弥散加权成像预测臭氧消融术治疗腰椎间盘突出症疗效的应用价值  

Application of diffusion weighted imaging in evaluation and prediction of curative effect of CT guided injection therapy for lumbar disc herniation

作　　者：王浩磊 赵丽 柴充 刘宗克 WANG Hao-lei;ZHAO Li;CHAI Chong;LIU Zong-ke(Bone Surgery,Pingmei Shenma Medical Group General Hospital,Pingdingshan,Henan 467000,China;Pharmaceutical Equipment Department,South Province Pingdingshan Coal Industry Group Company A Mine Staff Hospital,Pingdingshan,Henan 467000,China)

机构地区：[1]平煤神马医疗集团总医院骨外科,河南平顶山467000 [2]南省平顶山煤业集团公司一矿职工医院药械科,河南平顶山467000

出　　处：《颈腰痛杂志》2022年第2期225-229,共5页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的探讨弥散加权成像(diffusion weighted imaging,DWI)预测腰椎间盘突出症(lumbar disc herniation,LDH)患者CT引导下臭氧消融术后早期临床疗效的临床价值。方法选择91例接受臭氧消融术的LDH患者,观察其术前表观扩散系数(apparent diffusion coefficient,ADC),以及术前、术后1个月时的VAS评分、直腿抬高角度、ODI指数,观察术前ADC指数与术前ODI指数和ODI恢复率的相关性,使用ROC曲线计算ADC指数预测临床疗效的效能指标。结果患者术后1个月的VAS评分、ODI指数均较术前显著降低(P<0.05),直腿抬高角度显著升高(P<0.05)。治疗有效组患者的术前ADC指数、Pfirrmann分级Ⅰ~Ⅲ级占比和ODI恢复率均显著高于无效组,病程显著短于无效组,差异均有统计学意义(P<0.05)。ADC指数与术前ODI指数不存在相关性(r=0.103,P>0.05),与ODI恢复率呈正相关(r=0.827,P<0.05),与临床疗效呈正相关(r=0.873,P<0.05)。ROC曲线显示,术前ADC指数预测临床疗效的灵敏度为89.2%,特异性为76.5%,曲线下面积为0.886,95%CI为0.811~0.948,最佳截断值为6.72。结论术前ADC指数与CT引导下臭氧消融术后临床疗效存在相关性,可作为术后早期疗效的预测指标。Objective To investigate the clinical value of diffusion weighted imaging(DWI)in predicting the early clinical efficacy of CT guided O3 ablation in patients with lumbar disc herniation(LDH).Methods Ninetyone patients with LDH undergoing O_(3) ablation were selected as the research objects.The visual analogue pain scale(VAS),straight leg elevation test angle and Oswestry lumbar disability index(ODI)were observed before and 1 month after operation.The correlation between the preoperative apparent diffusion coefficient(ADC)index and preoperative ODI and ODI recovery rate was observed.The sensitivity,specificity,optimal cut-off value,area under curve(AUC)and 95%CI of ADC index were calculated by receiver operating curve(ROC).Results ADC index,Pfirrmann grade Ⅰ~Ⅲ percentage and ODI recovery rate in the effective group were significantly higher than those in the ineffective group,and the course of disease was significantly lower than that in the ineffective group(P<0.05).ADC index was not correlated with preoperative ODI(r=0.103,P>0.05),but positively correlated with ODI recovery rate(r=0.827,P<0.05),and positively correlated with clinical efficacy(r=0.873,P<0.05).ROC showed that the sensitivity,specificity,area under curve,95%CI and best cut-off value of ADC index in predicting clinical efficacy were 89.2%,76.5%,0.886,0.811-0.948 and 6.72,respectively.Conclusion The ADC index is correlated with the clinical efficacy after CT guided O3 discectomy,which can be used as a predictor of early postoperative efficacy.

关 键 词：弥散加权成像 CT引导 表观扩散系数 临床疗效 

分 类 号：R681.53[医药卫生—骨科学]