腰椎间盘退行性变的改良MRI短时间反转恢复序列八级分级系统  

MODIFIED MRI SHORT TIME INVERSION RECOVERY SEQUENCE GRADING SYSTEM FOR LUMBAR INTERVERTEBRAL DISC DEGENERATION

作　　者：潘文琦[1] 王建[1] 刘杰[1] 陆焱[1] 黄博[1] 

机构地区：[1]第三军医大学新桥医院骨科,重庆400037

出　　处：《中国修复重建外科杂志》2012年第12期1430-1434,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的建立一套在腰椎MRI短时间反转恢复(short time inversion recovery,STIR)序列图像上评价腰椎间盘退变程度的改良STIR序列八级分级系统,并检验其效度及可重复性。方法根据改良Pfirrmann八级分级系统及MRI检查结果建立并优化一套基于STIR序列图像的腰椎间盘矢状位分级系统。以2011年4月-2012年2月收治的60例腰椎间盘退行性变患者作为研究对象,其中男32例,女28例;年龄17～85岁,平均50岁。对每例研究对象5个腰椎间盘(L1、2～L5、S1)行T2加权像及STIR序列扫描。由3位分级者独立分级后再共同分级,分级者之间的效度及可重复性采用一致率和Kappa系数进行分析。结果共同分级示,所有椎间盘中无1级椎间盘,2级83个(27.7%),3级87个(29.0%),4级66个(22.0%),5级31个(10.3%),6级15个(5.0%),7级12个(4.0%),8级6个(2.0%)。分级者自身达极强一致性(Kappa值0.822～0.952),组间达高度至极强一致性(Kappa值0.749～0.843)。分级者两次分级与共同分级比较,分级一致率为82.7%～92.7%,平均85.6%;13.9%的分级差异发生于相邻1个级别,0.5%为相邻2个或以上级别。结论对于腰椎间盘退变程度可以采用改良STIR序列八级分级系统,提高了不同退变程度椎间盘分级的准确度。Objective To develop a modified short time inversion recovery （STIR） sequence grading system for lumbar intervertebral disc degeneration based on MRI STIR sequences, and to test the validity and reproducibility of this grading system. Methods A modified 8-level grading system for lumbar intervertebral disc degeneration based on routine sagittal STIR sequences and modified Pfirrmann grading system was developed, Between April 2011 and February 2012, 60 patients with different degrees of lumbar intervertebral disc degeneration were selected as objects of study, including 32 males and 28 females with an average of 50 years （range, 17-85 years）. T2 weighted and STIR sequence images were obtained from the lumbar discs of L1.2-L5, $1 of each object （total, 300 discs）. All examinations were analyzed independently by 3 observers and a consensus readout was performed after all data collected. The validity and reproducibility were analyzed by calculating consistent rate and Kappa value. Results According to the grading system, there were 0 grade 1, 83 （27.7%） grade 2, 87 （29.0%） grade 3, 66 （22.0%） grade 4, 31 （10.3%） grade 5, 15 （5.0%） grade 6, 12 （4.0%） grade 7, and 6 （2.0%） grade 8. Intra-observer consistency was strong （Kappa value range, 0.822-0.952）, and inter-observer consistency was high to strong （Kappa value range, 0.749-0.843）. According to the consensus analysis, the total consistent rate was 82.7%-92.7% （mean, 85.6%）. A difference of one grade occurred in 13.9% and a difference of two or more grades in 0.5% of all the cases. Conclusion Disc degeneration can be graded by using modified STIR sequence grading system, which can improve the accuracy of grading different degrees of lumbar intervertebral disc degeneration.

关 键 词：腰椎间盘退行性变 MRI 短时间反转恢复序列 退变分级 

分 类 号：R681.53[医药卫生—骨科学]