摘要
目的探讨腰痛患者腰椎间盘CT真空现象(VP)与MR高信号区(HIZ)对椎间盘退变的诊断价值。方法回顾性分析2011年1月至2015年5月临床诊断为慢性腰痛的325例患者资料,患者均行腰椎CT与MR检查。由从事骨肌病变诊断10年以上的放射科医师进行双盲法共同阅片判断L4～5及L5～S1椎间盘有无VP及HIZ征象,并将各椎间盘分为HIZ(-) VP(-)、HIZ(+) VP(-)、HIZ(-) VP(+)、HIZ(+) VP(+)四组,测量椎间盘高度,对椎间盘进行Pfirrmann分级,对比四组患者年龄、椎间盘高度、椎间盘Pfirrmann分级差异,并将HIZ与VP共存于同一椎间盘的频率与预测的随机频率相对比。结果 325例患者,男153例,女172例,平均年龄(55.41±15.46)岁,分析650个椎间盘:HIZ (-) VP (-)组椎间盘410个(63.08%),HIZ (+) VP (-)组椎间盘111个(17.08%),HIZ(-) VP(+)组椎间盘104个(16.00%),HIZ(+) VP(+)组椎间盘25个(3.85%);HIZ(-) VP(-)、HIZ(+) VP(-)组均比HIZ(-) VP(+)、HIZ(+) VP(+)组患者年龄小(P<0.05);HIZ(-) VP(-)组与HIZ(+) VP(-)、HIZ(-) VP(+)、HIZ(+) VP(+)组椎间盘比较,HIZ(+) VP(-)组与HIZ(-) VP(+)、HIZ(+) VP(+)组椎间盘比较,其椎间盘高度较低、Pfirrmann分级较高(P<0.05),HIZ(-) VP(+)组与HIZ(+) VP(+)组椎间盘的高度、Pfirrmann分级无明显差别(P>0.05);HIZ与VP共存于同一椎间盘的频率比预测的随机频率低(P=0.000)。结论 HIZ、VP分别代表中期、晚期椎间盘退变征象,两者之间可能相互排斥,同时出现HIZ、VP征象椎间盘较少见,VP(+)表现是椎间盘严重退变的特征。
Objective To evaluate the imaging diagnostic value of vacuum phenomenon(VP) on CT and high intensity zone(HIZ) on MRI in degenerated disc of patients with low back pain.Methods From April 2011 to May 2015,325 patients who had been diagnosed of chronic low back pain were enrolled in the study.Both CT and MR images of lumbar spine were obtained with the interval time less than 24 hours.The signs of VP on CT and HIZ on MRI in L4 ～ 5,L ～ 5 ～ S1 discs were identified by two experienced radiologists(who had more than 10 years diagnostic experience of musculoskeletal system),which were used as the criterions to classify the discs into four groups:HIZ(-) VP(-),HIZ(+) VP(-),HIZ(-) VP(+),HIZ(+) VP(+).The age,disc height,and the Pfirrmann classification of L4/5 and L5/S1 discs were compared between four groups,as well as the actual frequency of the coexistence of HIZ and VP was comparing to the expected frequency by chance.Results The data of 325 patients,including 153 males,and 172 females,with average of55.41 ± 15.46 years old were collected.HIZ(-) VP(-),HIZ(+) VP(-),HIZ(-) VP(+),HIZ(+) VP(+)groups account for 410 discs(63.08%),111 discs(17.08%),104 discs(16.00%),and 25 discs(3.85%),respectively.The ages of patients with HIZ(-) VP(-) or HIZ(+) VP(-) discs were lower than those with HIZ(-) VP(+) or HIZ(+) VP(+) discs(P<0.05).Comparing to HIZ(+) VP(-),HIZ(-) VP(+),or HIZ(+) VP(+) discs,HIZ(-) VP(-) discs have the higher disc height and lower Pfirrmann classification(P<0.05),similarly HIZ(+) VP(-)comparing to HIZ(-) VP(+) or HIZ(+) VP(+) discs(P<0.05).But the height and Pfirrmann classification of HIZ(-) VP(+) and HIZ(+) VP(+) discs made no significant differences to each other(P>0.05).The frequency of HIZ and VP coexistence in the same disc was significantly lower than expected by chance(P=0.000).Conclusion The HIZ and VP present as radiologic signs of moderate and severe degenerative discs,respectively,while they may tend to be mutually exclusive.The discs which possessed both HIZ and VP were relatively rare,and characterized the degenerative features of the VP positive discs.
引文
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