磁共振弥散加权成像对女性哺乳期腰椎间盘退行性变的应用研究
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摘要
目的探讨弥散加权成像(DWI)对女性哺乳期腰椎间盘退行性变的应用价值。方法选择女性哺乳期腰椎间盘突出患者34例,年龄20~35岁,平均年龄27岁。选择同年龄组30例女性健康志愿者作为对照组,年龄20~35岁,未婚。运用MRI,对腰椎间盘行常规矢状位轴位T2加权成像(T2WI)、矢状位T1加权成像(T1WI)加扫矢状位弥散加权成像(DWI),在MRI后处理工作站对椎间盘画出感兴趣区并测量其信号强度与表观弥散系数(ADC)值。分析女性哺乳期腰椎间盘平均ADC值变化及形成原因。结果常规腰椎扫描T1WI显示椎间盘退行性变均为低信号。T2WI显示正常椎间盘明亮均匀的高信号,退行性变椎间盘则为灰色,中等甚至低信号,信号不均匀,同时会有椎间隙变窄;DWI技术可见对退行性变椎间盘进行定量检测,退行性变椎间盘ADC值明显减低。DWI技术有特异性。腰椎间盘突出节段L4/515例,L5/S118例,腰椎间盘形态椎间盘范围缩小15例,椎间盘前部无信号17例,椎间盘无信号2例(图1)。产后ADC值为(0.29±0.15)×10-3mm2/s,1年为0.56×10-3 mm2/s。哺乳期腰椎间盘ADC值与健康同龄志愿者比较,差异有统计学意义(P <0.05)。结论女性哺乳期腰椎间盘ADC值随着产后时间的推移逐渐增高恢复至一定的稳定水平,DWI对腰椎间盘定量检测结果可以给临床医师选择保守治疗、介入治疗、外科手术治疗提供参考依据。
Objective To investigate the value of diffusion weighted imaging(DWI) on lactating females with lumbar intervertebral disc degeneration. Methods A total of 34 lactating females with intervertebral disc degeneration were enrolled, aged20-35 years old with mean age of 27 years old. Thirty unmarried healthy volunteers aged 20-35 years old consisted the control group. MRI was performed to get the conventional sagittal axial T2 WI, sagittal T1 WI and DWI in intervertebral disc. The signal intensity and apparent diffusion coefficient(ADC) value of interest area of intervertebral disc were measured by processing workstation after MRI, and analyzed the changes of ADC values of lumbar intervertebral disc during lactation and the relevant reasons. Results The conventional lumbar scan T1 WI showed disc degeneration with a low signal. T2 WI showed bright and uniform high signal in normal intervertebral disc, but degenerated intervertebral disc turned gray with medium or low signal. The signal was uneven with narrowed intervertebral disc. DWI could quantitatively and specifically detect the degeneration of intervertebral disc, and ADC value was significantly reduced. There were 15 cases of lumbar disc herniation segment of L4/5 and 18 of L5/S1, 15 cases of lumbar intervertebral disc morphology disc reduction, 17 cases of non-signal in front of intervertebral disc and 2 cases of non-signal in intervertebral disc. The postnatal ADC value was(0.29 ± 0.15) × 10-3 mm2/s,and 0.56 × 10-3 mm2/s after 1 year. The ADC value of lumbar intervertebral disc was significantly different between 2 groups(P < 0.05). Conclusion It is demonstrated that ADC value of lumbar intervertebral disc in female lactation gradually increases with postpartum time and returns to a certain stable level. The DWI could provide reference for clinicians by quantitative detection after conservative treatment, interventional therapy or surgical treatment of lumbar intervertebral disc.
Objective To investigate the value of diffusion weighted imaging(DWI) on lactating females with lumbar intervertebral disc degeneration. Methods A total of 34 lactating females with intervertebral disc degeneration were enrolled, aged20-35 years old with mean age of 27 years old. Thirty unmarried healthy volunteers aged 20-35 years old consisted the control group. MRI was performed to get the conventional sagittal axial T2 WI, sagittal T1 WI and DWI in intervertebral disc. The signal intensity and apparent diffusion coefficient(ADC) value of interest area of intervertebral disc were measured by processing workstation after MRI, and analyzed the changes of ADC values of lumbar intervertebral disc during lactation and the relevant reasons. Results The conventional lumbar scan T1 WI showed disc degeneration with a low signal. T2 WI showed bright and uniform high signal in normal intervertebral disc, but degenerated intervertebral disc turned gray with medium or low signal. The signal was uneven with narrowed intervertebral disc. DWI could quantitatively and specifically detect the degeneration of intervertebral disc, and ADC value was significantly reduced. There were 15 cases of lumbar disc herniation segment of L4/5 and 18 of L5/S1, 15 cases of lumbar intervertebral disc morphology disc reduction, 17 cases of non-signal in front of intervertebral disc and 2 cases of non-signal in intervertebral disc. The postnatal ADC value was(0.29 ± 0.15) × 10-3 mm2/s,and 0.56 × 10-3 mm2/s after 1 year. The ADC value of lumbar intervertebral disc was significantly different between 2 groups(P < 0.05). Conclusion It is demonstrated that ADC value of lumbar intervertebral disc in female lactation gradually increases with postpartum time and returns to a certain stable level. The DWI could provide reference for clinicians by quantitative detection after conservative treatment, interventional therapy or surgical treatment of lumbar intervertebral disc.
