3D-SPACE增强扫描神经成像在旁侧型腰椎间盘突出中的应用

目的探讨基于T2对比剂增强背景抑制三维可变翻转角快速自选回波序列(3D-SPACE)的增强扫描技术在诊断旁侧型腰椎间盘突出中的应用价值。方法回顾性分析34例旁侧型腰椎间盘突出患者的影像学和临床资料,按突出髓核组织与受累神经根的位置关系分为肩型、腋型和根型,分析磁共振神经成像(MRN)所示不同水平各型椎间盘突出卡压神经根的情况。结果34例患者共获得36组数据,病变主要集中在L3~S1椎间盘水平。3D-SPACE增强扫描示肩型、腋型及根型突出分别为10处、11处和15处,36.1%的突出累及相应神经根,63.9%的突出累及下一椎体神经根。以临床手术和体征为金标准,MRN的敏感性为97.3%,特异性为100%,阳性预测率为100%,阴性预测率为83%;常规扫描敏感性为86.5%,特异性为20%,阳性预测率为89%,阴性预测率为17%。结论与常规扫描比较,MRN与临床结果一致性较高,且可对腰椎间盘突出卡压的神经根进行具体且全面的评估,对患者的治疗方案选择、术前评估、手术方案制定等具有重要的指导意义。

Objective To explore the application value of enhanced scanning technology based on T2 contrast agent enhanced background suppression three-dimensional variable flip angle fast selective echo sequence(3D-SPACE)in the diagnosis of lateral lumbar disc herniation.Methods The imaging and clinical data of 34 cases of lateral lumbar disc herniation were retrospectively analyzed,and the positional relationship between the herniation nucleus pulposus tissue and the involved nerve root was divided into shoulder type,axillary type and root type as,shown by MRN,and the situation of each type of intervertebral disc herniation compressing nerve root at different levels as shown by MRN was summarized.Results A total of 36 groups of data were obtained in 34 patients,and the lesions were mainly concentrated at the levels of L3 to S1 intervertebral discs.The 3D-SPACE enhanced scans showed that the shoulder type,axillary type,and root type processes were 10,11,and 15,respectively 36.1%of the herniation involved the corresponding nerve roots,63.9%of the herniation involved the next vertebral nerve roots.Using clinical surgery and signs as the gold standard,the sensitivity and specificity of MRN were 97.3%,100%respectively,the positive predictive rate was 100%,and the negative predictive rate was 83%.The sensitivity and specificity of conventional scanning was 86.5%,20%respectively,the positive predictive rate was 89%,and the negative predictive rate was 17%.Conclusion Compared with conventional scanning,MRN has a higher consistency with clinical results,and can be used for specific and comprehensive evaluation of nerve root of the lumbar disc herniation,which has important guiding significance for the selection of treatment options,preoperative evaluation,and formulation of surgical options.