Overall anatomical features and clinical value of the sacral nerve in high resolution computed tomography reconstruction / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Sacral nerve injury is a common complication of pelvic or sacral fractures. As the sacral nerve courser within the sacrum and has a complex relationship with the surrounding tissues, different parts of the sacral plexus injury have similar clinical symptoms and signs. Since lack of specific imaging technique in the diagnosis of sacral nerve injury, especially on multi-segment, multi-site, how to determine the preoperative location and extent of the sacral nerve injury accurately becomes a concern of the general orthopaedic and images practitioners. This study was conducted to gain an insight into the overall anatomical features of the sacral nerve (SN) on the same slice in high resolution computed tomography (HRCT) reconstruction and to determine the value of this information for the clinical diagnosis of related diseases.</p><p><b>METHODS</b>Fifty healthy volunteers and 30 patients (40 sides) with SN lesions confirmed by surgery were scanned using a 16-slice helical CT scanner (Light Speed, GE, USA). Among the patients, 6 with intervertebral disk hernia (6 sides), 8 with spinal stenosis (12 sides), 11 with pelvic trauma (14 sides), 4 with pelvic malignancies (6 sides), and 1 with sacral vertebral tuberculosis (2 sides). The SN multiplanar reconstruction was performed using a UNIX-based SCD4.1 workstation where the image was set on the same slice. All images were stored in the Digital Imaging and Communications in Medicine format. The display of nerves in different sections was analyzed using a five-graded scale with coordinate curves of each individual score. The overall anatomic features visible on the slice were analyzed and the abnormalities of the lesions were studied.</p><p><b>RESULTS</b>The image of the same slice clearly revealed the shape, running direction, thickness, tension and adjacent anatomy of the S1-S4 nerves. The rank of display rates in different sections was: outward-rotated oblique sagittal > outward-rotated oblique coronal > oblique coronal plane > coronal > sagittal > transverse section. The S5 nerve was partially displayed from the starting point to the segment around the posterior sacral foramen. The overall anatomy of the triangular sacral plexus was only revealed in the oblique outward-rotated sagittal section, while 100% of its individual rami, as well as two or three of the adjacent rami, were displayed from their starting points to the anterior border of the piriformis. The abnormalities included 39 sides of morphological change (97.5%), 38 sides of compression (95.0%), 35 sides of adhesion (87.5%), 32 sides of displacement (80.0%), 34 sides of shrinkage (85.0%), 6 sides of thickening (15.0%), and 2 sides of abruption (5.0%).</p><p><b>CONCLUSIONS</b>The 16-slice CT multiplanar reconstruction was able to reveal the overall anatomic features of the SN on the same slice. The section of reconstruction was a crucial factor in determining the display capability of various sacral nerves. This technology was valuable in the diagnosis and management of related diseases.</p>

Study on the overall anatomical features and clinical value of lumbar nerve root, plexus and branches in CT reconstruction / 中华外科杂志

<p><b>OBJECTIVE</b>To identify the overall anatomical characteristics and the clinical value of the lumbar nerves under CT multiplanar reconstruction.</p><p><b>METHODS</b>Fifty normal subjects and 30 patients with LN diseases (51 sides) were selected, including 10 patients with lumber intervertebral disk hernia, eight patients with spinal stenosis, 5 patients with spondylolisthesis, 1 patient with tethered cord syndrome, 1 patient with lumbar scoliosis, and 5 patients with spinal trauma The 16-slice helical CT (Light Speed, GE Company) was used for scanning the lumbar vertebra with multiplanar reconstruction in Workstation (ADW4.1) with UNIX System in DICOM format. The image was set on the same slice for the overall anatomy and manifestations of the lesions.</p><p><b>RESULTS</b>The same-slice imaging showed the strip-like LN slightly lower than the surrounding muscle in density. Each LN went out of the dural sac at an acute angle. The course of the lumbar plexus and its major branches, including the obturator nerve, femoral nerve and reproductive nerve, and their relations to the adjacent structures were clearly revealed. The percentage of the segments displayed was well associated with the reconstruction angle, with the order being oblique coronal > outward-rotated oblique coronal > oblique sagittal > coronal > sagittal section. The major manifestations of abnormal LN included compression and displacement (50 sides, 98.0%), morphological changes (49 sides, 96.1%), adhesion (41 sides, 80.4%).</p><p><b>CONCLUSIONS</b>The CT multiplanar reconstruction is ideal for the imaging of the overall size, shape, running and tension of the LN root; it is valuable in clinical diagnosis.</p>

Features and clinic values of normal lumbar nerve root anatomy with CT on multiple plane reconstruction techniques at the same slice / 中华放射学杂志

Objective To explore features and clinic values of LNR anatomy with multiple planar reconstruction techniques with 16-slice spiral CT at the same slice.Methods The lumbar vertebrae with normal adults of 55 cases and 23 cases with abnormal ENR caused by 8 cases with protrusion of lumbar disc, 5 cases with spinal stenosis,4 cases with malignant tumor,5 cases with trauma and 1 case with lumbar TB confirmed by operation were scanned with 16-slice spiral CT made in American GE company in routine posture of the lumbar vertebrae,reconstructed LNR with UNIX system in workstation (ADW 4.1),and analyzed their normal and abnormal anatomic manifestations at the same slice.Results All of LNR can symmetrically showed on oblique and coronal planes according to different segments:one segment from L1 to L5(55,100% ),two segments: from L1 to L2,L2 to L3 and L3 to L4(55,100% ),three segments: from L1 to L3 (49,88%),from L2to L4(46,84% )and from L3 to L5(20,36% ),four segments: from L1 to L4 (15,27% )and five segments:(8,15% ),respectively.Each LNR,including their whole shapes of passage from starting to end,direction,size,shape,tension and peripheral relationship and so on can showed clearly on oblique and coronal planes and on other planes. However,the later planes can increase LNR but decreasing numbers of LNR and especially increase very long one LNR reconstruction.Primary manifestation of all diseases can be showed on oppressing along its walking line,meanwhile,20 cases with adhesion, 14 cases with displacement,13 cases atrophy and 9 cases with increasing diameter.Conclusions Image anatomy features of full LNR with 16-slice spiral CT with the multiple plane reconstruction techniques is very ideal ways at the same slice.It is a very valuable way to make diagnosis and treatment of LNR diseases.The concept of"road sing"and showing"at the same slice"of LNR are tried to rise from in order to make foundation for studying their image.