DCE-MRI和IVIM-DWI对下腰痛患者退变椎间盘新生血管的研究

Study of DCE-MRI and IVIM-DWI on degenerative intervertebral disc neovascularization in patients with low back pain

目的探讨动态增强磁共振成像(dynamic contrast enhanced magnetic resonance imaging,DCE-MRI)和体素内不相干运动扩散加权成像(intravoxel incoherent motion diffusion-weighted imaging,IVIM-DWI)对下腰痛患者退变椎间盘新生血管的评估价值。材料与方法选取51例经腰椎后路手术治疗的腰椎间盘突出患者设为实验组,选取8例腰椎骨折经手术治疗的患者为对照组。所有患者术前行DCE-MRI和IVIM-DWI扫描,并分别测量DCE参数K_(trans)、K_(ep)、V_e和IVIM参数D~*、D和f。椎间盘通过免疫组织化学方法,并计算微血管密度(microvessel density,MVD)。应用Pearson相关分析IVIM-DWI、DCE-MRI参数和MVD的相关性,采用单因素方差分析IVIM-DWI、DCE-MRI各项参数值在不同退变程度患者中的差异。结果 K_(trans)值随着退变分级增加而增大(P<0.05),D值随退变分级增加而减低(P<0.05)。K_(trans)值、f值分别与MVD具有良好相关性(r分别为0.794,0.589;P值均小于0.05)。结论 DCE-MRI和IVIM-DWI磁共振技术可无创重复地观察椎间盘退变的血管形成情况,并对患者椎间盘退变程度进行评估。

Objective： To evaluate the value of dynamic contrast enhanced magnetic resonance imaging（DCE-MRI） and incoherent motion diffusion-weighted imaging（IVIM-DWI） in the assessment of the neovascularization of the degenerative intervertebral disc in patients with lower back pain. Materials and Methods： Fiftyone patients with lumbar disc herniation treated by lumbar posterior approach were selected as the experimental group. Eight patients with lumbar fractures were selected as the control group. All subjects underwent IVIM and DCE-MRI examinations before operation,DCE parameters K（trans）,K（ep）,Ve and IVIM parameters D-＊,D and f were measured respectively. After operation,immunohistochemistry of intervertebral disc were analyzed. The microvessel density（MVD） was calculated by CD34 labeled vascular endothelial cells. The correlation between the parameters of two imaging modalities and microvessel density was analyzed by Pearson correlation. One-way analysis of variance was used to compare differences in IVIM-DWI and DCE-MRI parameters among patients with different degenerative degrees. Results： The K（trans） value increased with the grade of degeneration（P〈0.05）. The D value decreased with the grade of degeneration（P〈0.05）. K（trans） and f values were well correlated with MVD（r=0.794,0.589,P〈0.05）. Conclusions： DCE-MRI and IVIM-DWI can observe the vascularization of intervertebral disc degeneration non-invasively and repeatedly. They can also assess the degree of intervertebral disc degeneration.