磁共振增强3D STIR SPACE序列在腰骶神经根中的应用价值

Application Value of Magnetic Resonance Enhanced 3D STIR SPACE Sequence in Lumbosacral Nerve Root

目的分析磁共振三维快速自旋回波短时翻转恢复序列成像(3D STIR SPACE)增强序列在腰骶神经根评估中应用价值。方法选取本院2019年2月至2022年2月因腰椎疼痛入院者51例,最终纳入存在腰骶神经根压迫者42例。42例患者均进行MRI平扫+增强检查,在注射GD-DTPA对比剂前、后均进行1次冠状位3D STIR SPACE序列扫描。由两名诊断医师采用“双盲法”阅片,使用4等级法评估3D STIR SPACE序列平扫及增强的图像质量,于同一断层内测量2组图像神经根信号强度(SI神经根)、腰大肌信号强度(SI肌肉)、肾脏信号强度(SI肾脏),并计算神经根/腰大肌信号强度比(SI神经/肌肉)。通过SPSS 20.0软件分析获取的数据,使用独立样本t检验评估2组神经根形态显示及背景抑制情况,应用Kappa检验评价两种方法的一致性。结果3D STIR SPACE序列扫描的图像质量评分中,3D STIR SPACE增强序列神经根显示、背景抑制得分均明显高于3D STIR SPACE平扫序列,差异有统计学意义(P<0.05)。3D STIR SPACE增强序列SI神经根、SI神经/肌肉比值信号均明显低于3D STIR SPACE平扫序列,SI肌肉、SI肾脏信号强度高于3D STIR SPACE平扫序列,差异有统计学意义(P<0.05)。3D STIR SPACE增强序列对腰骶神经根压迫检出情况与手术检查一致性一般(Kappa值=0.655,P<0.001),灵敏度为88.10%(37/42)、特异度为88.89%(8/9)3DSTIR SPACE平扫序列对腰骶神经根压迫检出情况与手术检查一致性较差(Kappa值=0.249,P<0.05),灵敏度为69.05%(29/42)、特异度为66.67%(6/9)。结论磁共振3D SPACE STIR增强序列可清楚显示腰骶神经根形态及与周围组织关系,在显示神经根走势、受压中有显著优势。

Objective To analyze the application value of magnetic resonance-enhanced three-dimensional fast spin echo short-time inversion recovery sequence imaging(3D STIR SPACE)sequence in the evaluation of lumbosacral nerve roots.Methods A total of 51 patients who were admitted to our hospital due to lumbar spine pain from February 2019 to February 2022 were selected,and 42 patients with lumbosacral nerve root compression were finally included.All 42 patients underwent routine MRI scan and enhanced examination.Before and after the injection of GD-DTPA contrast agent,a coronal 3D STIR SPACE sequence scan was performed respectively.Two diagnostic physicians were used to assess the image quality of 3D STIR SPACE sequences in both flat and enhanced images using a 4-grade method,and to measure the signal intensity of two groups of nerve roots(SI nerve roots),psoas major muscle(SI muscle),and kidney(SI kidney)within the same tomography,and to calculate the nerve root/psoas major muscle signal intensity ratio(SI nerve/muscle).The data obtained were analysed by SPSS 20.0 software,and the morphological display and background inhibition of the nerve roots in the 2 groups were assessed using the independent samples t-test,and the Kappa test was applied to evaluate the consistency of the two methods.Results In the image quality score of 3D STIR SPACE sequence scanning,3D STIR SPACE enhanced sequence showed nerve root display and background suppression scores were significantly higher than 3D STIR SPACE plain scan sequence,and the difference was statistically significant(P<0.05).The signals of SI nerve root and SI nerve/muscle ratio of the 3D STIR SPACE enhanced sequence were significantly lower than those of the 3D STIR SPACE sequence,and the signal intensities of the SI muscle and SI kidney were higher than those of the 3D STIR SPACE sequence,and the differences were statistically significant(P<0.05).The detection of lumbosacral nerve root compression by 3D STIR SPACE enhanced sequence was generally consistent with the surgical examination(Kappa value=0.655,P<0.001),with a sensitivity of 88.10%(37/42)and a specificity of 88.89%(8/9).The 3D STIR SPACE unenhanced scan sequence had poor consistency between the detection of lumbosacral nerve root compression and the surgical examination(Kappa value=0.249,P<0.05),with a sensitivity of 69.05%(29/42)and a specificity of 66.67%(6/9).Conclusion The 3D SPACE STIR enhancement sequence of magnetic resonance can clearly show the morphology of the lumbosacral nerve roots and their relationship with the surrounding tissues,and has significant advantages in showing nerve root alignment and compression.