3.0 T MR Dixon椎旁肌成像参数评估退变性腰椎侧凸患者冠状位失衡的临床价值

Clinical value of 3.0T MR Dixon paraspinal muscle imaging parameters in evaluating coronal imbalance in patients with degenerative lumbar scoliosis

目的探讨高场强磁共振水脂分离序列(3.0T MR Dixon)椎旁肌成像参数评估退变性腰椎侧凸患者冠状位失衡的临床价值。方法选取2020年9月至2022年4月山西省运城市中心医院脊柱外科收治的80例退变性腰椎侧凸患者为病例组,另选取30例健康志愿者为对照组,均接受3.0T MR Dixon椎旁肌成像,测量椎旁双侧多裂肌、竖脊肌和腰大肌Dixon-VIBE序列参数:横截面积(CSA)、脂肪浸润面积(FIA),计算FIA占CSA的比例(FSF)、凹侧与凸侧CSA比值(rCSA)、凹侧与凸侧FSF比值(rFSF),比较病例组和对照组CSA、FSF,比较病例组凹侧与凸侧CSA、FSF;采用Pearson相关性分析法分析脊柱-骨盆冠状位X线参数(Cobb角、冠状面平衡距离)与椎旁肌不对称度相关性。结果病例组多裂肌和竖脊肌的FSF高于对照组,多裂肌、竖脊肌和腰大肌的CSA低于对照组(P<0.05),病例组与对照组腰大肌FSF比较差异无统计学意义(P>0.05)。病例组凹侧多裂肌、竖脊肌和腰大肌的CSA均低于凸侧,多裂肌和竖脊肌的FSF均高于凸侧(P<0.05),凹凸侧腰大肌FSF差异无统计学意义(P>0.05)。病例组Cobb角10.20°~58.25°,平均(25.55±6.93)°,冠状位平衡距离0.22~71.5 mm,中位距离18.50(8.24~29.10)mm。Pearson相关性分析结果显示,多裂肌rCSA与脊柱-骨盆冠状位Cobb角及冠状位平衡距离呈显著负相关(r=-0.579、-0.511,P<0.001),竖脊肌和腰大肌rCSA与脊柱-骨盆冠状位平衡距离呈显著负相关(r=-0.361、-0.402,P<0.01)。结论多裂肌、竖脊肌和腰大肌3.0T MR Dixon成像参数与退变性腰椎侧凸患者冠状位Cobb角及冠状面平衡距离关系密切,对评估退变性腰椎侧凸患者冠状位失衡有重要参考价值。

Objective To investigate the clinical value of paraspinal muscle imaging parameters with using high-field-intensity magnetic resonance multi-echo multi-echo hydrolipid separation(3.0 T MR Dixon)for evaluating coronal imbalance in patients with degenerative lumbar scoliosis.Methods From September 2020 to April 2022,eighty patients with degenerative lumbar scoliosis treated in thehospital were selected as case group,and 30 healthy volunteers were selected as control group,all of whom received 3.0T MR Dixon paraspinal muscle imaging,and bilateral paravertebral multifidus,erector spinae,and psoas major Dixon-VIBE sequence parameters were measured:cross-sectional area(CSA),fatty infiltration area(FIA),calculated FIA to CSA ratio(FSF),concave side Ratio of CSA to convex side(rCSA),ratio of FSF to concave side to convex side(rFSF).The CSA and FSF of case group and control group were compared,and the CSA and FSF of the concave and convex sides ofcase group were compared.The correlation between spine-pelvic coronal X-ray parameters(Cobb angle,coronal balance distance)and paraspinal muscle asymmetry was analyzed by Pearson correlation analysis.Results The FSF of multifidus and erector spinae incase group was higher than that in control group,and CSA of multifidus,erector spinae and psoas major lower than that incontrol group(P<0.05).There was no difference in FSF of psoas major muscle between case group and control group(P>0.05).In case group,CSA values of concave multifidus,erector spinae and psoas major were lower than those of the convex side,and FSF values of the multifidus and erector spinae were higher than those of the convex side(P<0.05).There was no difference in FSF value of the psoas major between the concave side and the convex side(P>0.05).Cobb angle in case group was 10.20°~58.25°,with an average of(25.55±6.93)°,the coronal balance distance was 0.22~71.5 mm,and the median distance was 18.50(8.24~29.10)mm.The Pearson correlation analysis showed that multifidus r CSA was significantly negatively correlated with spine-pelvic coronal Cobb angle and coronal balance distance(r=-0.579,-0.511,P<0.001).The r CSA of erector spinae and psoas major were significantly negatively correlated with spine-pelvic coronal balance distance(r=-0.361,-0.402,P<0.01).Conclusion 3.0T MR Dixon imaging parameters of multifidus,erector spinae and psoas major are closely related to coronal Cobb angle and coronal balance distance in patients with degenerative lumbar scoliosis,which are important references value for evaluating coronal imbalance in patients with degenerative lumbar scoliosis.