磁共振T2WI直方图在腰椎间盘退变中的应用价值研究
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摘要
目的:探讨磁共振T2WI直方图在定量评价腰椎间盘退变中的价值。方法:43例患者进行腰椎1.5T常规MRI T2WI检查,对椎间盘进行Pfirrmann分级,采用软件测量髓核T2WI信号强度(signal intensity, SI)直方图参数(平均值、标准差、偏度、峰度)。结果:椎间盘髓核T2WI SI平均值、标准差及偏度与Pfirrmann分级分别呈高度负相关(r=-0.83,P<0.01)、中度负相关(r=-0.66,P<0.01)及中度正相关(r=0.69,P<0.01)。平均值、标准差在Ⅳ级与Ⅴ级间无统计学差异(P>0.5),在其余各级间均有统计学差异(P<0.01);偏度在所有各级间均存在统计学差异(P<0.01);峰度在Ⅰ～Ⅲ级间均无统计学差异,在其余各级间均存在统计学差异(P<0.01)。Ⅰ～Ⅲ级椎间盘T2WI SI直方图为负偏态分布,高峰平缓;Ⅳ～Ⅴ级椎间盘为正偏态分布,高峰陡峭。对于鉴别Ⅰ级与Ⅱ级、Ⅱ级与Ⅲ级椎间盘,平均值、标准差及偏度ROC曲线均具有中等效能(P<0.01);对于鉴别Ⅲ级与Ⅳ级,平均值曲线效能最佳(P<0.01),峰度效能中等(P<0.01);对于鉴别Ⅳ级与Ⅴ椎间盘,偏度及峰度均具有中等效能(P均<0.01)。结论:磁共振T2WI信号直方图具有定量评价腰椎间盘退变的可行性,具有一定的临床参考价值。
Objective: To investigate the value of T2 WI histogram analysis in assessing lumbar intervertebral disc degeneration on MRI. Methods: Forty-three patients were examined at 1.5 T MR by T2-weighted sagittal imaging. For all patients, Pfirrmann grading system and T2 WI histogram parameters(mean, standard deviation, skewness, kurtosis) were used to evaluate the degenerative degree of the discs. Results: The correlation between Pfirrmann grades with mean, standard deviation and skewness of T2 WI signal intensity were significant negative, moderate negative and moderate positive, respectively(r=-0.83,-0.66,and 0.69,respectively, all P value <0.01). Except between grades IV and V, the differences of the mean and standard deviation between the rest of any 2 grades were significant(P<0.01). No statistical difference of kurtosis were found between grade I to III, however, the rest of any 2 grades were significant(P<0.01). There were significant differences in skewness between any 2 grades of all(P<0.01). The histogram of the mean value of intervertebral disc with grade I to III was a negative skewness distribution with flat peak. In contrast, the histogram of grade IV and V was a positive skewness distribution with steep peak. For differentiating between grade I and II, II and III of intervertebral disc, the mean, standard deviation and skewness ROC curve have moderate efficiency(P<0.01); For differentiating between grade III and IV, the mean value ROC curve showed the highest efficiency(P<0.01); Both skewness and kurtosis can identify between grade IV and V, with its moderate efficiency(all P<0.01). Conclusions: The T2 WI histogram analysis has the feasibility of quantitative assessment of lumbar disc degeneration, which has some certain reference value for the clinic.
