后纤维环T_2弛豫时间与腰椎间盘突出的相关性
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摘要
目的探讨腰椎间盘后纤维环T2弛豫时间和腰椎间盘突出之间的相关性。方法采用3. 0T磁共振成像系统对54例腰痛研究对象共256个腰椎间盘进行矢状位T2WI和T2mapping扫描,分析扫描图像并根据椎间盘突出或膨出的程度进行分级及分组;正常椎间盘为G1组,存在侧面突出和膨出的椎间盘为G2组,存在正中、中间侧面和旁正中局限性后部突出的椎间盘为G3组。计算各组的Pfirrmann得分,通过后处理计算得到各纤维环、后10%椎间盘(PAF-10)和后20%椎间盘(PAF-20)的T2弛豫时间,进行统计学分析。结果 256个椎间盘中G1组104个(40. 6%),G2组116个(45. 3%),G3组36个(14. 1%),各组Pfirrmann平均得分依次为(2. 16±0. 55)分、(2. 59±0. 71)分、(3. 21±0. 74)分。经过后处理计算,G1组,G2组及G3组椎间盘PAF-10和PAF-20的T2弛豫时间分别为(32. 6±5. 6) ms/(67. 8±12. 3) ms、(34. 2±5. 4) ms/(55. 6±10. 2) ms、(40. 2±7. 2) ms/(46. 9±9. 8) ms。PAF-20的T2值从G1组到G3组逐渐降低,而PAF-10的T2弛豫时间呈现相反的变化趋势,从G1组到G3组逐渐升高。和G2组比较,G3组PAF-10的T2值明显升高,且和髓核的T2弛豫时间无相关性。而G3组PAF-20的T2弛豫时间和髓核之间存在一定的相关性。结论 MR T2mapping能对腰椎间盘T2弛豫时间进行定量评估,且PAF-10的高T2值与椎间盘突出存在明显的相关性。
Objective To investigate the relationship between the T2 relaxition time of the posterior annulus fibrosus and lumbar disc herniation. Methods The sagittal T2 WI and T2 mapping images of a total of 256 lumbar intervertebral discs from 54 patients were scanned by the 3. 0 T magnetic resonance imaging system. The images were analyzed,and the discs were rated and divided into 3 groups according to the degree of disc herniation or bulging,namely the G1 group( normal disc),the G2 group( intervertebral disc with lateral protrusion and bulging),and the G3 group( intervertebral disc with central,medial and paramedian localized posterior protrusion). The T2 relaxation time of each annulus fibrosus,posterior 10% intervertebral discs( PAF-10) and posterior 20% intervertebral discs( PAF-20) was calculated and stastistically analyzed. Results Among the 256 discs,104 discs( 40. 6%) were in the G1 group,116 discs( 45. 3%) were in the G2 group,and 36 discs( 14. 1%) were in the G3 group. The mean scores of Pfirrmann in each group were( 2. 16 ± 0. 55),( 2. 59 ± 0. 71),and( 3. 21 ±0. 74) respectively. The T2 relaxation times of PAF-10 and PAF-20 in G1,G2,and G3 group were( 32. 6 ± 5. 6) ms/( 67. 8 ± 12. 3) ms,( 34. 2 ± 5. 4) ms/( 55. 6 ± 10. 2) ms,and( 40. 2 ± 7. 2) ms/( 46. 9 ± 9. 8) ms,respectively. The T2 value of PAF-20 gradually decreased from G1 to G3 group,while the T2 relaxation time of PAF-10 showed an opposite trend,which gradually increased from G1 to G3 group. Compared with the G2 group,the T2 value of PAF-10 in G3 group was significant higher in the herniation intervertebral disc and showed no association to the nucleus pulposus. However,there was a certain correlation between the T2 relaxation time of the PAF-20 and the nucleus pulposus in the G3 group. Conclusion MR T2 mapping can quantitatively evaluate the T2 relaxation time of lumbar intervertebral disc,and there is a significant correlation between high T2 value of PAF-10 and intervertebral disc herniation.
