MRI冠状面多回波回复梯度回波序列对椎间孔外型腰椎间盘突出症的诊断价值

doi:10.3760/cma.j.cn101202-20230917-00080

摘要
图/表
参考文献
相关文章 (15)

全文: PDF (1761 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要目的探讨MRI冠状面多回波回复梯度回波（C-MERGE）序列对椎间孔外型腰椎间盘突出症（ELDH）的诊断价值。方法横断面研究。纳入2019年3月—2023年4月滨州医学院烟台附属医院和烟台市烟台山医院经手术及组织病理确诊的ELDH患者50例,其中男29例、女21例,年龄22~82（58.1±11.3）岁,病程2~24（8.1±3.8）个月;患者均为单侧单节段受累,受累节段为L_2/3 1例、L_3/4 4例、L_4/5 17例、L₅/S₁ 28例。所有患者接受C-MERGE和冠状面T₂加权像（C-T₂WI）两种序列的MR扫描。观察并比较两种序列对突出椎间盘的检出率和受压神经根（神经根成角、变细、深压迹和肿胀）的显示率,并对两种序列图像清晰度评分。结果本组50例患者C-MERGE和C-T₂WI序列对突出椎间盘的检出率分别为100%（50/50）、94%（47/50）,差异无统计学意义（χ²=1.33,P=0.250）。C-MERGE序列对神经根成角、变细、深压迹、肿胀的显示率分别为78%（39/50）、60%（30/50）、72%（36/50）、46%（23/50）,高于C-T₂WI序列的64%（32/50）、40%（20/50）、52%（26/50）、28%（14/50）,差异均有统计学意义（χ²=5.14、5.79、5.79、5.82,P值均<0.05）。C-MERGE序列的突出椎间盘以及神经根成角、变细、深压迹、肿胀的图像清晰度评分均为3.00（3.00,3.00）分,高于C-T₂WI序列的2.00（1.00,2.00）、2.00（1.00,2.25）、2.00（1.00,2.25）、2.00（1.00,2.00）、2.00（1.00,2.00）分,差异均有统计学意义（Z=6.13、5.40、5.40、5.56、5.83,P值均<0.001）。结论相比于C-T₂WI,C-MERGE对突出椎间盘和神经根受压程度的显示更敏感,也更清晰,可作为常规横断面、矢状面MRI的重要补充序列,是ELDH有效的影像学诊断方法之一。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	李淑玲
	孙振中
	曲德鑫
	朱振利
	谭江威
	沈晓君
	刘旭林

关键词 ：椎间盘移位, 椎间孔外型腰椎间盘突出症, 多回波回复梯度回波, 磁共振成像, 诊断

Abstract：Objective This study aimed to investigate the diagnostic value of MRI coronal multi-echo gradient echo (C-MERGE) sequence in external foraminal lumbar disc herniation (ELDH). Methods A cross-sectional study was conducted. A total of 50 ELDH patients diagnosed by surgery and histopathology from Yantai Affiliated Hospital of Binzhou Medical College and Yantai Yantai Mountain Hospital from March 2019 to April 2023 were included. Among them, 29 were males and 21 were females, aged 22-82 (58.1±11.3) years, and the course of disease was 2-24 (8.1±3.8) months. All patients had unilateral single-segment involvement, including L_2/3 1 case, L_3/4 4 cases, L_4/5 17 cases and L₅/S₁ 28 cases. All patients underwent MRI scans of both C-MERGE and coronal T₂WI (C-T₂WI) sequences. The detection rate of disc herniation and the display rate of compressed nerve roots (nerve root angulation, thinning, deep indentation, and swelling) of the two sequences were observed and compared. The image clarity of disc herniation and nerve root compression of the two sequences was scored and compared. Results Among the 50 patients, the detection rates of C-MERGE and C-T2WI sequences for disc herniation were 100% (50/50) and 94% (47/50), respectively, and no significant difference in the detection rates was found between the two sequences (χ²=1.33, P=0.250). The display rates of nerve root angulation, nerve root thinning, nerve root deep impression, and nerve root swelling were 78% (39/50), 60% (30/50), 72% (36/50), and 46% (23/50), respectively. The display rates of C-T₂WI sequences were 64% (32/50), 40% (20/50), 52% (26/50), and 28% (14/50), respectively, and C-MERGE sequences were superior to C-T₂WI sequences. A significant difference in the display rate was found between the two sequences (χ²=5.14, 5.79, 5.79, 5.82, all P values < 0.05). The image resolution of disc herniation, nerve root angulation, nerve root thinning, nerve root deep indentation, and nerve root swelling in C-MERGE sequences were all 3.00 (3.00, 3.00) points, which were higher than those of C-T₂WI sequences of 2.00 (1.00, 2.00), 2.00 (1.00, 2.25), 2.00 (1.00, 2.25), 2.00 (1.00, 2.00), and 2.00 (1.00, 2.00) points. The comparative differences between the two sequences were statistically significant (Z=6.13, 5.40, 5.40, 5.56, 5.83, all P values < 0.001). Conclusion Compared with C-T₂WI, C-MERGE is more sensitive and clear to display the degree of herniation disc and nerve root compression, which can be used as an important supplementary sequence to conventional cross-sectional and sagittal MRI and is an effective imaging diagnosis methods for ELDH.

