腰椎MR成像椎间盘终板区Modic征象的诊断价值

Diagnostic Value of MRI Signal Changes of Vertebral Bodies Adjacent to the End Plates for Low Back Pain

目的探讨腰椎终板区椎体MRI征象特征及其在腰腿痛病因诊断中的价值。方法回顾分析106例有腰痛伴或不伴下肢放射痛病人132个椎间节段和86例正常成人112个椎间节段腰椎间盘近终板区椎体MRI信号改变(Modic征)发生率,并与手术病理学检查对照,评价其诊断价值。临床治疗效果依据手术前、后Oswestry下腰痛功能障碍指数评定法评定。MRI敏感性=阳性/(阳性+假阴性)×100%。结果腰腿痛病人组和正常对照组Modic征发生率分别为53.03%、3.57%,二者有显著性差异(P<0.05)。其中Ⅰ、Ⅱ、Ⅲ型发生率分别12.7%、23.9%和2.1%。以腰腿痛为主要症状者多表现为Ⅰ、Ⅱ型病变(P<0.05)。病程在1年以内者多表现为Ⅰ型和Ⅱ型病变,超过1年者以Ⅲ型变化为主。Oswestry功能障碍指数由74.68%改善为18.37%,手术效果良好。Modic征对诊断椎间盘源性腰腿痛敏感性为73.9%。结论腰腿痛病人腰椎MR成像Modic征发生率较正常人高,且以Ⅰ、Ⅱ型多见,是诊断椎间盘退变性下腰痛较敏感的影像学参数。

Objective To investigate the diagnostic value of MRI signal changes of vertebral bodies adjacent to the end plates of disc for low back pain. Methods The MRI signal changes in vertebral bodies adjacent to the end plates were analysed in the patients with low back pain （ n = 106, 132 discs） and normal people （ n = 86, 112 discs）. The postoperative pathological observation was referred. The clinical results were evaluated by the Oswestry disability index. Results The positive rates of MRI signal changes was 53.03% in the patients with low back pain, which was significantly higher than that （3.57 % ） of the normal group （ P 〈 0.05 ）. The sensitivity of MR1 signal changes in the end plates zone for the diagnosis of disc degenerative low back pain was 79.43 %. The Oswestry disability index of patients was reduced from 74.68% preoperatively to 18.37 % postoperatively. Conclusion The Modids sign occurred more frequently in the patients with low back pain than that of the normal group. MRI signal changes in the end plates zone is an important radiological parameter in the diagnosis of disc degenerative low back pain.