磁共振增强T_(2)-SPACE序列在腰骶神经根压迫中的诊断及应用  

The value of contrast-enhanced three-dimensional isotropic T_(2)-weighted turbo spin-echo SPACE sequence in the diagnosis of lumbosacral nerve root compression

作　　者：戎冬冬[1] 李翔宇 孔超 王宇 孙思远 孙峥[1] 张苗[1] 鲁世保[2] 卢洁[1] RONG Dong-dong;LI Xiang-yu;KONG Chao;WANG Yu;SUN Si-yuan;SUN Zheng;ZHANG Miao;LU Shi-bao;LU Jie(Department of Radiology,Xuanwu Hospital,Capital Medical University,Beijing,100053,China)

机构地区：[1]首都医科大学宣武医院放射科,北京100053 [2]首都医科大学宣武医院骨科,北京100053

出　　处：《中国骨与关节杂志》2021年第11期840-846,共7页Chinese Journal of Bone and Joint

摘　　要：目的探讨磁共振(MRI)增强三维T_(2)-weighted turbo spin-echo SPACE(T_(2)-SPACE)序列检查在腰骶神经根压迫中的诊断及应用价值,并评估此影像技术对不同年龄人群的诊断效力。方法纳入2017年10月至2020年10月就诊于我院骨科诊断为腰椎退行性疾病行并手术治疗的162例患者。所有患者术前均行MRI腰椎平扫及T_(2)-SPACE成像扫描。分别采用常规腰椎平扫和常规平扫+T_(2)-SPACE(源图像+MIP像)的方式分析所得影像,判断神经根具体分支的受压情况(有或无)并作记录节段,并记录神经根受压位置(中央管、侧隐窝、椎间孔、极外侧),根据年龄大小将患者分为中年组与老年组。结果常规MRI及T_(2)-SPACE影像组内一致性均较好,Kappa值分别为0.87和0.95。常规MRI影像诊断灵敏度82.76%,特异度93.04%。T_(2)-SPACE影像诊断灵敏度95.40%,特异度95.65%,常规MRI及T_(2)-SPACE影像对椎间孔内及极外侧区域神经压迫的诊断一致性较差,Kappa值分别为0.149和0.354。对于中年组患者,常规MRI和T_(2)-SPACE影像的灵敏度分别为93.33%和97.78%,但对于老年组患者,常规MRI和T_(2)-SPACE影像的灵敏度分别为71.43%和92.86%。结论MRI T_(2)-SPACE序列图像可以清晰显示腰骶神经根的形态及其与周围组织的空间关系,较传统MRI,T_(2)-SPACE序列对判断腰骶神经根走行及受压情况具有明显优势,尤其可提高老年患者神经根压迫的诊断准确性,T_(2)-SPACE在诊断腰骶神经根压迫方面可完全代替常规MRI。Objective To investigate the diagnostic value of contrast-enhanced three-dimensional(3D)T_(2)-weighted turbo spin-echo SPACE(T_(2)-SPACE)sequence in the diagnosis of lumbosacral nerve root compression(LNRC),and to assess its effectiveness for different LNRC age groups.Methods A series of 162 patients underwent traditional two-dimensional(2D)magnetic resonance imaging(MRI)scan and 3D T_(2)-SPACE imaging scan before lumbar surgery from October 2017 to October 2020.Maximum intensity projection and curved planar reformation images of 3D T_(2)-SPACE sequence were constructed.The compression of the specific branch of the nerve root(presence or absence)was evaluated and recorded.The compression area(central spinal canal,lateral recess,neural foraminal,or extra foraminal)was recorded.All patients were divided into junior adult group and senior adult group.Results Interobserver reliability was great for 2D MRI and 3D T_(2)-SPACE sequences(Kappa=0.87,Kappa=0.95,respectively).The 2D MRI and 3D T_(2)-SPACE had sensitivities of 82.76%and 95.40%,with specificities of 93.04%and 95.65%,respectively,for LNRC.The diagnostic accuracy of 2D MRI and 3D T_(2)-SPACE sequence were not significantly different(P=0.888,Kappa=0.668).2D MRI and 3D T_(2)-SPACE showed poor homogeneity for the detection of neural foraminal and extra foraminal nerve compression(Kappa=0.149,Kappa=0.354,respectively).For junior adults,the 2D MRI and 3D T_(2)-SPACE had sensitivities of 93.33%and 97.78%,respectively.For senior adults,the 2D MRI and 3D T_(2)-SPACE had sensitivities of 71.43%and 92.86%,respectively.Conclusions The images obtained by T_(2)-SPACE sequence can clearly show the morphology of the lumbosacral nerve roots and its spatial relationship with surrounding tissues.The 3D T_(2)-SPACE scan could be a good complement to routine 2D MRI in clinical diagnosis,especially for elderly patients.

关 键 词：脊神经根 磁共振成像 成像 三维 脊神经 

分 类 号：R445.2[医药卫生—影像医学与核医学] R745.4[医药卫生—诊断学]