Objective To investigate the relationship between the T2 relaxition time of the posterior annulus fibrosus and lumbar disc herniation. Methods The sagittal T2 WI and T2 mapping images of a total of 256 lumbar intervertebral discs from 54 patients were scanned by the 3. 0 T magnetic resonance imaging system. The images were analyzed,and the discs were rated and divided into 3 groups according to the degree of disc herniation or bulging,namely the G1 group( normal disc),the G2 group( intervertebral disc with lateral protrusion and bulging),and the G3 group( intervertebral disc with central,medial and paramedian localized posterior protrusion). The T2 relaxation time of each annulus fibrosus,posterior 10% intervertebral discs( PAF-10) and posterior 20% intervertebral discs( PAF-20) was calculated and stastistically analyzed. Results Among the 256 discs,104 discs( 40. 6%) were in the G1 group,116 discs( 45. 3%) were in the G2 group,and 36 discs( 14. 1%) were in the G3 group. The mean scores of Pfirrmann in each group were( 2. 16 ± 0. 55),( 2. 59 ± 0. 71),and( 3. 21 ±0. 74) respectively. The T2 relaxation times of PAF-10 and PAF-20 in G1,G2,and G3 group were( 32. 6 ± 5. 6) ms/( 67. 8 ± 12. 3) ms,( 34. 2 ± 5. 4) ms/( 55. 6 ± 10. 2) ms,and( 40. 2 ± 7. 2) ms/( 46. 9 ± 9. 8) ms,respectively. The T2 value of PAF-20 gradually decreased from G1 to G3 group,while the T2 relaxation time of PAF-10 showed an opposite trend,which gradually increased from G1 to G3 group. Compared with the G2 group,the T2 value of PAF-10 in G3 group was significant higher in the herniation intervertebral disc and showed no association to the nucleus pulposus. However,there was a certain correlation between the T2 relaxation time of the PAF-20 and the nucleus pulposus in the G3 group. Conclusion MR T2 mapping can quantitatively evaluate the T2 relaxation time of lumbar intervertebral disc,and there is a significant correlation between high T2 value of PAF-10 and intervertebral disc herniation.
引文
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[22]Yoon MA,Hong SJ,Kang CH,et al.T1rho and T2 mapping of lumbar intervertebral disc:Correlation with degeneration and morphologic changes in different disc regions[J].Magn Reson Imaging,2016,34(7):932-939.doi:10.1016/j.mri.2016.04.024.
[23]Messner A,Stelzeneder D,Trattnig S,et al.Does T2 mapping of the posterior annulus fibrosus indicate the presence of lumbar intervertebral disc herniation?A 3.0 Tesla magnetic resonance study[J].Eur Spine J,2017,26(3):877-883.doi:10.1007/s00586-016-4873-x.
[2]Carvalho C,Caetano JM,Cunha L,et al.Open-label placebo treatment in chronic low back pain:a randomized controlled trial[J].Pain,2016,157(12):2766-2772.doi:10.1097/j.pain.0000000000000700.
[3]Turner JA,Anderson ML,Balderson BH,et al.Mindfulness-based stress reduction and cognitive behavioral therapy for chronic low back pain:similar effects on mindfulness,catastrophizing,self-efficacy,and acceptance in a randomized controlled trial[J].Pain,2016,157(11):2434-2444.doi:10.1097/j.pain.0000000000000635.
[4]Yorimitsu E,Chiba K,Toyama Y,et al.Long-term outcomes of standard discectomy for lumbar disc herniation:a follow-up study of more than10 years[J].Spine,2001,26(6):652-657.doi:10.1097/00007632-200103150-00019.
[5]Luoma K,Riihimki H,Luukkonen R,et.al.Low back pain in relation to lumbar disc degeneration[J].Spine,2000,25(4):487-492.doi:10.1097/00007632-200002150-00016
[6]Urrutia J,Besa P,Campos M,et al.The Pfirrmann classification of lumbar intervertebral disc degeneration:an independent inter-and intra-observer agreement assessment[J].Eur Spine J,2016,25(9):2728-2733.doi:10.1007/s00586-016-4438-z.
[7]Yu HJ,Bahri S,Gardner V,et al.In vivo quantification of lumbar disc degeneration:assessment of ADC value using a degenerative scoring system based on Pfirrmann framework[J].Eur Spine J,2015,24(11):2442-2448.doi:10.1007/s00586-014-3721-0.
[8]Radek M,Pacholczyk-Sienicka B,Jankowski S,et al.Assessing the correlation between the degree of disc degeneration on the Pfirrmann scale and the metabolites identified in HR-MAS NMR spectroscopy[J].Magn Reson Imaging,2016,4(4):376-380.doi:10.1016/j.mri.2015.12.005.
