MRI对马尾神经冗余定量分析的临床价值

The clinical value of MRI in quantitative analysis of redundant nerve roots

目的分析MRI对腰椎管狭窄病人马尾神经冗余(RNR)的定量检测数据,探讨MRI对RNR定量分析的临床价值。方法收集临床确诊腰椎管狭窄病人275例,男103例、女172例,年龄18~81岁,平均(60.50±8.84)岁。根据是否存在RNR分为RNR组和非RNR组,其中RNR组122例,男48例、女74例,平均年龄(63.16±7.76)岁;非RNR组153例,男55例、女98例,平均年龄(58.39±9.09)岁。采用腰椎MRI常规序列(矢状面T1WI、T2WI,横断面T2WI)扫描,测量腰椎管最狭窄处硬膜囊横截面积(CSA)、RNR相对长度;对病人腰椎进行日本骨科协会评估治疗(JOA)评分和Oswestry功能障碍指数(ODI)评分。2组性别比较采用卡方检验,年龄、CSA及临床评分比较采用独立样本t检验;采用Pearson或Spearman相关分析RNR相对长度与腰椎临床评分、病程、病人年龄及CSA的相关性。结果RNR组与非RNR组病人性别差异无统计学意义(P>0.05)。与非RNR组相比,RNR组病人的平均年龄较大,CSA较小,腰椎JOA评分较低,而腰椎ODI评分较高(均P<0.05)。腰椎管狭窄病人RNR的发生率为44.36%(122/275)。RNR组RNR相对长度为4.35±1.41,与腰椎JOA评分呈负相关(r=-0.678,P<0.001),与腰椎ODI评分(r=0.626,P<0.001)及病程呈正相关(rs=0.276,P=0.002),与病人年龄及CSA均无相关性(均P>0.05)。结论MRI检查可以为RNR病人的临床诊疗和预后判断提供更多影像学支持,具有较高的临床意义。

Objective To investigate the clinical value of MRI in the quantitative analysis of redundant nerve roots(RNR)in patients with lumbar spinal stenosis.Methods All of 275 patients(male n=103,female n=172,age range 18~81 years old,mean age 60.50±8.84 years old)with lumbar spinal stenosis were collected.According to the existence of RNR,the patients were divided into RNR and non-RNR groups,there were 122 cases in the RNR group(male n=48,female n=74,mean age 63.16±7.76 years old)and 153 cases in the non-RNR group(male n=55,female n=98,mean age 58.39±9.09 years old).Each patient underwent lumbar MRI with conventional MRI sequences(sagittal T1WI,T2WI,and transverse T2WI).The cross-sectional area of dural sac(CSA)and relative length of RNR were measured.The JOA(Japanese Orthopedic Association)and ODI(Oswestry Disability Index)scores were calculated.Chi-square test was used to compare the gender between the two groups,independent sample t-test was used to compare age,CSA and clinical scores,and Pearson or Spearman correlation analysis was used to analyze the correlation between the relative length of RNR and lumbar clinical scores,course of disease,age and CSA.Results There was no significant difference in gender between the RNR group and non-RNR group(P>0.05).Compared with the non-RNR group,the average age of patients in the RNR group was older,CSA was smaller,JOA score was lower,and ODI score was higher(all P<0.05).The incidence of RNR was 44.36%(122/275).The relative length of RNR in the RNR group was 4.35±1.41,which was negatively correlated with the lumbar JOA score(r=-0.678,P<0.001),positively correlated with the lumbar ODI score(r=0.626,P<0.001)and course of disease(rs=0.276,P=0.002),but not correlated with the age and CSA(all P>0.05).Conclusion MRI can provide imaging support for clinical diagnosis,treatment and prognosis,which has a high clinical significance.