椎间盘源性下腰部疼痛患者腰椎间盘MRI高信号区发生特点

Characteristics of high-intensity zone of lumbar intervertebral disc on MRI in discogenic low back pain patients

目的探讨椎间盘源性下腰部疼痛（LBP）患者腰椎间盘MRI高信号区（HIZ）发生特点与规律。方法对72例椎间盘源性LBP患者（LBP组）、30例无LBP病史患者（对照组）行1.5T腰椎MRI,评价所有节段腰椎间盘退变程度及HIZ,并对采集数据进行统计学分析。结果两组患者HIZ均发生于Ⅲ～V级退变椎间盘,以L3-4、L4-5、L5-S1腰椎间盘最易受累。LBP组HIZ阳性34例,共累及99个腰椎间盘,25例为多发HIZ（HIZ累及≥2个腰椎间盘）;对照组HIZ阳性11例,共累及21个腰椎间盘,4例为多发HIZ。两组患者椎间盘HIZ发生率（LBP组：99/360,27.50%;对照组：21/150,14.00%）、多发HIZ患者数差异均有统计学意义（x^2=10.725、5.010,P=0.001、0.025）。结论 HIZ是Ⅲ级以上椎间盘退变的表现,并不是椎间盘源性LBP的特异性征象,但LBP患者椎间盘HIZ发生率增高,多椎间盘受累对提示椎间盘源性LBP诊断有重要意义。

Objective To investigate the occurring characteristics and regularity of high-intensity zone（HIZ）of lumbar intervertebral disc on MRI in discogenic low back pain（LBP）patients.Methods Seventy-two patients with discogenic LBP（LBP group）and thirty subjects without history of clinically relevant LBP（control group）were examined by a 1.5tesla MR scanner.The lubar disc degeneration and HIZ were evaluated.Then all obtained data were analyzed by statistical analysis.Results HIZs were occurred in gradesⅢ—V degenerative discs in both groups,most of which at L3-4、L4-5、L5-S1.HIZs were identified in 34 LBP patients involving 99 lubar discs,and 25 cases were found to be multiple HIZs（HIZ involved≥ 2lumbar discs）.Whereas HIZs were positive in 11 cases of control group involving 21 lubar discs,and 4cases were found to be multiple HIZs.Significant differences（x^2=10.725,5.010,P=0.001,0.025）were found in incidence rates of HIZ（LBP group：99/360,27.50%;control group：21/150,14.00%）of intervertebral disc and cases of multiple HIZs between the two group.Conclusion HIZ is a manifestation of gradesⅢ to V degenerative discs but not specific for discogenic LBP.However,HIZ is more frequently occurred in LBP patients＇ lumbar discs,and multiple HIZs in a patient can be considered as important marker of discogenic LBP.