冠状位磁共振成像PROSET水激发序列对多节段腰椎间盘突出症致病节段的诊断价值  

Diagnostic Value of Coronal Magnetic Resonance Imaging and PROSET Water Excitation Sequence in the Pathogenic Segments of Multilevel Lumbar Disc Herniation

作　　者：陈水斌[1] 林毅 罗爱芳 肖玉辉[1] 欧阳林[1] CHEN Shui-bin;LIN Yi;LUO Ai-fang;XIAO Yu-hui;OUYANG Lin(Department of Radiology,The 909th Hospital of Joint Logistics Support Force,Dongnan Hospital of Xiamen University,Zhangzhou 363000,Fujian Province,China)

机构地区：[1]联勤保障部队第九〇九医院,厦门大学附属东南医院放射科,福建漳州363000

出　　处：《中国CT和MRI杂志》2024年第5期158-160,共3页Chinese Journal of CT and MRI

基　　金：福建省区域发展项目(2019Y3007);军队后勤保障部面上项目(CLB21J017)。

摘　　要：目的评估冠状位磁共振成像和PROSET水激发序列对多节段腰椎间盘突出症致病节段的准确性。方法回顾性分析2019年1月至2022年12月在我院接受手术治疗的66例多节段腰椎间盘突出症患者临床和影像学资料。MRI检查使用3.0TMR扫描仪(荷兰Philips Ingenia公司,3.0T),之后使用冠状位PROSET水激发序列进行扫描。收集MRI图像上多节段腰椎间盘突出症的表现及与神经根受压关系。以术中和术后患者疗效为受压神经根节段的判断标准,分析计算冠状位MRI诊断受压神经根的敏感性、特异性、阳性预测值、阴性预测值和准确性。并使用Kappa一致性分析两者诊断一致性。结果66例多节段腰椎间盘突出症患者,MRI图像上共识别到31例患者存在2节段腰椎间盘受累,25例存在3节段受累,10例存在4节段受累,共涉及177个椎间盘。在冠状位腰椎MRI上,椎间盘突出症引起的神经根压迫存在一系列形态学变化,包括神经根凹陷、神经节信号增强、神经根肿胀或神经根断裂。L4/L5神经根起点多位于椎间盘平面(69.81%),L5/S1神经根起点多位于椎间盘上方(72.58%)。共79处神经根受压,其中以L5的神经根受压比例最高82.28%(65/79)。冠状位MRI在多节段椎间盘突出症患者定位致病节段的诊断敏感性为97.4%、特异性为99.3%、阳性预测值为93.7%、阴性预测值为98.6%、准确性为98.6%。冠状位MRI与术中及术后诊断Kappa一致性高(k=0.926)。结论冠状位MRI对定位多节段椎间盘突出症患者的致病节段、受压神经根具有较高准确性,值得今后进一步研究。Objective To evaluate the accuracy and practicability of coronal magnetic resonance imaging and PROSET water excitation sequence in the diagnosis of multiple levels of lumbar disc herniation.Methods The clinical data of 66 patients with multilevel lumbar disc herniation who received surgical treatment in our hospital from January 2019 to December 2022 were retrospectively analyzed.The MRI scanning sequence was performed using a 3.0TMR scanner(Philips Ingenia,Netherlands,3.0T),followed by a coronal PROSET water challenge sequence.To collect the manifestations of multilevel lumbar disc herniation on MRI images and its relationship with compressed nerve roots.The sensitivity,specificity,positive predictive value,negative predictive value,and accuracy of coronal MRI diagnosis of compressed nerve roots were calculated based on the intraoperative and postoperative patient efficacy as the judgment criteria.Kappa consistency analysis was used to analyze the diagnostic consistency between the two.Results In 66 patients with multilevel lumbar disc herniation,MRI images identified a total of 31 patients with 2-level lumbar disc involvement,25 patients with 3-level lumbar disc involvement,and 10 patients with 4-level lumbar disc involvement,involving 177 intervertebral discs.On coronal lumbar MRI,there are a series of morphological changes in nerve root compression caused by spinal disc herniation,including nerve root depression,ganglion signal enhancement,nerve root swelling or nerve root fracture.The L4/L5 nerve root origins are mostly located at 69.81%of the intervertebral disc plane,while the L5/S1 nerve root origins are mostly located at 72.58%above the intervertebral disc.A total of 79 nerve roots were compressed,with L5 having the highest compression rate of 82.28%(65/79).The sensitivity,specificity,positive predictive value,negative predictive value,and accuracy of coronal MRI in locating the diseased segment in patients with multi-level Spinal disc herniation were 97.4%,99.3%,93.7%,98.6%,and 98.6%respectively.High c

关 键 词：多参数磁共振成像 椎间盘突出症 神经根 

分 类 号：R445.2[医药卫生—影像医学与核医学]