[9]温群,孟凡华,钱亭,等.1.5T磁共振T2mapping成像在腰椎间盘退行性变中的诊断价值[J].中国医学影像学杂志,2017,25(7):531-535.doi:10.3969/j.issn.1005-5185.2017.07.014.
[10]龚静山,凌人男,周阳泱,等.采用3.0T MRI T2和T2*mapping评价下腰痛患者腰椎间盘退变[J].中国CT和MRI杂志,2016,14(10):113-116.doi:10.3969/j.issn.1672-5131.2016.10.036.
[11]张啸波,孙维荣,张肖,等.T2 mapping对腰椎间盘退行性变的定量研究[J].中国医学影像学杂志,2015,23(7):544-548.doi:10.3969/j.issn.1005-5185.2015.07.018.
[12]Cui YZ,Yang XH,Liu PF,et al.Preliminary study on diagnosis of lumbar disc degeneration with magnetic resonance T1p,T2 mapping and DWI quantitative detection technologies[J].Eur Rev Med Pharmacol Sci,2016,20(16):3344-3350.
[13]Foltz MH,Kage CC,Johnson CP,et al.Noninvasive assessment of biochemical and mechanical properties of lumbar discs through quantitative magnetic resonance imaging in asymptomatic volunteers[J].J Biomech Eng,2017,139(11).doi:10.1115/1.4037549.
[14]Menezes-Reis R,Salmon CE,Bonugli GP,et al.Lumbar intervertebral discs T2 relaxometry and T1rho relaxometry correlation with age in asymptomatic young adults[J].Quant Imaging Med Surg,2016,6(4):402-412.doi:10.21037/qims.2016.08.01.
[15]Fardon DF,Williams AL,Dohring EJ,et al.Lumbar disc nomenclature:version 2.0:Recommendations of the combined task forces of the North American Spine Society,the American Society of Spine Radiology and the American Society of Neuroradiology[J].Spine J,2014,14(11):2525-2545.doi:10.1016/j.spinee.2014.04.022.
[16]Nilsson M,Lagerstrand K,Kasperska I,et al.Axial loading during MRIinfluences T2-mapping values of lumbar discs:a feasibility study on patients with low back pain[J].Eur Spine J,2016,25(9):2856-2863.doi:10.1007/s00586-016-4670-6.
[17]Nisolle JF,Bihin B,Kirschvink N,et al.Prevalence of age-related changes in ovine lumbar intervertebral discs during computed tomography and magnetic resonance imaging[J].Comp Med,2016,66(4):300-307.
[18]Detiger SE,Holewijn RM,Hoogendoorn RJ,et al.MRI T2*mapping correlates with biochemistry and histology in intervertebral disc degeneration in a large animal model[J].Eur Spine J,2015,24(9):1935-1943.doi:10.1007/s00586-014-3498-1.
[19]Ogon I,Takebayashi T,Takashima H,et al.Analysis of chronic low back pain with magnetic resonance imaging T2 mapping of lumbar intervertebral disc[J].J Orthop Sci,2015,20(2):295-301.doi:10.1007/s00776-014-0686-0.
[20]Yamabe D,Murakami H,Chokan K,et al.Evaluation of water content in lumbar intervertebral discs and facet joints before and after physiological loading using T2 mapping MRI[J].Spine(Phila Pa1976),2017,42(24):E1423-E1428.doi:10.1097/BRS.0000000000002204.
[21]Yoo YH,Yoon CS,Eun NL,et al.Interobserver and test-retest reproducibility of T1rho and T2 measurements of lumbar intervertebral discs by 3T magnetic resonance imaging[J].Korean J Radiol,2016,17(6):903-911.doi:10.3348/kjr.2016.17.6.903.
[22]Yoon MA,Hong SJ,Kang CH,et al.T1rho and T2 mapping of lumbar intervertebral disc:Correlation with degeneration and morphologic changes in different disc regions[J].Magn Reson Imaging,2016,34(7):932-939.doi:10.1016/j.mri.2016.04.024.
[23]Messner A,Stelzeneder D,Trattnig S,et al.Does T2 mapping of the posterior annulus fibrosus indicate the presence of lumbar intervertebral disc herniation?A 3.0 Tesla magnetic resonance study[J].Eur Spine J,2017,26(3):877-883.doi:10.1007/s00586-016-4873-x.