Objective: To investigate the value of T2 WI histogram analysis in assessing lumbar intervertebral disc degeneration on MRI. Methods: Forty-three patients were examined at 1.5 T MR by T2-weighted sagittal imaging. For all patients, Pfirrmann grading system and T2 WI histogram parameters(mean, standard deviation, skewness, kurtosis) were used to evaluate the degenerative degree of the discs. Results: The correlation between Pfirrmann grades with mean, standard deviation and skewness of T2 WI signal intensity were significant negative, moderate negative and moderate positive, respectively(r=-0.83,-0.66,and 0.69,respectively, all P value <0.01). Except between grades IV and V, the differences of the mean and standard deviation between the rest of any 2 grades were significant(P<0.01). No statistical difference of kurtosis were found between grade I to III, however, the rest of any 2 grades were significant(P<0.01). There were significant differences in skewness between any 2 grades of all(P<0.01). The histogram of the mean value of intervertebral disc with grade I to III was a negative skewness distribution with flat peak. In contrast, the histogram of grade IV and V was a positive skewness distribution with steep peak. For differentiating between grade I and II, II and III of intervertebral disc, the mean, standard deviation and skewness ROC curve have moderate efficiency(P<0.01); For differentiating between grade III and IV, the mean value ROC curve showed the highest efficiency(P<0.01); Both skewness and kurtosis can identify between grade IV and V, with its moderate efficiency(all P<0.01). Conclusions: The T2 WI histogram analysis has the feasibility of quantitative assessment of lumbar disc degeneration, which has some certain reference value for the clinic.
引文
[1] 高俊.CT检测联合核磁共振成像在腰椎间盘突出治疗中的应用[J]. 陕西医学杂志,2017,46(4) :517-519.
[2] Schiebler ML, Camerino VJ, Fallon MD,et al. In vivo and ex vivo magnetic resonance imaging evaluation of early disc degeneration with histopathologic correlation[J]. Spine, 1991;16(6):635-640.
[3] 张国琴,陈鑫,张思静.等. T2WI直方图鉴别诊断脑胶质母细胞瘤与单发转移瘤的价值[J].中国医学影像技术, 2017, 33 (12) :1779-1783.
[4] Vignati A, Mazzetti S, Giannini V, et al. Texture features on T2-weighted magnetic resonance imaging: new potential biomarkers for prostate cancer aggressiveness[J]. Phys Med Biol, 2015,60(7):2685-2701.
[5] Henderson S, Purdie C, Michie C, et al. Interim heterogeneity changes measured using entropy texture features on T2-weighted MRI at 3.0 T are associated with pathological response to neoadjuvant chemotherapy in primary breast cancer[J]. Eur Radiol, 2017,27(11):4602-4611.
[6] Pfirrmann CW, Metzdorf A, Zanetti M, et al. Magnetic resonance classification of lumbar intervertebral disc degeneration[J].Spine (Phila Pa 1976), 2001, 26(17): 1873 -1878.
[7] 朱碧云,陈卉.医学图像纹理分析的方法及应用[J].中国医学装备, 2013, 10 (8) :77-81.
[8] Marinelli NL, Haughton VM, Munoz A, et al. T2 relaxation times of intervertebral disc tissue correlated with water content and proteoglycan content[J]. Spine,2009,34(5):520-524.
[9] Stelzeneder D, Welsch GH, Kovacs BK, et al. Quantitative T2 evaluation at 3.0T compared to morphological grading of the lumbar intervertebral disc: a standardized evaluation approach in patients with low back pain[J]. Eur J Radiol, 2012, 81(2):324 -330.
[10] 郝定均,陈明霞,贺宝荣,等.退变性腰椎间盘突出症髓核的超微结构与MRI对照研究[J].陕西医学杂志, 2011,40(6) :681-684.
[11] Zhou Z, Jiang B, Zhou Z, et al. Intervertebral disk degeneration: T1ρ MR imaging of human and animal models[J]. Radiology, 2013,268(2):492-500.
[12] Sobajima S, Vadala G, Shimer A,et al. Feasibility of a stem cell therapy for intervertebral disc degeneration[J]. Spine J,2008, 8(6): 888 -896.
[13] 赵晓梅,黄耀渠. 磁共振T2弛豫时间定量评估腰椎间盘退变的价值[J].广东医学, 2015, 36(16) :2515-2518.
[14] Zhang X, Yang L, Gao F, et al. Comparison of T1ρ and T2 relaxation mapping in patients with different grades of disc degeneration at 3T MR[J]. Med Sci Monit, 2015,21:1934-1941.