Key words： Intervertebral disc displacement External foraminal lumbar disc herniation Multiple-echo recalled gradient echo Magnetic resonance imaging Diagnosis

收稿日期: 2023-09-17

基金资助:山东省烟台市科技计划（2021YD072、2015WS069、2011236）

通讯作者: 刘旭林,Email：liuxulinli@163.com

引用本文:

李淑玲, 孙振中, 曲德鑫, 朱振利, 谭江威, 沈晓君, 刘旭林. MRI冠状面多回波回复梯度回波序列对椎间孔外型腰椎间盘突出症的诊断价值[J]. 中华解剖与临床杂志, 2024, 29(4): 239-243.
Li Shuling, Sun Zhenzhong, Qu Dexin, Zhu Zhenli, Tan Jiangwei, Shen Xiaojun, Liu Xulin. Diagnostic value of MRI coronal multiple-echo recalled gradient echo sequence in external foraminal lumbar disc herniation. Chinese Journal of Anatomy and Clinics, 2024, 29(4): 239-243.

链接本文:

http://www.cjac.com.cn/CN/10.3760/cma.j.cn101202-20230917-00080 或 http://www.cjac.com.cn/CN/Y2024/V29/I4/239

[1]	丁伟国, 徐卫星, 卢笛, 等. 经皮内镜下腰椎间盘切除术治疗极外侧型腰椎间盘突出症[J]. 浙江医学, 2016, 38(12): 918-921.Ding WG, Xu WX, Lu D, et al.Treatment of far lateral lumbar disc herniation with percutaneous endoscopic lumbar discectomy[J]. Zhejiang Medicine, 2016, 38(12): 918-921.
[2]	刘元彬, 张智, 郑佳状, 等. 椎间孔镜经横突间入路治疗L5-S1椎间孔外型腰椎间盘突出症的临床研究[J]. 颈腰痛杂志, 2022, 43(2): 165-167. DOI:10.3969/j.issn.1005-7234. 2022.02.004.Liu YB, Zhang Z, Zheng JZ, et al.Clinical study of discectomy of extraforaminal lumbar disc herniation through intertransverse processes by percutaneous endoscope[J]. The Journal of Cervicodynia and Lumbodynia, 2022, 43(2): 165-167. DOI:10.3969/j.issn.1005-7234.2022.02.004.
[3]	耿军祖, 刘旭林, 常青, 等. MR常规矢状位-轴位扫描与冠状位迭代分解水和脂肪的回声不对称与最小二乘法估计技术诊断椎间孔外型腰椎间盘突出症[J]. 中国医学影像技术, 2018, 34(2):288-292. DOI:10.13929/j.1003-3289.2001704118.Geng JZ, Liu XL, Chang Q, et al.MR conventional sagittal-axial plane and coronal iterative decomposition of water and fat with echo asymmetry and least-squares estimation technique in diagnosis of extraforaminal lumbar disc herniation[J]. Chin J Med Imaging Technol, 2018, 34(2): 288-292. DOI:10.13929/j.1003-3289.2001704118.
[4]	唐剑华, 刘旭林, 张国伟, 等. MR冠状面迭代分解水和脂肪的回声不对称与最小二乘法估计技术水像对极外侧型腰椎问盘突出症的诊断价值[J]. 中华放射学杂志, 2014, 48(7): 572-576. DOI:10.3760/cmad.issn.1005-1201.2014.07.011.Tang JH, Liu XL, Zhang GW, et al.Diagnostic value of MR coronal iterative decomposition of water and fat with echo asymmetry and least-squares estimation water imaging in the far later lumbar disc herniation[J]. Chin J Radiol, 2014, 48(7): 572-576. DOI:10.3760/cmad.issn.1005-1201.2014.07.011.
