磁共振成像对腰肌劳损腰痛的诊断价值

Value of MRI in diagnosing lumbago with lumbar muscle strain

目的探讨腰肌劳损MRI检查方法与影像学表现。方法症状性慢性腰肌劳损患者30例,对照组为无症状健康志愿者35例,两组间性别及年龄构成比差异均无统计学意义(前者P=0.084,后者P=0.850)。MRI检查方法包括:常规梯度回波小角度激发T1加权横断面成像(GRET1WI)、快速自旋回波T2加权横断面成像(TSET2WI)和短时反转恢复T2加权横断面成像+脂肪抑制(T2-STIR-FS)、快速反转恢复T2加权横断面成像+脂肪抑制(T2-TIRM-FS)、快速自旋双回波T2加权横断面成像+脂肪抑制(T2+T2-TSE-FS)、弥散加权横断面成像(DWI)。评价征象包括:(1)腰骶背肌-肌间隙改变;(2)腰骶背肌-骨间隙改变;(3)多裂肌厚度改变;(4)多裂肌内脂肪浸润程度。结果腰骶背肌间隙不规则扭曲、积液,棘突旁间隙积液,横突窝积液和小关节突窝积液,髂骨-髂周肌间隙积液这些征象在症状组的发生率显著高于对照组(P<0.05)。多裂肌厚度和脂肪浸润程度在两组间差异无统计学意义(P>0.05)。各种征象中,诊断试验真实性最好的是棘突旁间隙积液征象(YI=0.73)。联合多种MRI征象诊断症状性腰肌劳损的准确性较依靠某一种征象的高,以联合2种MRI征象诊断腰肌劳损的真实性最好(YI=0.79)。检查方法STIR-FS、DWI、TIRM-FS和T2+T2-TSE-FS可以敏感地显示积液征象,显示敏感性基本相同(P>0.05)。结论合理地选择应用MRI常规T1WI和T2WI序列和特殊成像序列STIR-FS、DWI、TIRM-FS或T2+T2-TSE-FS可以很好地显示慢性腰肌劳损的病理生理改变,包括肌-肌间隙改变,肌-骨间隙改变,腰背肌形态结构改变。

Objective To study the MR imaging methods and findings of lumbar muscle strain. Methods Symptomatic chronic lumbar muscle strain patients 30 cases, control group including nonsymptomatic health volunteer 35 cases, between two sets, the discrepancy sex and age constituent ratio had no significant diviation （ the former P = 0. 084, the latter P = 0. 850 ）. MRI methods included： Routine sequences of GRE T1WI,TSE T2WI and special sequences of T2-STIR-Fs, DWI, T2-TIRM-FS or T＇2 ＋ T2- TSE-FS. MR! signs-evaluated included： Changes in intramuscle spatium; Changes of spatiums between muscle-bone;Thickness of muhifidus muscle; Extent of fat soakage in multifidus. Results Signs of lower lumbar dorsal muscles spatium irregularity twist and fluidffy, spinous process lateral spatium fluid, transverse process and arthro-process fossa fluidify, and spatium fluidify of external iliac muscle-bone were showed in the symptom group significantly higher rate than in the control group （ P 〈 0. 05）. The average thickness of multifidus muscle and extent of fat soakage in multifidus had no statistic significant between two groups of objects（P 〉 0. 05 ）. In all MRI signs, the sign with best authenticity of diagnosis test was spinous process lateral spatium fluidify（ YI = 0. 73 ）. Combine multiple MRI signs to diagnose had higher accurate than by one sign. The best authenticity of diagnosis test was combined two MRI signs （YI = 0. 79）. The MRI fluidify signs of lumbar muscle strain were mostly displayed in the transverse imaging of T2-weighted fat suppressed sequence,including STIR-FS, TIRM-FS, T2 ＋ T2-TSE-FS and DWI. The sensitivities of the 4 methods were almost equal（P 〉 0. 05 ）. Conclusions Applying in reason the MRI methods of routine sequences of T1WI, T2WI and special sequences of STIR-FS, DWI, TIRM-FS or T2 ＋ T2-TSE-FS could well display the pathology and physiology changes of chronic lumbar muscle strain, including Changes of spatiums between muscles- muscles, changes of spatiums between muscles-bones, changes of multifidus muscle thickness and fat soakage in multifidus.