查的患者中解剖结构CF、AB、IC、RRA、CT、SR、ILL和PM的位置。
在我们的研究中，81.4%的患者脊柱节段正常，14.7%有骶化，3.8%有腰化。血管标志的起源各不相同。相对于腰化和骶化存在尾侧和头侧移位。在正常组93.8%的病例中，ILL单独从L5或相邻椎间盘发出。在骶化组中，ILL常见于L5。在腰化组中，ILL从L5和相邻椎间盘发出（66.6%）。在正常组和腰化组中，分别有96.9%和91.7%的患者在D12处发现CF。在正常组和骶化组的大多数患者中，观察到PM起点位于D12或D12-L1。
CF、PM和ILL是D12和L5的良好识别标志，但没有一个是100%准确的。