[15] Zhang Yd, Wang Q, Wu Cj, et al. The histogram analysis of diffusion-weighted intravoxel incoherent motion (IVIM) imaging for differentiating the gleason grade of prostate cancer[J]. Eur Radiol, 2015,25(4): 994-1004.
[16] Baek HJ, Kim HS, Kim N, et al. Percent change of perfusion skewness and kurtosis: a potential imaging biomarker for early treatment response in patients with newly diagnosed glioblastomas[J]. Radiology, 2012, 264(3): 834-843.
[2] Schiebler ML, Camerino VJ, Fallon MD,et al. In vivo and ex vivo magnetic resonance imaging evaluation of early disc degeneration with histopathologic correlation[J]. Spine, 1991;16(6):635-640.
[3] 张国琴,陈鑫,张思静.等. T2WI直方图鉴别诊断脑胶质母细胞瘤与单发转移瘤的价值[J].中国医学影像技术, 2017, 33 (12) :1779-1783.
[4] Vignati A, Mazzetti S, Giannini V, et al. Texture features on T2-weighted magnetic resonance imaging: new potential biomarkers for prostate cancer aggressiveness[J]. Phys Med Biol, 2015,60(7):2685-2701.
[5] Henderson S, Purdie C, Michie C, et al. Interim heterogeneity changes measured using entropy texture features on T2-weighted MRI at 3.0 T are associated with pathological response to neoadjuvant chemotherapy in primary breast cancer[J]. Eur Radiol, 2017,27(11):4602-4611.
[6] Pfirrmann CW, Metzdorf A, Zanetti M, et al. Magnetic resonance classification of lumbar intervertebral disc degeneration[J].Spine (Phila Pa 1976), 2001, 26(17): 1873 -1878.
[7] 朱碧云,陈卉.医学图像纹理分析的方法及应用[J].中国医学装备, 2013, 10 (8) :77-81.
[8] Marinelli NL, Haughton VM, Munoz A, et al. T2 relaxation times of intervertebral disc tissue correlated with water content and proteoglycan content[J]. Spine,2009,34(5):520-524.
[9] Stelzeneder D, Welsch GH, Kovacs BK, et al. Quantitative T2 evaluation at 3.0T compared to morphological grading of the lumbar intervertebral disc: a standardized evaluation approach in patients with low back pain[J]. Eur J Radiol, 2012, 81(2):324 -330.
[10] 郝定均,陈明霞,贺宝荣,等.退变性腰椎间盘突出症髓核的超微结构与MRI对照研究[J].陕西医学杂志, 2011,40(6) :681-684.
[11] Zhou Z, Jiang B, Zhou Z, et al. Intervertebral disk degeneration: T1ρ MR imaging of human and animal models[J]. Radiology, 2013,268(2):492-500.
[12] Sobajima S, Vadala G, Shimer A,et al. Feasibility of a stem cell therapy for intervertebral disc degeneration[J]. Spine J,2008, 8(6): 888 -896.
[13] 赵晓梅,黄耀渠. 磁共振T2弛豫时间定量评估腰椎间盘退变的价值[J].广东医学, 2015, 36(16) :2515-2518.
[14] Zhang X, Yang L, Gao F, et al. Comparison of T1ρ and T2 relaxation mapping in patients with different grades of disc degeneration at 3T MR[J]. Med Sci Monit, 2015,21:1934-1941.
[15] Zhang Yd, Wang Q, Wu Cj, et al. The histogram analysis of diffusion-weighted intravoxel incoherent motion (IVIM) imaging for differentiating the gleason grade of prostate cancer[J]. Eur Radiol, 2015,25(4): 994-1004.
[16] Baek HJ, Kim HS, Kim N, et al. Percent change of perfusion skewness and kurtosis: a potential imaging biomarker for early treatment response in patients with newly diagnosed glioblastomas[J]. Radiology, 2012, 264(3): 834-843.