DTI联合椎体脂肪及椎旁肌脂肪半定量评分在腰椎间盘退变中的应用研究  

DTI combined with semi-quantitative scoring of vertebral body fat and paravertebral muscle fat for evaluation of lumbar intervertebral disc degeneration

作　　者：宋绍文 李晓静[2] 王凤 郭会利 刘玉珂 张斌青 SONG Shao-wen;LI Xiao-jing;WANG Feng;GUO Hui-li;LIU Yu-ke;ZHANG Bin-qing(Medical Imaging Center,Luoyang Orthopedic-Traumatological Hospital of Henan Province(Henan Provincial Orthopedic Hospital),Luoyang Henan 471002,China;Department of Radiology,China-Japan Union Hospital of Jilin University,Changchun 130033,China)

机构地区：[1]河南省洛阳正骨医院(河南省骨科医院)影像中心,河南洛阳471002 [2]吉林大学中日联谊医院放射科,吉林长春130033

出　　处：《中国临床医学影像杂志》2025年第2期131-136,共6页Journal of China Clinic Medical Imaging

基　　金：河南省医学科技攻关计划基金资助项目(LHGJ20230484)。

摘　　要：目的:分析弥散张量成像(DTI)中的各向异性分数(FA值)和表观弥散系数(ADC值)在腰椎间盘退变中的应用,评价其对退变程度的量化评估价值。并探讨腰椎间盘退变与相邻椎体、椎旁肌脂肪浸润的关联,以揭示其是否为一种肌骨协同的整体性病变。方法:纳入我院2022年9月—2023年10月符合研究标准的60例患者作为研究对象,并行腰椎MRI和DTI检查。收集患者的一般临床资料(年龄、性别、解剖节段),并由2位医师分别评估患者影像学资料,用组内相关系数(ICC)评估测量结果一致性。比较不同PM分级里FA值和ADC值的差异、椎体和椎旁肌脂肪浸润评分的差异,并分析PM分级与年龄、解剖节段、DTI参数、椎体和椎旁肌脂肪浸润评分的相关性。结果:两医师测量结果除右侧腰大肌外,其余ICC均>0.75,测量一致性良好。不同PM分级中,双侧腰大肌脂肪浸润评分差异无统计学意义(P>0.05),FA值和ADC值、上下椎体脂肪浸润评分、双侧多裂肌和双侧竖脊肌脂肪浸润评分差异具有统计学意义(P<0.05)。FA值与PM分级呈强相关(r_(FA)=0.748),ADC值、解剖节段、年龄和上椎体脂肪浸润与PM分级呈中等相关(r_(ADC)=-0.539、r_(解剖节段)=0.571、r_(年龄)=0.471、r_(上椎体)=0.371),下椎体脂肪浸润、双侧多裂肌和双侧竖脊肌脂肪浸润与PM分级均呈弱相关(r_(下椎体)=0.250、r_(右多裂肌)=0.185、r_(左多裂肌)=0.198、r_(右竖脊肌)=0.102、r_(左竖脊肌)=0.126),双侧腰大肌与PM分级无相关。结论:FA值和ADC值可用于量化评估腰椎间盘退变的程度,且腰椎间盘退变是一种肌骨协同整体性的病变。Objective:To analyze the application of fractional anisotropy(FA)and apparent diffusion coefficient(ADC)derived from diffusion tensor imaging(DTI)in assessing lumbar intervertebral disc degeneration,evaluating their value in quantifying the degree of degeneration.Additionally,to investigate the association between disc degeneration and adjacent vertebral body and paraspinal muscle fat infiltration,elucidating whether disc degeneration represents a synergistic musculoskeletal disorder.Methods:A total of 60 patients meeting inclusion criteria between September 2022 and October 2023 were enrolled,undergoing both lumbar MRI and DTI scans.Demographic data(age,sex,anatomic level)were collected,and two radiologists independently evaluated imaging findings.Intraclass correlation coefficients(ICCs)were used to assess inter-rater agreement.Differences in FA and ADC values,vertebral body and paraspinal muscle fat infiltration scores across different PM grades were compared,and correlations between PM grade,age,anatomic level,DTI parameters,and fat infiltration scores were analyzed.Results:ICCs for measurements by both radiologists were>0.75,indicating good consistency,except for the right erector spinae muscle.No statistically significant differences were observed in bilateral erector spinae fat infiltration scores among different PM grades(P>0.05),while FA,ADC,fat infiltration scores of upper and lower vertebrae,and bilateral multifidus and erector spinae muscles showed significant differences(P<0.05).FA demonstrated a strong correlation with PM grade(r_(FA)=0.748),while ADC,anatomic level,age,and upper vertebral fat infiltration were moderately correlated(r_(ADC)=-0.539,r_(anatomic level)=0.571,r_(age)=0.471,r_(upper vertebral)=0.371).Lower vertebral fat infiltration and bilateral multifidus and erector spinae muscle fat infiltration exhibited weak correlations(r_(lower vertebral)=0.250,r_(right multifidus)=0.185,r_(left multifidus)=0.198,r_(right erector spinae)=0.102,r_(left erector spinae)=0.126).Bilateral erector spin

关 键 词：椎间盘退行性变 磁共振成像 

分 类 号：R681.53[医药卫生—骨科学] R445.2[医药卫生—外科学]