磁共振弥散张量成像在PTED术治疗腰椎间盘突出症效果评估中的应用

The application effects of DTI in the evaluation of the efficacy of PTED in treatment of lumbar disc herniation

目的探讨磁共振扩散张量成像技术(DTI)在经皮椎间孔镜下髓核摘除术(PTED)术治疗腰椎间盘突出症疗效评估中的应用价值。方法选取2019年1月至2021年2月50例行PTED术的腰椎间盘突出症患者的临床资料进行回顾性分析,于术前、术后予以DTI检查。评估经PTED治疗后的优良率;观察术前、术后3 d、术后1个月、3个月的MRI影像表现,以及观察术前、术后3 d、术后1个月、3个月的L5、S1神经患侧、健侧的FA、ADC、VAS评分、JOA评分、ODI评分;分析L5、S1神经患侧FA、ADC与VAS评分、JOA评分、ODI评分的相关性;评估FA、ADC预测PTED术治疗腰椎间盘突出症疗效的AUC值、敏感度、特异度、约登指数。结果50例腰椎间盘突出症患者经PTED治疗后3个月后,优良率为96.00%,其中,优36例(72.00%)、良12例(24.00%)、可1例(2.00%)、差1例(2.00%)。单因素方差分析显示,L5、S1神经患侧的FA、ADC、AS评分、JOA评分、ODI评分在术前1 d、术后3 d、术后1个月、3个月比较中,差异有统计学意义(P<0.05);L5、S1健侧的FA、ADC在术前1 d、术后3 d、术后1个月、3个月比较中,差异无统计学意义(P>0.05)。Pearson相关性分析显示,L5、S1神经患侧FA与VAS评分、ODI评分呈负相关,与JOA评分呈正相关(P<0.05);L5、S1神经患侧ADC与VAS评分、ODI评分呈正相关,与JOA评分呈负相关(P<0.05)。ROC曲线分析显示,L5、S1神经患侧FA、ADC预测疗效的AUC分别为(0.996、0.980、0.979、0.994,P<0.05);敏感度分别为94.40%、97.20%、97.40%、100.00%;特异度分别为100.00%、100.00%、92.90%、92.90%。结论DTI能定量评估LDH患者术后不同时期的神经根显微结构,为疗效评估提供重要参考信息。

Objective To investigate the application effects of magnetic resonance diffusion tensor imaging(DTI)in the evaluation of the efficacy of percutaneous foraminal nucleus pulposus(PTED)in treatment of lumbar disc herniation.Methods The clinical data about 50 patients with lumbar disc herniation who underwent PTED surgery in our hospital from January 2019 to February 2021 were retrospectively analyzed.DTI examinations were performed before and after surgery to assess the excellent and good rate after PTED treatment,and to observe the MRI imaging performance as well as FA,ADC,VAS score,JOA score,ODI score of L5,S1 neuropathic side and uninfected side before operation,at 3d,1m,3m after operation.Moreover the correlation between FA,ADC and VAS score,JOA score,ODI score on L5,S1 neuropathic side was analyzed,and the AUC value,sensitivity,specificity,and Youden index of FA and ADC in predicting the curative effect of PTED surgery were analyzed.Results After 3-month treatment,in the good/excellent rate was 96.00%,of whom,36 cases were excellent(72.00%),12 cases were good(24.00%),and 1 case(2.00%)was fair and 1 case(2.00%)was poor.One-way analysis of variance showed that there were significant differences in the FA,ADC,AS scores,JOA scores,and ODI scores of the affected side of L5 and S1 nerves in different time points(before operation,at 3d,1m,3m after operation)(P<0.05).However there were no significant differences in FA and ADC of L5 and S1 contralateral side in different time points(P>0.05).Pearson correlation analysis showed that the FA on the affected side of L5 and S1 nerves was negatively correlated with the VAS score and ODI score,however,which was positively correlated with the JOA score(P<0.05),and the ADC on the affected side of L5 and S1 nerves was positively correlated with the VAS score and ODI score,but,which was negatively correlated with JOA score(P<0.05).ROC curve analysis showed that the AUC of FA and ADC on the affected side of L5 and S1 nerves were 0.996,0.980,0.979,0.994,respectively(P<0.05),Moreover the sensitivities were 94.40%,97.20%,97.40%,100.00%,respectively,and the specificities were 100.00%,100.00%,92.90%,92.90%,respectively.Conclusion DTI can quantitatively evaluate the microstructure of nerve roots in patients with LDH in different time points after surgery,so as to provide important reference information for the evaluation of therapeutic effects.