合成MRI技术对腰椎间盘变性级别的定量诊断研究  

Evaluation of lumbar intervertebral disc degeneration with synthetic MRI

作　　者：张洧蓝 朱婧怡 徐晓晗 范国光[1] Zhang Weilan;Zhu Jingyi;Xu Xiaohan;Fan Guoguang(Department of Radiology,First Affiliated Hospital of China Medical University,Shenyang 110001,China)

机构地区：[1]中国医科大学附属第一医院放射科,沈阳110001

出　　处：《中华放射学杂志》2021年第6期621-626,共6页Chinese Journal of Radiology

摘　　要：目的:探讨合成MRI的多定量参数对腰椎间盘变性级别的诊断价值。方法:前瞻性收集2018年9月至2019年2月中国医科大学附属第一医院因腰痛接受腰椎MRI的患者,共纳入85例患者的414个腰椎间盘。对合成MRI图像进行后处理,生成T_(1)、T_(2)及质子密度(PD)mapping 3组定量序列。由两名医师分别测量L1~S1的椎间盘前纤维环、后纤维环及髓核的T_(1)、T_(2)、PD值,采用ICC评估观察者间及观察者内的一致性。采用单因素方差分析或Kruskal-Wallis H检验比较不同Pfirrmann级别椎间盘间各定量参数的差异。对差异有统计学意义的参数绘制ROC曲线,评价其诊断不同级别的效能,并以Z检验比较曲线下面积(AUC)的差异。结果:各椎间盘的定量伪彩图的颜色随着椎间盘变性级别的升高而变化,这种变化与T_(2)WI信号减低相对应。一致性分析结果显示腰椎间盘髓核的ICC值最大,均>0.900,其次是前纤维环,ICC均>0.700,后纤维环最低,但ICC均>0.600。相邻Pfirrmann级别间分析结果显示PfirrmannⅠ和Ⅱ级间的髓核T_(2)值(P=0.004)和PD值差异有统计学意义(P<0.001);PfirrmannⅡ和Ⅲ级间髓核T_(1)、T_(2)及PD值差异有统计学意义(P均<0.001);PfirrmannⅢ和Ⅳ级间髓核T_(1)、T_(2)及PD值(P均<0.001),后纤维环T_(1)(P=0.025)及PD值(P<0.001)差异有统计学意义;PfirrmannⅣ和Ⅴ级间髓核T_(2)值差异有统计学意义(P=0.031)。髓核T_(2)值诊断PfirrmannⅡ与Ⅲ级、Ⅳ与Ⅴ级的AUC高于PD值(Z=2.443、3.591,P=0.015、<0.001)。结论:合成MRI技术可以定量评估腰椎间盘变性的Pfirrmann级别,其中髓核T_(2)值是重复性好、诊断效能较高的定量指标。Objective To investigate the value of synthetic MRI for evaluating lumbar intervertebral disc degeneration.Methods A total of 414 lumbar intervertebral discs from 85 patients were included prospectively from September 2018 to February 2019 in First Affiliated Hospital of China Medical University.The T1,T2 and proton density(PD)mapping were generated from synthetic MRI.Two doctors measured the T1,T2 and PD values to evaluate intraobserver agreement by using ICC.For Pfirrmann grade comparisons,the variables with normal distribution were analyzed with the one-way analysis of variance,whereas those with skewed distribution were analyzed with the Kruskal-Wallis H test.Furthermore,the ROC curves were used on significant parameters to evaluate their diagnostic efficacy.The Z test was used to compare the differences of area under the ROC curves(AUC).Results The color of the quantitative mapping changed along with the increase of the Pfirrmann grade of the intervertebral discs,which corresponded to the decrease of the T2WI signal intensity.The ICC values of the quantitative values of nucleus pulposus indicated excellent agreement(ICC>0.900),followed by anterior annulus fibrosus(ICC>0.700)and then the posterior annulus fibrosus(ICC>0.600).The results of the adjacent Pfirrmann grade comparisons were as follows:between Pfirrmann gradeⅠandⅡ,the differences of T2 and PD values of nucleus pulposus were statistically significant(P=0.004 and P<0.001,respectively);between Pfirrmann gradeⅡandⅢ,the differences of T1,T2 and PD values of nucleus pulposus were statistically significant(all P<0.001);between Pfirrmann gradeⅢtoⅣ,the T1,T2 and PD values of nucleus pulposus(all P<0.001)and the T1 and PD values of posterior annulus fibrosus(P=0.025,P<0.001,respectively)had statistically significant differences;between Pfirrmann gradeⅣtoⅤ,the difference of T2 values of nucleus pulposus were statistically significant(P=0.031).The AUC of T2 values of nucleus pulposus between Pfirrmann gradeⅡtoⅢand gradeⅣto V were higher th

关 键 词：磁共振成像 椎间盘变性 定量MRI 

分 类 号：R681.53[医药卫生—骨科学] R445.2[医药卫生—外科学]