PROSET序列在多节段腰椎椎间孔狭窄症中确定责任神经根的价值

The Diagnostic Value of PROSET Sequences in Identifying the Relevant Spinal Nerve Root in Multi-Segmental Lumbar Foraminal Stenosis

目的探讨1.5 T MRI选择性激励技术(PROSET)序列在多节段腰椎椎间孔狭窄症(LFS)中确定责任神经根的价值。方法搜集2014年1月至2017年3月杨凌示范区医院的多节段LFS患者58例,经过选择性神经根阻滞(SNRB)及电生理测试确诊为单侧单一神经根受损,2名观察者对MRI常规序列、PROSET序列及PROSET结合MRI常规序列L2~S1节段神经根的影像表现进行分析,并确定责任神经根,当评价结果不一致时,通过协商达成一致后作为最终结果,将其与SNRB和电生理测试结果比较。MRI常规序列仅通过椎间盘突出、椎间孔脂肪移位及侧隐窝狭窄等间接征象来推测责任神经根;而PROSET序列全面清楚地显示神经根的形态及走行,通过神经根肿胀和/或走行异常来确定责任神经根。采用Kappa检验比较2名观察者评价的一致性,采用两两配对McNemar检验比较三种观察方法的诊断准确率。结果2名观察者对于三种方法的评价结果具有良好的一致性,Kappa值分别为0.885、0.891、0.901。MRI常规序列诊断准确率96.03%,灵敏度67.86%,特异度99.05%,阳性预测值88.37%,阴性预测值96.65%。PROSET序列诊断准确率96.38%,灵敏度66.07%,特异度99.62%,阳性预测值94.87%,阴性预测值96.49%。PROSET结合MRI常规序列诊断准确率98.62%,灵敏度87.50%,特异度99.81%,阳性预测值98.00%,阴性预测值98.68%。PROSET结合MRI常规序列诊断准确率较单独MRI常规序列及PROSET序列有所提高,差异有统计学意义(P<0.05)。结论责任神经根在PROSET序列上表现为神经根肿胀和/或走行异常,结合MRI常规序列可提高多节段LFS责任神经根的诊断准确率。

Objective The present research aimed to investigate the diagnostic value of 1.5 T MRI PROSET sequences in identifying the relevant spinal nerve root in multi-segmental lumbar foraminal stenosis.Methods The 58 multi-segmental lumbar foraminal stenosis cases analyzed in the current research were collected from Yangling Demonstration Zone hospital from 2014 January to 2017 March.These patients were diagnosed of single nerve damage by selective nerve root block(SNRB)and electrophysiological test.The conventional MRI sequences,PROSET sequences,and PROSET combined with conventional MRI sequences scanning were employed to determine the relevant spinal nerve root between L2 to S1 by two observers.The final diagnostic results were concluded by negotiating to consensus when the evaluation was not consistent,and thus respectively compared with SNRB and electrophysiological test results.Conventional MRI sequences could indirectly speculate the relevant spinal nerve root by symptoms such as herniation of intervertebral disc,fat translocation of intervertebral foramen,lateral recess stenosis.However,the PROSET sequences could directly and clearly demonstrate the spinal nerve root morphology and its running course.And the relevant spinal nerve root could be diagnosed by swelling and/or running course abnormality.The Kappa test was used to compare the consistency of the two Observers’evaluation,and McNemar test was used to compare the accuracy of the three observation methods.Results The two observers had good consistency in the evaluation results of the three methods,and the Kappa values were 0.885,0.891,0.901.The diagnosis results demonstrated that the diagnostic sensitivity of conventional MRI,PROSET sequences,and PROSET combined with conventional MRI sequences were 67.86%,66.07%,87.50%,respectively.The specificity was 99.05%,99.62%,99.81%.The positive predictive values were 88.37%,94.87%,98.00%.The negative predictive values were 96.65%,96.49%,98.68%.The accuracy was 96.03%,96.38%,98.62%,respectively.The diagnostic accuracy of PROSET sequences scanning combined with conventional MRI sequence was significantly higher than that of single routine sequences and PROSET sequences(P<0.05).Conclusions The current study revealed that the relevant spinal nerves root could be detected as nerve swelling and/or running course abnormality in the PROSET sequences scanning.Moreover,the PROSET sequences combined with conventional MRI sequence scanning can improve the accuracy of diagnosis the relevant spinal nerve root in multi-segmental lumbar foraminal stenosis.