[5]	Bakar B, Tekkok IH.Far lateral disc herniation evaluated by coronal magnetic resonance imaging: case series[J]. Turk Neurosurg, 2015, 25(1):132-136. DOI:10.5137/1019-5149.JTN.8102-13.1.
[6]	Xiao L, Siu CW, Yeung K, et al.MRI of the cervical spine with 3D gradient echo sequence at 3 T: initial experience[J]. Clin Radiol, 2015,70(9):926-931. DOI: 10.1016/j.crad.2015.05.012.
[7]	van Rijn JC, Klemetsö N, Reitsma JB, et al. Observer variation in MRI evaluation of patients suspected of lumbar disk herniation[J]. AJR Am J Roentgenol, 2005,184(1):299-303. DOI: 10.2214/ajr.184.1.01840299.
[8]	Li Y, Fredrickson V, Resnick DK.How should we grade lumbar disc herniation and nerve root compression? A systematic review[J]. Clin Orthop Relat Res, 2015,473(6):1896-1902. DOI: 10.1007/s11999-014-3674-y.
[9]	罗维斯, 董斐然, 刘志方. MR 3D-FIESTA序列对腰椎间盘突出症腰骶神经根受压程度的评估价值[J]. 海南医学, 2022, 33(7): 1835-1838. DOI:10.3969/j.issn.1003-6350.2022.14.019.Luo WS, Dong FR, Liu ZF.Application value of MR 3D-FIESTA sequence in evaluating the compression degree of lumbosacral nerve root in lumbar disc herniation[J]. Hainan Med J, 2022, 33(7):1835-1838. DOI:10.3969/j.issn.1003-6350.2022.14.019.
[10]	Lee JH, Lee SH.Clinical and radiological characteristics of lumbosacral lateral disc herniation in comparison with those of medial disc herniation[J]. Medicine, 2016, 95(7):e2733. DOI:10.1097/MD.0000000000002733.
[11]	Kulkarni AG, Kantharajanna SB, Dhruv AN.The use of tubular retractors for translaminar discectomy for cranially and caudally extruded discs[J]. Indian J Orthop, 2018,52(3):328-333. DOI: 10.4103/ortho.IJOrtho_364_16.
[12]	王成日, 黄保华. 极外侧型腰椎间盘突出症及其椎间孔镜治疗进展[J]. 中国微创外科杂志, 2019, 19(7): 641-644. DOI: 10.3969/j.issn.1009-6604.2019.07.018.
[13]	何易祥, 王文己. 极外侧型腰椎间盘突出症研究进展[J]. 实用临床医学, 2020, 21(5): 99-102. DOI: 10.13764/j.cnki.lcsy.2020.05.034.
[14]	朱华, 王懋成, 唐雨微, 等. 极外侧型腰椎间盘突出症手术治疗的研究进展[J]. 中国伤残医学, 2021, 29(8): 99-100. DOI: 10.13214/j.cnki.cjotadm.2021.08.068.Zhu H, Wang MC, Tang YW, et al.Research progress of operative treatment of far lateral lumbar disc herniation[J]. Chinese Journal of Trauma and Disability Medicine, 2021, 29(8): 99-100. DOI: 10.13214/j.cnki.cjotadm.2021.08.068.
[15]	曾晟, 韩福刚. 磁共振神经成像在腰椎间盘突出腰骶神经根受压中的研究进展[J]. 中国临床医学影像杂志. 2016, 27(5): 370-372.Zeng C, Han FG.Research progress of MR neuroimaging in lumbosacral nerve root compression caused by lumbar disc herniation[J]. J Chin Clin Med Imaging, 2016, 27(5): 370-372.
[16]	赵定麟, 侯铁胜, 陈德玉, 等. 现代脊柱外科学[M]. 北京: 世界图书出版公司, 2006: 703-704.
