Application of MRI fat occlusion quadrant grading system in evaluating the degree of foraminal stenosis in patients with intervertebral foraminal lumbar disc herniation
Li Shuling1, Zhang Guowei1, Xia Jikai2, Li Xiang2, Shen Xiaojun2, Liu Xulin2
1Department of Radiology, Yantaishan Hospital of Yantai City, Yantai 264001, China; 2Department of Radiology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai 264100, China
Abstract：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 L2/3, 7 cases were L3/4, 30 cases were L4/5, and 46 cases were L5/S1. 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 T1WI and T2WI 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 degree grade evaluated by the quadrant system and clinical treatment style (χ2=14.57 P<0.001). Conclusion The adoption of the quadrant system can comprehensively and accurately evaluate the degree of IFS in patients with intervertebral FLDH. The method is simple and has high reproducibility. The evaluation of the degree of IFS and the clinical treatment shows good correlation, which can provide effective imaging reference for the selection of clinical treatment.
李淑玲, 张国伟, 夏吉凯, 李翔, 沈晓君, 刘旭林. 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[J]. 中华解剖与临床杂志, 2023, 28(5): 288-294.
Li Shuling, Zhang Guowei, Xia Jikai, Li Xiang, Shen Xiaojun, Liu Xulin. Application of MRI fat occlusion quadrant grading system in evaluating the degree of foraminal stenosis in patients with intervertebral foraminal lumbar disc herniation. Chinese Journal of Anatomy and Clinics, 2023, 28(5): 288-294.
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2023, Vol. 28 
