仰卧及俯卧过屈位MRI动态评估多裂肌形态变化与腰椎间盘突出症的关系

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摘要目的：探讨仰卧及俯卧过屈位MRI动态检查多裂肌形态变化在腰椎间盘突出症（LDH）中的意义。方法：选取2016年3月至2018年4月于中国人民解放军联勤保障部队第903医院就诊的43例LDH患者（LDH组）及42例健康志愿者（对照组），均行腰椎仰卧及俯卧过屈位配对MRI检查，包括矢状位T1WI、T2WI及轴位T2WI扫描。应用ImageJ软件测量并计算多裂肌总横截面积（TCSA）、多裂肌功能性横截面积（FCSA）、两侧多裂肌横截面积不对称性（CSAasy）、多裂肌脂肪浸润比（FIR）及仰卧位与俯卧位过屈位TCSA差值（S-P）。采用ROC曲线评估多裂肌形态学参数对LDH的提示效能。结果：在对照组和LDH组中，L3-S1各节段仰卧位较俯卧过屈位多裂肌TCSA增大（P＜0.001）。L3-4节段LDH组S-P值较对照组减小（P＜0.001）；L4-5节段LDH组TCSA、S-P值较对照组减小（P＜0.05），而LDH组CSAasy值较对照组增大（P=0.015）；L5-S1节段LDH组TCSA、FCSA及S-P值较对照组减小（P＜0.05）。ROC曲线分析结果显示，S-P对LDH具有较高的提示价值（AUC=0.957），优于其他多裂肌形态学参数（TCSA：AUC=0.723；FCSA：AUC=0.704；CSAasy：AUC=0.662；FIR：AUC=0.643）。结论：仰卧及俯卧过屈位MRI检查可动态观察多裂肌形态变化；LDH患者不同体位多裂肌形态变化程度缩小，多裂肌收缩功能减退是引起LDH的重要原因之一。

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	苏娜
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	陈兴灿

关键词 ：腰椎间盘突出症, 多裂肌, 磁共振成像, 横截面积

Abstract：Objective: To evaluate the value of the difference in lumbar multifidus muscle (LMM) morphology for lumbar disc herniation (LDH) by dynamic evaluation with supine and prone flexion MRI. Methods: A total of 43 patients with LDH and 42 normal control (NC) subjects at 903 RD Hospital of PLA from March 2016 to April 2018 were enrolled in this study. All patients and healthy volunteers underwent supine and prone flexion paired lumbar MRI, including sagittal T1WI, T2WI and axial T2WI sequences. LMM morphological parameters were obtained using the ImageJ software, including the total cross-sectional area (TCSA), the functional cross-sectional area (FCSA), muscle cross-sectional area asymmetry (CSAasy), fatty infiltration ratio (FIR), and muscle morphological change between supine and prone flexion positions (S-P). The ROC curve was used to evaluate the differentiating ability of multifidus morphological parameters on LDH. Results: In both LDH and NC groups, TCSA of supine position was larger than that of prone flexion position in L3-S1 segments (P<0.001). At L3-4 segment, S-P was lower in LDH group than NC group (P<0.001); At L4-5 segment, TCSA and S-P were lower in LDH group than NC group (P<0.05), while CSAasy was higher in LDH group than NC group (P=0.015). At L5-S1 segment, TCSA, FCSA and S-P were lower in LDH group than NC group (P<0.05). The results of ROC curve showed that the classification performance of S-P (AUC=0.957) was better than other LMM morphological parameters (TCSA: AUC=0.723; FCSA: AUC=0.704; CSAasy: AUC=0.662; FIR: AUC=0.643). Conclusion: The supine and prone flexion MRI could be a useful tool to dynamically evaluate LMM morphological changes. Declined of LMM morphological change was demonstrated in LDH patients, of which contractive impairment of LMM may be an important factor.

Key words： lumbar disc herniation multifidus muscle magnetic resonance imaging cross-sectional area

收稿日期: 2019-02-22

通讯作者: 陈兴灿，主任医师，硕士生导师，Email：genius1174@163.com。

作者简介: 苏娜（1990-），女，陕西延安人，硕士生。

链接本文:

https://xb.wmu.edu.cn/CN/ 或 https://xb.wmu.edu.cn/CN/Y2019/V49/I7/501

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