引文
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[4] SHEN Si, WANG Hao, WANG Fei, et al. The application study of MR DWI and DTI in lumbar intervertebral disc prophase degeneration[J]. Journal of Jinan University:Natural Science&Medicine Edition, 2012, 33(4):409-413.[沈思,王昊,汪飞,等. DWI和DTI对腰椎间盘早期退变的诊断价值[J].暨南大学学报:自然科学与医学版,2012,33(4):409-413.]
[5] Feng H, Danfelter M, Str觟mqvist B, et al. Extracellular matrix in disc degeneration[J]. J Bone Joint Surg Am, 2006, 88(Suppl 2):25-29.
[6] Yamashita Y, Tang Y, Takahashi M. Ultrafast MR imaging of the abdomen:echo planar imaging and diffusion-weighted imaging[J]. J Magn Reson Imaging, 1998, 8(2):367-374.
[7] Engelter ST, Wetzel SG, Bonati LH, et al. The clinical significance of diffusion-weighted MR imaging in stroke and TIA patients[J]. Swiss Med Wkly, 2008, 138(49-50):729-740.
[8] Beattie PF, Morgan PS, Peters D. Diffusion-weighted resonance imaging of normal and degenerative lumbar intervertebral discs:a new method to potentially quantify the physiologic effect of physical therapy intervention[J]. J Orthop Sports Phys Ther, 2008, 38(2):42-49.
[9] ZHANG Xiao-peng. Exploring micro-motion in macro-stillness:Some insights about clinical application of diffusionweighted MR imaging[J]. Chinese Journal of Medical Imaging Technology, 2005, 21(12):1796-1798.[张晓鹏.在宏观静止中感受微观运动:磁共振扩散加权成像临床应用的若干认识[J].中国医学影像技术,2005,21(12):1796-1798.]
[10] XIE Guang-you, YANG Hai-tao, LüFu-rong, et al. Quantitative T2mapping to monitor the process of lumbar intervertebral disc degeneration in a rabbit model[J]. Chinese Journal of Magnetic Resonance Imaging, 2016, 7(3):213-217.[谢光友,杨海涛,吕富荣,等. T2mapping动态定量监测兔腰椎间盘退变模型[J].磁共振成像,2016,7(3):213-217.]
[2] Urban JP, Smith S, Fairbank JC. Nutrition of the intervertebral disc[J]. Spine(Phila Pa 1976), 2004, 29(23):2700-2709.
[3] Majumdar S. Magnetic resonance imaging and spectroscopy of the intervertebral disc[J]. NMR Biomed, 2006, 19(7):894-903.
[4] SHEN Si, WANG Hao, WANG Fei, et al. The application study of MR DWI and DTI in lumbar intervertebral disc prophase degeneration[J]. Journal of Jinan University:Natural Science&Medicine Edition, 2012, 33(4):409-413.[沈思,王昊,汪飞,等. DWI和DTI对腰椎间盘早期退变的诊断价值[J].暨南大学学报:自然科学与医学版,2012,33(4):409-413.]
[5] Feng H, Danfelter M, Str觟mqvist B, et al. Extracellular matrix in disc degeneration[J]. J Bone Joint Surg Am, 2006, 88(Suppl 2):25-29.
[6] Yamashita Y, Tang Y, Takahashi M. Ultrafast MR imaging of the abdomen:echo planar imaging and diffusion-weighted imaging[J]. J Magn Reson Imaging, 1998, 8(2):367-374.
[7] Engelter ST, Wetzel SG, Bonati LH, et al. The clinical significance of diffusion-weighted MR imaging in stroke and TIA patients[J]. Swiss Med Wkly, 2008, 138(49-50):729-740.
[8] Beattie PF, Morgan PS, Peters D. Diffusion-weighted resonance imaging of normal and degenerative lumbar intervertebral discs:a new method to potentially quantify the physiologic effect of physical therapy intervention[J]. J Orthop Sports Phys Ther, 2008, 38(2):42-49.
[9] ZHANG Xiao-peng. Exploring micro-motion in macro-stillness:Some insights about clinical application of diffusionweighted MR imaging[J]. Chinese Journal of Medical Imaging Technology, 2005, 21(12):1796-1798.[张晓鹏.在宏观静止中感受微观运动:磁共振扩散加权成像临床应用的若干认识[J].中国医学影像技术,2005,21(12):1796-1798.]
[10] XIE Guang-you, YANG Hai-tao, LüFu-rong, et al. Quantitative T2mapping to monitor the process of lumbar intervertebral disc degeneration in a rabbit model[J]. Chinese Journal of Magnetic Resonance Imaging, 2016, 7(3):213-217.[谢光友,杨海涛,吕富荣,等. T2mapping动态定量监测兔腰椎间盘退变模型[J].磁共振成像,2016,7(3):213-217.]