腰椎间盘突出症术前磁共振成像弥散张量成像结果对术后复发的预测价值分析  

Predictive value of preoperative magnetic resonance imaging diffusion tensor imaging result for postoperative recurrence of lumbar disc herniation

作　　者：朱明洪[1] 张艳玲 Zhu Minghong;Zhang Yanling(Department of Radiology,Chongqing Fuling Central Hospital,Chongqing 408000,China)

机构地区：[1]重庆市涪陵中心医院放射科,重庆408000

出　　处：《中国医学前沿杂志（电子版）》2021年第11期133-138,共6页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

摘　　要：目的探讨腰椎间盘突出症(lumbar disc herniation,LDH)术前磁共振成像(magnetic resonance imaging,MRI)弥散张量成像(diffusion tensor imaging,DTI)对术后复发的预测价值。方法选取2015年1月至2017年3月于重庆市涪陵中心医院行椎间孔镜手术治疗的136例LDH患者为研究对象,根据术后36个月内有无复发将入选患者分为复发组和非复发组。比较两组患者围手术期临床资料和术前MRI DTI检查相关指标[椎间盘髓核的部分各向异性(fractional anisotropy,FA)值与表观扩散系数(apparent diffusion coefficient,ADC)]值。采用多因素Logistic回归分析探讨患者术后复发的独立预测因素。采用受试者操作特征曲线(receiver operating characteristic curve,ROC曲线)的曲线下面积(area under the curve,AUC)评价术前MRI DTI检查相关指标对术后复发的预测价值。结果全部136例LDH患者术后36个月内共有27例复发,复发率为19.9%,将其纳入复发组,其中12个月内、13-24个月、25-36个月分别复发15例、5例、7例,其余109例未复发患者纳入未复发组。复发组患者年龄、体质量指数、病程、手术节段为L4-L5的比例、术后椎间活动度、FA值均显著高于未复发组(均P<0.05),ADC值显著低于未复发组(P<0.05)。多因素Logistic回归分析表明,年龄、FA值、ADC值、手术节段为L4-L5均为LDH患者术后复发的独立影响因素(均P<0.05)。ROC曲线结果表明,FA值、ADC值对LDH复发均有一定的预测价值,AUC分别达到0.733、0.793。结论术前MRI DTI检查对LDH患者术后复发具有一定的预测价值,FA值越高、ADC值越低,术后复发风险越高。Objective To investigate the predictive value of preoperative magnetic resonance imaging(MRI)diffusion tensor imaging(DTI)result for postoperative recurrence of lumbar disc herniation(LDH).Method One hundred and thirty-six patients with LDH underwent intervertebral foramen surgery from January 2015 to March 2017 in Chongqing Fuling Central Hospital were enrolled for the study and divided into recurrence group and non-recurrence group according to whether recurrence occurred within 36 months after operation.The clinical data during perioperative period and the related indexes of preoperative MRI DTI[fractional anisotropy(FA)and apparent diffusion coefficient(ADC)of nucleus pulposus of intervertebral disc]were compared between the two groups.Multivariate Logistic regression was used to analyze the independent predictors of postoperative recurrence.The area under the curve(AUC)of the receiver operating characteristic(ROC)curve was performed to evaluate the predictive value of preoperative MRI DTI for postoperative recurrence.Result Twenty-seven patients recurred within 36 months in all 136 patients with LDH classified as recurrence group,and the recurrence rate was 19.9%.Among them,15 cases,5 cases and 7 cases recurred within 12 months,13 to 24 months and 25 to 36 months respectively,and the rest 109 cases were classified as non-recurrence group.The age,body mass index,course of disease,the proportion of operative segment L4 to L5,the postoperative intervertebral activity and FA value in recurrence group were significantly higher than those in non-recurrence group(all P<0.05),and the ADC value was significantly lower than that in non-recurrence group(all P<0.05).Multivariate Logistic regression analysis showed that age,FA value,ADC value and operative segment L4 to L5 were the independent predictors(P<0.05).ROC curve showed that FA value and ADC value had certain predictive value,whose AUC were 0.733 and 0.793 respectively.Conclusion Preoperative MRI DTI has a certain predictive value for postoperative recurrence of

关 键 词：弥散张量成像 腰椎间盘突出症 预测 磁共振成像 部分各向异性 表观扩散系数 

分 类 号：R445.2[医药卫生—影像医学与核医学] R687.3[医药卫生—诊断学]