能谱CT基物质成像定量、定性评估腰椎间盘退变

Energy spectrum CT based material imaging for quantitative and qualitative evaluation on lumbar intervertebral disc degeneration

目的探讨能谱CT基物质成像定量、定性评估腰椎间盘退变的价值。方法对82例腰腿痛患者采集腰椎能谱CT和MRI,获取74 keV CT、水[硫酸软骨素(CS)]和CS(水)基物质图;根据Pfirrmann分级(PG)标准基于MRI行椎间盘分级,比较不同PG级别腰椎间盘髓核(NP)及纤维环(AF)的CT值、水(CS)及CS(水)浓度,分析其与PG的关系。基于水(CS)和CS(水)伪彩色图对腰椎间盘进行视觉分型,比较不同分型之间PG级别分布及其与PG的相关性。结果共纳入250个腰椎间盘,其中PGⅠ级22个、Ⅱ级49个、Ⅲ级83个、Ⅳ级96个。不同PG级别椎间盘之间,前AF、NP及后AF的CT值及水(CS)及CS(水)浓度总体差异均有统计学意义(P均<0.001),其CT值均与PG呈负相关(r_(s)=-0.504、-0.399、-0.258,P均<0.001),水(CS)浓度均与PG呈正相关(r_(s)=0.476、0.753、0.324,P均<0.001)而CS(水)浓度均与PG呈负相关(r_(s)=-0.486、-0.760、-0.329,P均<0.001)。不同视觉分型椎间盘间PG级别差异均有统计学意义(P均<0.001),且视觉分型与PG级别均呈正相关(r_(s)均≥0.700,P均<0.001)。结论能谱CT基物质成像可用于定量、定性评估腰椎间盘退变。

Objective To explore the value of energy spectrum CT based material imaging for quantitatively and qualitatively evaluating lumbar intervertebral disc degeneration.Methods Lumbar energy spectrum CT and MRI were collected from 82 patients with back and leg pain,and 74 keV CT,water(chondroitin sulfate[CS])and CS(water)material images were obtained.Intervertebral discs Pfirrmann grading(PG)was performed based on MRI.CT values,water(CS)and CS(water)concentration of nucleus pulposus(NP)and annulus fibrosus(AF)in lumbar intervertebral disc with different PG grades were compared,and the relations with PG grades were analyzed.Visual classification of lumbar intervertebral disc was performed based on water(CS)and CS(water)falsecolor map,while PG distribution of different visual classification were compared,and the relations with PG grades were observed.Results Totally 250 lumbar intervertebral discs were enrolled,including 22 of PGⅠ,49 of PGⅡ,83 of PGⅢand 96 of PGⅣ.CT values,water(CS)and CS(water)concentration of anterior AF,NP and posterior AF of intervertebral disc with different PG grades were significantly different(all P<0.001),and CT values were negatively correlated with PG grades(r_(s)=-0.504,-0.399,-0.258,all P<0.001),while water(CS)concentration was positively correlated(r_(s)=0.476,0.753,0.324,all P<0.001)but CS(water)concentration was negatively correlated with PG grades(r_(s)=-0.486,-0.760,-0.329,all P<0.001).Significant differences of PG grades were found among different water(CS)and CS(water)falsecolor images visual classification(all P<0.001),while water(CS)and CS(water)falsecolor images visual classification were all positively correlated with PG grades(all r_(s)≥0.700,all P<0.001).Conclusion Energy spectrum CT based material imaging could be used for quantitatively and qualitatively evaluating lumbar intervertebral disc degeneration.