椎间盘源性下腰痛的 MRI 观察

Magnetic resonance imaging study of disc low back pain

目的：观察MRI T2 WI腰椎间盘后方/侧后方高信号带对盘源性下腰痛的诊断价值。方法收集解放军第一一七医院2011年5月至2012年6月有慢性下腰痛病史、无典型的神经根性症状和体征、CT平扫和MRI检查无腰椎间盘突出征象的21例患者，行MRI和CT椎间盘造影（ CTD）配对检查；制定统一的CTD分型及阳性椎间盘的标准；MRI对阳性椎间盘诊断的敏感性、特异性和阳性预测值使用SPSS15．0软件进行统计学分析。结果21例患者中，MRI显示28个腰椎间盘信号异常，其中12个为腰椎间盘后方、3个为侧后方的高信号带，其他13个仅显示椎间盘退行性改变；28个异常信号腰椎间盘和5个正常信号腰椎间盘行CTD配对检查的结果：（1）CTD显示19个为2型的单纯椎间盘纤维环破裂中，MRI显示12个腰椎间盘纤维环后方及2个腰椎间盘侧后方高信号带，其形态与CTD显示对比剂聚积在外层纤维环下的形态一致，其余5个MRI显示腰椎间盘为退行性改变，19个均为阳性椎间盘；（2） CTD显示1个为5型的纤维环完全破裂是3个MRI显示腰椎间盘侧后方高信号带中的另1个，为阳性椎间盘；（3）CTD显示7个为3型的弥漫性椎间盘纤维环破裂，均为阴性椎间盘，MRI显示为椎间盘退行性改变；（4）CTD显示6个为1型的正常椎间盘，为阴性椎间盘，MRI显示1个为椎间盘退行性改变，5个椎间盘信号无改变，即正常腰椎间盘；（5）MRI对阳性椎间盘诊断的敏感度为75％、特异度和阳性预测值分别为100％。结论 MRI T2 WI腰椎间盘后方/侧后方高信号带是由于椎间盘纤维环纵向破裂，液体积聚在外层纤维环下所致，是腰椎间盘破裂的典型征像，对盘源性下腰痛的诊断具有重要的临床意义。

Objective To study the diagnostic value of disc low back pain （ DLBP ） with lumbar disc high-intensity zone on magnetic resonance imaging （ MRI ） .Methods The 21 patients of pare examination with MRI and CT discography （ CTD ） must have chronic low back pain without radicular pain and with no disc herniation on the CT or MRI .We have worked out the standard of CTD group and positive disc.The sensitivity, specificity and positive predictive value that the positive disc was diagnosed with MRI was used for statistical analysis in SPSS 15.0.Results MRI showed 28 abnormal signal discs in 21 patients, including the high-intensity zone of posterior annulus in 12 discs and later-posterior annulus in 3 discs and discs degeneration in other 13 discs .The results of pare examination with MRI and CTD to 28 abnormal signal discs and 5 normal signal discs was （ 1 ） MRI showed the high-intensity zone of poster annulus in 12 discs and later-poster annulus in 2 discs and discs degeneration in 5 discs, while CTD showed 19 discs for group 2 with all positive discs .The shape of high-intensity zone showed on MRI was showed no difference with the shape of contrast agent collected under periphery disc on CTD .（2） MRI showed another high-intensity zone of later-poster annulus in 3 discs, while CTD showed one disc for group 5 with positive. （3） MRI showed the discs degeneration, while CTD showed 7 discs for group 3 with negative discs.（4） MRI showed 1 disc degeneration and 5 normal discs, while CTD showed 6 discs for group 1 with negative discs.（5）The sensitivity of diagnosis positive discs was 75%, the specificity and positive predictive value was respectively 100%with MRI.Conclusions The high-intensity zone of poster/later-poster annulus on MRI was typical sign of disc disruption and the important clinical role for diagnosing disc low back pain .