腰椎间盘纤维环的MR扩散张量成像

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摘要目的：评价扩散张量成像（DTI）显示腰椎间盘纤维环的能力。方法：对15例健康志愿者（对照组）及20例腰椎间盘突出症（LDH）患者（病例组）进行矢状位T1WI、T2WI及轴位T2WI、DTI扫描。利用DTI原始数据将所得腰椎间盘的图像进行后处理得到相应腰椎间盘的纤维示踪（FT）图，按照FT图上纤维环的形态、连续性制定FT图分型标准，分为规则型[连续型（A1）及不连续型（A2）]、杂乱型[连续型（B1）及不连续型（B2）]及成团型（C），同时以Pfirrmann分级标准对所有腰椎间盘进行分级，将所有腰椎间盘的FT图分型与Pfirrmann分级进行Spearman相关分析。结果：对照组74个腰椎间盘纤维环FT图分型：A1型22个（I级10个，II级12个），A2型32个（I级14个，II级18个），B1型15个（I级1个，II级6个，III级8个），B2型3个（II级1个，III级2个），C型2个皆为III级；病例组86个腰椎间盘的纤维环FT图分型：A1型8个（II级5个，III级3个），A2型7个（II级4个，III级3个），B1型32个（II级2个，III级27个，IV级3个），B2型4个（III级4个），C型35个（III级16个，IV级17个，V级2个），其中22个突出腰椎间盘行手术治疗，经手术证实包容性突出9个（B1型2个，B2型3个，C型4个），非包容性突出13个（B1型2个，C型11个），后者有3个为脱出型，FT图皆为C型；所有腰椎间盘的FT图分型与腰椎间盘的Pfirrmann分级具有强的正相关性（r=0.741，P＜0.001）。结论：DTI能无创地显示腰椎间盘的退变，其腰椎间盘纤维环的FT图分型对临床治疗具有指导意义

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关键词 ：磁共振成像, 扩散张量成像, 纤维示踪, 椎间盘移位, 腰椎, 退变, 纤维环

Abstract：Objective: To evaluate the manifested ability of MR diffusion tensor imaging for lumbar disc annulus fibrosus. Methods: 15 healthy volunteers (control group) and 20 patients (patients group) with lumbar intervertebral disc herniation (LDH) underwent sagittal T1WI, T2WI and axial T2WI, DTI scan. Fiber tracking (FT) maps of these lumbar intervertebral discs were reconstructed based on the DTI data. The classification criterion of FT map was set and all FT maps were classified as regulars [continuous (A1) and discontinuous (A2)], disordes [continuous (B1) and discontinuous (B2)] and masses (C) by the morphological characteristics and continuity of annulus fibrosus in FT maps. All lumbar intervertebral discs were evaluated through Pfirrmann’s classification system. Spearman’s correlation coefficient of data was analyzed by SPSS software between the types of FT maps and Pfirrmann’s classification system. Results: There were 74 lumbar intervertebral discs examined in control group, in which type A1 was 22 (grade I 10, II 12), type A2 was 32 (grade I 14, II 18), type B1 were 15 (grade I 1, II 6, III 8), type B2 were 3 (grade II 1, III 2), type C were 2 (grade III 2); there were 86 lumbar intervertebral discs examined in patients group, in which, type A1 was 8 (grade II 5, III 3), type A2 was 7 (grade II 4, III 3), type B1 were 32 (grade II 2, III 27, IV 3), type B2 were 4 (grade III 4), type C were 35 (grade III 16, IV 17, V 2). 22 LDH in 20 patients underwent surgical operation. And there were 9 contained LDH (B1 2, B2 3, C 4) and 13 noncontained LDH (B1 2, C 11) were confirmed by operation. There is strong correlation between the type of FT maps and Pfirrmann’s classification system (r=0.741, P<0.001). Conclusion: DTI can manifest degeneration of lumbar intervertebral disc noninvasively. The pattern of FT map for lumbar disc annulus fibrosus plays a guiding role in clinical treatment.

Key words： magnetic resonance imaging diffusion tensor imaging fiber tracking intervertebral disk displacement lumbar degeneration annulus fibrosus

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https://xb.wmu.edu.cn/CN/ 或 https://xb.wmu.edu.cn/CN/Y2018/V48/I2/123

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