MRI T2WI量化指标评估胸椎黄韧带骨化症手术预后的价值  

Value of quantitative MRI T2WI parameters in predicting surgical outcome of thoracic ossification of the ligamentum flavum

作　　者：申沧海[1,2] 冯永健[2] 宋彦澄 刘钢 刘志伟[2] 王玲[2] 戴海洋 Shen Canghai;Feng Yongjian;Song Yancheng;Liu Gang;Liu Zhiwei;Wang Ling;Dai Haiyang(Cangzhou Central Hospital Teaching Hospital,Tianjin Medical University,Cangzhou 061000,Hebei Province,China;Fourth Department of Orthopedics,Cangzhou Central Hospital,Cangzhou 061000,Hebei Province,China;Department of MRI,Cangzhou Central Hospital,Cangzhou 061000,Hebei Province,China)

机构地区：[1]天津医科大学沧州市中心医院教学医院,河北省沧州市061000 [2]沧州市中心医院骨四科,河北省沧州市061000 [3]沧州市中心医院磁共振成像科,河北省沧州市061000

出　　处：《中国组织工程研究》2020年第18期2893-2899,共7页Chinese Journal of Tissue Engineering Research

基　　金：沧州市重点研发计划指导项目(172302149)，项目负责人：申沧海~~

摘　　要：背景:MRI对于胸脊髓病变具有较高的灵敏性,能够通过脊髓受压的形态及信号强度变化来评估脊髓受损情况,并且对胸椎管狭窄症患者手术预后有提示作用。目的:分析MRI T2WI量化指标对胸椎黄韧带骨化症患者手术预后的评估价值,并建立预后不良的预测模型,为其预后评估提供参考。方法:回顾性分析2010年1月至2019年1月沧州市中心医院87例行胸椎管后壁切除减压术且完成术后随访的胸椎黄韧带骨化症患者的临床与影像学资料。根据术后6个月随访时的JOA评分改善率将患者分为预后优良组(改善率≥50%)和预后不良组(改善率<50%)。比较两组患者年龄、性别、病程、JOA评分、骨化物Sato分型、脊髓矢状径残余率、脊髓横截面积、脊髓高信号分布、脊髓信号强度比值、高信号范围、胸椎局部后凸角、后凸角矫正度数、减压节段数以及脑脊液漏变化。单因素分析有显著性差异的指标。采用受试者工作特征曲线(ROC)进行预后分析,纪录曲线下面积及预测界值。多因素Logistic回归分析确定预后不良的独立危险因素,并建立预测模型。结果与结论:①预后优良组与预后不良组患者病程、JOA评分、脊髓矢状径残余率、脊髓横截面积、脊髓信号强度比值、高信号范围比较差异有显著性意义(P<0.05);②ROC曲线分析显示,上述各指标预测手术预后不良的曲线下面积分别为0.670,0.733,0.647,0.715,0.753和0.765,预测界值分别为13个月、4分、29.8%、0.25 cm2、1.593和13.64 mm。病程与脊髓矢状径残余率预测价值较低(ROC曲线下面积<0.7);JOA评分、脊髓横截面积、脊髓信号强度比值与高信号范围具有中等预测价值(ROC曲线下面积0.7-0.9)。脊髓信号强度比值联合高信号范围预测预后不良的ROC曲线下面积为0.791。③多因素Logistic回归分析显示:JOA评分、脊髓横截面积、脊髓信号强度比值联合高信号范围为预后�BACKGROUND:MRI has high sensitivity to thoracic myelopathy,which can assess the spinal cord injury by morphology and magnitude of cervical spinal cord compression.Additionally,it is a valuable tool for the prognosis evaluation of thoracic spinal stenosis.OBJECTIVE:To explore the value of quantitative MRI T2WI parameters in predicting surgical outcome of thoracic ossification of the ligamentum flavum,and to establish the prediction model of poor prognosis,so as to provide reference for prognosis evaluation.METHODS:From January 2010 to January 2019 at Cangzhou Central Hospital,clinical and imaging data of 87 cases of thoracic ossification of the ligamentum flavum treated by thoracic laminectomy were reviewed retrospectively.According to the JOA recovery rate at 6-month follow-up,the patients were divided into good recovery group(≥50%)and poor recovery group(<50%).Age,sex,duration of disease,JOA score,Sato type of ossification,maximum spinal cord compression,cross-sectional area,distribution of hyperintense signal,signal intensity ratio,intramedullary signal size,local kyphosis,kyphosis correction,number of decompressed levels and incidence of cerebrospinal fluid were compared between two groups.Univariate analysis was used to analyze indicators with significant differences.Receiver operating characteristic curve was plotted to analyze prognosis.Areas under the curve and cut-off values were recorded.The independent predictors of poor recovery were estimated through multivariate logistic regression analysis and the prediction model was established.RESULTS AND CONCLUSION:(1)The duration of disease,JOA score,maximum spinal cord compression,cross-sectional area,signal intensity ratio and intramedullary signal size showed significant difference between good recovery and poor recovery groups(P<0.05).(2)Receiver operating characteristic curve analysis showed that the area under the curve of the duration of disease,JOA score,maximum spinal cord compression,cross-sectional area,signal intensity ratio and intramedullary sig

关 键 词：磁共振成像 脊柱疾病 胸椎 黄韧带 椎管狭窄 后路减压手术 影像学参数 高信号 影响因素 预后 组织工程 

分 类 号：R441[医药卫生—诊断学] R322[医药卫生—临床医学]