多层螺旋CT(MSCT)与核磁共振(MRI)诊断腰椎间盘突出症(LDH)的临床价值

The Clinical Value of Multi-slice Spiral CT(MSCT) and Magnetic Resonance(MRI)in the Diagnosis of Lumbar Intervertebral Disc Herniation(LDH)

目的分析多层螺旋CT(MSCT)与核磁共振(MRI)对腰椎间盘突出症(LDH)的诊断效果。方法选取该院2016年1月—2021年1月收治的疑似腰椎间盘突出症患者300例,均予以MSCT、MRI检查,并以手术病理结果为判断依据,比较两种方法的诊断效能。结果 300例患者经手术病理确诊病变178例,MSCT准确诊断出165例病变患者,诊断准确度为91.00%,灵敏度为92.70%,特异度为88.52%,阳性与阴性预测值为92.69%和89.26%。MRI准确检出170例病变患者,其诊断准确度、灵敏度分别为95.33%和95.51%,特异度为95.08%,阳性预测值为96.59%,阴性预测值为93.55%,各指标均高于MSCT检查,但差异无统计学意义(P>0.05)。联合检查的准确度98.33%,灵敏度98.88%,特异度97.54%,阳性预测值94.97%,阴性预测值98.35%,与单独MSCT及MRI比较,差异有统计学意义(χ^(2)=16.816、8.269、9.000、8.714、8.499,P<0.05)。MSCT诊断硬膜囊受压、钙化、椎间盘积气、神经根受压的检出率高于MRI,差异有统计学意义(χ^(2)=25.320、22.063、17.140、11.756,P<0.05);MRI诊断脊髓变性、椎间盘变性的检出率高于MSCT,差异有统计学意义(χ^(2)=25.205、13.941,P<0.05)。结论 MSCT、MRI检查对腰椎间盘突出症均具有较好诊断效果,必要时可将两者联合应用,以提升临床诊断结果的准确性。

Objective To analyze the diagnostic effect of multi-slice spiral CT(MSCT) and magnetic resonance imaging(MRI) on lumbar disc herniation(LDH).Methods A total of 300 patients with suspected lumbar intervertebral disc herniation admitted to the hospital from January 2016 to January 2021 were selected for MSCT and MRI examinations.And based on the surgical pathological results,the diagnostic efficacy of the two methods was compared.Results 300 patients were diagnosed with 178 lesions by surgery and pathology.MSCT accurately diagnosed 165 patients with lesions.The diagnostic accuracy was 91.00%,the sensitivity was 92.70%,the specificity was 88.52%,and the positive and negative predictive values were 92.69% and 89.26%.MRI accurately detected 170 patients with lesions.The diagnostic accuracy and sensitivity were 95.33% and 95.51%,the specificity was 95.08%,the positive predictive value was 96.59%,and the negative predictive value was 93.55%.All indexes were higher than MSCT,but the difference was not statistically significant(P>0.05).The accuracy of combined examination was 98.33 %,the sensitivity was 98.88 %,the spectificity was 97.54%,the positive predictive value was 94.97%,and the negative predictive value was 98.35%.Compared with MSCT and MRI alone,the difference was statistically significant(χ^(2)=16.816,8.269,9.000,8.714,8.499,P<0.05).The detection rate of MSCT in the diagnosis of dural sac compression,calcification,intervertebral disc pneumatosis and nerve root compression was higher than that of MRI,the difference was statistically significant(χ^(2)=25.320,22.063,17.140,11.756,P<0.05).The detection rate of MRI in the diagnosis of spinal cord degeneration and intervertebral disc degeneration was higher than that of MSCT,and the difference was statistically significant(χ^(2)=25.205,13.941,P<0.05).Conclusion Both MSCT and MRI have a good diagnostic effect on lumbar disc herniation.If necessary,the two can be combined to improve the accuracy of clinical diagnosis.