[17]	吴海璐, 裴晓蕾, 夏标, 等. 1.5T MRI+3D-STIR神经根成像技术对腰椎间盘突出症与神经根压迫的临床分析[J]. 影像研究与医学应用, 2022, 6(12): 147-149. DOI: 10.3969/j.issn.2096-3807.2022.12.048.
[18]	孔许强, 严李阶, 袁明远, 等. MRI低剂量增强3D-DIR-SPACE序列在腰骶丛神经成像中的应用价值[J]. 医学影像学杂志, 2023, 33(3): 479-483.Kong XQ, Yan LJ, Yuan MY, et al.Application of low dose Enhanced 3D-DIR-SPACE sequence in lumbosacral plexus Imaging[J]. J Med ImaginR, 2023, 33(3): 479-483.
[19]	余琴琴, 陈焱君, 张晓东, 等. 三种3D 序列显示腰骶丛神经及影像解剖的比较[J]. 中国临床解剖学杂志, 2020, 38(4): 385-390. DOI: 10.134l8/j .issn.l001-165x.2020.04.005.Yu QQ, Chen YJ, Zhang XD, et al.Comparison of three 3D magnetic resonance neurography sequences in displaying lumbar sacral plexus and imaging anatomy[J]. Chinese Journal of Clinical Anatomy, 2020, 38(4): 385-390. DOI: 10.134l8/j .issn.l001-165x.2020.04.005.
[20]	李奕均, 李磊磊, 林港, 等. 3D STIR SPACE序列在坐骨神经成像中的价值研究[J]. 中国CT和MRI杂志, 2023, 21(8): 152-154. DOI:10.3969/j.issn.1672-5131.2023.08.048.Li YJ, Li LL, Lin G, et al.The application value of 3D STIR SPACE sequence in sciatic nerve imaging[J]. Chinese Journal of CT and MRI, 2023, 21(8): 152-154. DOI:10.3969/j.issn.1672-5131.2023.08.048.
[21]	Zhang J, Ding S, Zhao H, et al.Evaluation of chronic carotid artery occlusion by non-contrast 3D-MERGE MR vessel wall imaging: comparison with 3D-TOF-MRA, contrast-enhanced MRA, and DSA[J]. Eur Radio, 2020, 30(11): 5805-5814. DOI:10.1007/s00330-020-06989-1.
[22]	陈细香, 查云飞, 刘昌盛, 等. 3D MERGE序列在腰骶丛神经成像中的应用[J]. 影像诊断与介入放射学, 2015, 24(5): 413-416. DOI:10.3969/j.issn.1005-8001.2015.05.013.Chen XX, Zha YF, Liu CS, et al.Application of 3D MERGE sequence in MRI of lumbosacral plexus[J].Diagnostic Imaging & Interventional Radiology, 2015, 24(5): 413-416. DOI:10.3969/j.issn.1005-8001.2015.05.013.
[23]	刘玉涛, 洪国斌, 李淑明, 等. MR多回波回复梯度回波序列在骶髂关节软骨成像中的应用[J]. 中国医学影像技术, 2016, 32(9): 1436-1439. DOI:10.13929/j.1003-3289.2016.09.030.Liu YT, Hong GB, Li SM, et al.Application of MR multiple echo recalled gradient echo sequence in sacroiliac joint cartilage imaging[J]. Chin J Med Imaging Techno, 2016, 32(9): 1436-1439. DOI:10.13929/j.1003-3289.2016.09.030.
[24]	李兰, 殷小丹, 李旭雪, 等. 3D MERGE与3D SPACE STIR序列在腰椎间盘突出症检查中的应用比较[J]. 中国医学物理学杂志, 2024, 41(1): 27-31. D01:10.3969/j.issn.1005-202X.2024.01.004.Li L, Yin XD, Li XX, et al.Application of 3D MERGE sequence versus 3D SPACE STIR sequence in the examination of lumbar disc herniation[J]. Chinese Journal of Medical Physics, 2024, 41(1): 27-31. D01:10.3969/j.issn.1005-202X.2024.01.004.