腰椎间盘突出症神经根及神经节受累的磁共振神经成像研究

Magnetic Resonance Neurography Study of Nerve Root and Ganglion Compression in Lumbar Disc Herniation

目的 初步探讨磁共振神经成像(MRN)技术评估腰椎间盘突出症神经根及神经节受累情况。方法 搜集2021年2月至6月因腰骶神经根性疼痛就诊并诊断为腰椎间盘突出症患者49例。应用三维水激发双回波稳态(3D-DESS-WE)序列及三维可变翻转角快速自旋回波(3D-SPACE)序列评价神经根及神经节显示清晰度并测量神经根、椎体、肌肉的信号强度及计算神经根/椎体、神经根/肌肉的对比噪声比(CNR)。在神经节显示更清晰的序列上测量神经根受压水平双侧神经节各方位最大径线并计算神经节体积。应用配对检验比较同水平双侧神经节测量指标及两种3D序列对神经显示情况。结果 3D-DESS-WE序列神经根及神经节主观评分均高于3D-SPACE序列。3D-DESS-WE序列CNR_(神经根/椎体)(0.70±0.08)高于3D-SPACE序列(0.63±0.11),而CNR_(神经根/肌肉)(0.18±0.09)低于3D-SPACE序列(0.70±0.09),差异均具有统计学意义(P<0.01)。神经根受压侧神经节前后径(6.62±1.22)mm、上下径(11.93±1.64)mm及体积(262.79±84.12)mm^(3)较健侧[(5.95±1.17)mm;(11.09±1.94)mm;(217.25±91.75)mm^(3)]明显增大,差异有统计学意义(P<0.01)。而受压侧神经节左右径与对侧差异无统计学意义(P=0.09)。结论 3D-DESS-WE序列对神经根及神经节的显示优于3D-SPACE序列。3D-DESS-WE序列可清晰显示腰椎间盘突出受压侧神经节肿大情况,且患侧脊神经节前后径及上下径较健侧肿大更明显,这可为临床制定针对性治疗策略提供客观影像学证据。

Objective To evaluate the compression situation of nerve root and dorsal nerve ganglion with lumbar disc herniation by 3 D magnetic resonance neurography(3 D-MRN).Methods Totally 49 patients with lumbosacral radicular pain diagnosed as lumbar disc herniation were collected from February to June 2021.The display resolution of nerve root and ganglion,the signal intensity of nerve root,vertebral body and muscles,and the CNR of nerve root vertebral body,and nerve root-muscle were evaluated and measured by 3 D double-echo steady-state with water excitation(3 D-DESS-WE) and 3 D sampling perfection with application optimized contrasts using different flip angle evolutions(3 D-SPACE).On the sequence with a clearer ganglion display,the maximum diameter of each position of the bilateral ganglion of nerve root compression level were measured and the ganglion volume was calculated.Paired test was used to compare the measurement index of bilateral ganglion at the same level and the nerve display of two 3 D sequence.Results Subjective scores of nerve roots and ganglion in 3 D-DESS-WE sequence were higher than those in 3 D-SPACE sequence.The CNR of nerve root/vertebral(0.70±0.08) in 3 D-DESS-WE sequence was higher than that in 3 D-SPACE sequence(0.63±0.11),while the CNR of nerve root/muscle(0.18±0.09) were lower than that in 3 D-SPACE sequence(0.70±0.09),the differences were statistically significant(P<0.01).The anterior and posterior diameter(6.62±1.22)mm,the upper and lower diameter(11.93±1.64)mm,and the volume(262.79±84.12)mm~3 of ganglion on the compression side of the nerve root were higher than those on the healthy side [(5.59±1.17)mm;(11.09±1.94)mm;(217.25±91.75)mm~3],the difference was statistically significant(P<0.01).There was no significant difference between the left and right diameters of the compressed side and the contralateral side(P=0.09).Conclusion The display of nerve root and ganglion by 3 D-DESS-WE sequence is better than that by 3 D-SPACE sequence.3 D-DESS-WE sequence can clearly show the enlarged ganglion on the compressed side of lumbar disc herniation,and the anterior and posterior diameter and upper and lower diameter of ganglion on the affected side are more obvious than those on the healthy side,which can provide objective imaging evidence for the clinical development of targeted treatment strategies.