MRI表观弥散系数值在鉴别急慢性腰椎间盘损伤的应用研究

The application of MR apparent diffusion coefficient value in acute/chronic injury of lumbar disc

目的评价磁共振弥散加权成像表观弥散系数(ADC)在鉴别腰椎间盘急、慢性损伤的应用价值。方法回顾性分析行腰椎间盘磁共振检查男性患者175例,扫描序列为矢状位T1WI、T2WI、T2WI-SPAIR、DWI及轴位T2WI;选取Pfirrmann分级Ⅲ/Ⅳ级腰4/5及腰5/骶1椎间盘为研究对象,共262个椎间盘(88个Ⅱ/Ⅴ级椎间盘未纳入研究);Ⅲ级133个椎间盘,急、慢性损伤组及退变组分别44、44及45个;Ⅳ级129个椎间盘,急、慢性损伤组及退变组分别43、44及42个;分别测量各椎间盘ADC值并进行统计学分析。结果 PfirrmannⅢ级椎间盘急、慢性损伤组及退变组间ADC值差异有统计学意义(P<0.05),两两比较差异有统计学意义(P<0.05),急性组最大,退变组次之,慢性组最小;Ⅳ级椎间盘急、慢性损伤组及退变组间差异有统计学意义(P<0.05),两两比较慢性损伤组与退变组差异无统计学意义(P>0.05),急性损伤组与慢性损伤组及退变组间差异有统计学意义(P<0.05),且急性损伤组ADC值大于慢性损伤组与退变组。PfirrmannⅢ级各组椎间盘ADC值均高于对应Ⅳ级各组,且差异有统计学意义(P<0.05)。结论 MRI表观弥散系数值能为椎间盘急慢性损伤的鉴别诊断提供依据。

Objective To study the clinical application of MR apparent diffusion coefficient value in acute/chronic injury of lumbar disc. Methods 175 male subjects who underwent lumbar disc MRI scanning were selected for study. MR se- quence contained sagittal T1 WI, T2 WI, T2 WI-SPAIR, DWI and axial T2 WI. 262 lumbar discs at L4/5 , L5/S1 belonging to Pfirrmann＇s ~I/IV grade were selected. 133 discs in grade Ill were divided into three groups as followings., acute injury group, 44 cases; chronic injury group, 44 cases; and degeneration group, 45 cases. 129 discs in grade IV were divided into three groups too, the number of discs of acute injury group, chronic injury group and degeneration group was 43, 44 and 42, respectively. The ADC value was recorded for each disc. All data were calculated by SPSS 13.0 software package. Re- sults Statistically significant difference （ P〈0.05） was found in ADC value among the three groups in grade Ⅲ , signifi cant statistics differences were found in multiple comparison （ P 〈0.05）, with the chronic group the lowest, the degener- ation group the second, the acute group the highest. Statistically significant difference （ P 〈0.05） was found in ADC val- ue among the three groups in grade IV, significant statistics differences were found in multiple comparison （ P 〈0.05）, except hetween the chronic group with the degeneration group （ P 〉0.05）, with higher ADC values in the acute group than the chronic group and the degeneration group. Statistically significant difference （P 〈0. 05） was found between grade Ⅲ and grade IV in every group, with higher ADC values in grade 11. Conclusion ADC value can provide more in formation in differential diagnosis between the acute and chronic lumbar disc injury.