基于MRI的脂肪闭塞象限分级系统在椎间孔型腰椎间盘突出症患者椎间孔狭窄程度评估中的应用  

Application of MRI fat occlusion quadrant grading system in evaluating the degree of foraminal stenosis in patients with intervertebral foraminal lumbar disc herniation

作　　者：李淑玲[1] 张国伟[1] 夏吉凯 李翔 沈晓君 刘旭林 Li Shuling;Zhang Guowei;Xia Jikai;Li Xiang;Shen Xiaojun;Liu Xulin(Department of Radiology,Yantaishan Hospital of Yantai City,Yantai 264001,China;Department of Radiology,Yantai Affiliated Hospital of Binzhou Medical University,Yantai 264100,China)

机构地区：[1]烟台市烟台山医院影像科,烟台264001 [2]滨州医学院烟台附属医院影像科,烟台264100

出　　处：《中华解剖与临床杂志》2023年第5期288-294,共7页Chinese Journal of Anatomy and Clinics

基　　金：山东省烟台市科技计划(2021YD072、2015WS069、2011236)。

摘　　要：目的探讨基于MRI的脂肪闭塞象限分级系统(象限系统)在椎间孔型腰椎间盘突出症(FLDH)患者椎间孔狭窄(IFS)程度评估中的应用价值。方法纳入2019年3月—2021年6月烟台市烟台山医院和滨州医学院烟台附属医院85例单节段FLDH患者的临床资料,其中男45例、女40例,年龄34~82(60.7±9.8)岁。病变椎间盘位置L_(2/3)2例,L_(3/4)7例,L_(4/5)30例,L_(5)/_(S1)46例。85例患者按治疗方式不同分为手术组41例,保守组44例。85例患者治疗前均行MRI检查,在矢状面T_(1)WI、T_(2)WI上,分别采用Lee系统及象限系统,依据脂肪闭塞特征对IFS程度进行评估分级。观察指标:(1)观察2种系统评估IFS程度的一致性;(2)比较2种系统对IFS程度分级的识别情况;(3)观察象限系统评估的IFS级别与临床治疗方式之间的相关性。结果(1)Lee系统:2位观察者内Kappa值分别为0.684、0.659,一致性均高;观察者间Kappa值为0.482~0.598,一致性均中等。象限系统:2位观察者内Kappa值分别为0.909、0.945,一致性均极好;观察者间Kappa值为0.872~0.946,一致性均极好。(2)在85例85个椎间孔中,Lee系统仅能对58个椎间孔进行准确分级,分级率为68.2%;在象限系统中,85例85个椎间孔均能进行准确分级,分级率为100.0%。(3)采用象限系统评估的IFS程度分级与临床治疗方式之间存在关联(χ^(2)=14.57,P<0.001)。结论基于MRI的象限系统能全面、准确地评估FLDH患者IFS程度,方法简单,可重复性高,评估IFS程度级别与临床治疗方式之间有很好的相关性,可为临床治疗方式的选择提供有效的影像学参考。Objective This study aimed explore the clinical application value of MRI fat occlusion quadrant grading system(quadrant system)in evaluating the degree of intervertebral foraminal stenosis(IFS)among patients with foraminal lumbar disc herniation(FLDH).Methods Clinical data of 85 patients with single-level FLDH from Yantaishan Hospital and Yantai Affiliated Hospital of Binzhou Medical University from March 2019 to June 2021 were included,including 45 males and 40 females aged 34-82(60.7±9.8)years.Among them,2 cases were L_(2/3),7 cases were L_(3/4),30 cases were L_(4/5),and 46 cases were L_(5)/S_(1).All patients were divided into operation group(41 cases)and conservative group(44 cases)in accordance with different treatment methods.They were diagnosed with single-level FLDH by lumbar MRI.On the sagittal T_(1)WI and T_(2)WI of the patients,the Lee system and quadrant system were used to evaluate and grade the degree of IFS in accordance with the features of fat occlusion.In terms of observational indicators,(1)the consistency of the two systems in assessing the degree of IFS was observed,(2)the recognition in assessing the degree of IFS classification by the two systems was compared,and(3)the quadrant system was used to evaluate the association between the degree of IFS classification and the clinical treatment modalities.Results(1)For the Lee system,the Kappa values of the two observers were 0.684 and 0.659,respectively,with high consistency,and the inter-observer Kappa values ranged from 0.482 to 0.598,with moderate consistency.For the quadrant system,the Kappa values of the observers were 0.909 and 0.945,respectively,with excellent consistency.The Kappa values among observers ranged from 0.872 to 0.946,with excellent consistency.(2)Among the 85 foramina in 85 cases,only 58 foramina could be accurately graded by the Lee system,with a grading rate of 68.2%.In the quadrant system,85 patients with 85 foramina could be accurately graded,and the grading rate was 100.0%.(3)A linear correlation was found between IFS de

关 键 词：椎间盘移位 椎间孔狭窄 影像学评估方法 磁共振成像 

分 类 号：R681.53[医药卫生—骨科学]