CT引导下盘源性神经根病臭氧微创治疗术前弥散加权成像的临床应用价值研究

Diffusion-weighted imaging for pre-treatment evaluation and prediction of therapeutic effect in patients undergoing CT-guided ozone injection for the treatment of spinal radiculitis due to lumbar disc herniation

目的 评价表观扩散系数(ADC)的变化能否预测臭氧治疗盘源性神经根病的疗效.方法 选取成都市双流区中医医院疼痛科2017年6月至2018年3月表现为单侧单根盘源性神经根病患者52例,接受盘内(3 ml)、背根神经节周围(5 ml)臭氧注射治疗.按如下公式计算病变侧神经根相对对侧正常神经根的ADC值指数:治疗前ADC值指数=[(ADC病变数侧神经根-ADC对侧正常神经根)/ADC埘侧正常神经根]×100.分析治疗前功能障碍指数、治疗后功能障碍指数恢复分数与治疗前ADC值指数间的关系.以此推测治疗前ADC值指数用于预测臭氧治疗效果的敏感性及特异性.结果 功能障碍指数与ADC值指数两者无显著相关(r=-0.125,P=0.093).ADC值指数和功能障碍指数恢复率具有显著相关性(r=0.819,P<0.001).以7.10为临界值,ADC值指数预测第一个月末臭氧治疗疗效:敏感性为86.3%,特异性为82.9%.结论 病变侧神经根ADC值指数减低预示着临床症状改善效果不佳;ADC值指数对预测CT引导下臭氧注射治疗盘源性神经根病早期疗效是一个有用的指标.

Objective To determine whether the change of apparent diffusion coefficient (ADC) value could predict early response to CT-guided oxygen-ozone (O2-O3) injection therapy in patients with unilateral mono-radiculopathy due to lumbar disc herniation.Methods A total of 52 patients with unilateral mono-radiculopathy in Department of Pain Management,Chengdu Shuangliu Hospital of Traditional Chinese Medicine from June 2017 to March 2018,received a single intradiscal (3 ml) and periganglionic (5 ml) injection of an O2-O3 mixture.An ADC index of the involved side to the intact side was calculated using the following formula:pre-treatment ADC index=[(ADC involved side-ADC intact side)/ADC intact side] × 100.Analyzed the relationship between the pre-treatment Oswestry disability index (ODI) and the ADC index.In addition,the correlation between ODI recovery ratio and ADC index was investigated.The sensitivity and specificity of the ADC index for predicting response in O2-O3 therapy was determined.Results There was no significant correlation between ODI and ADC index (r=-0.125,P=0.093).There was significant correlation between ADC index and recovery rate of ODI (r=0.819,P<0.001).When using 7.10 as the cut-off value,the ADC index was obtained a sensitivity of 86.3% and a specificity of 82.9% for predicting successful response to therapy at the end of first month of follow-up.Conclusion The patients with decreased ADC index tend to show poor improvement of clinical symptoms.The ADC index may be a useful indicator to predict early response to CT-guided O2-O3 injection therapy in patients with unilateral mono-radiculopathy due to lumbar disc herniation.