腰椎间盘退行性变的T2加权像高信号区及椎间盘IVIM-DWI定量参数变化及临床意义

Changes and Clinical Significance of T2-weighted Imaging High Intensity Zone and Intervertebral Disc IVIM-DWI Quantitative Parameters in Patients with Lumbar Intervertebral Disc Degeneration

目的分析腰椎间盘退行性变患者T2加权像(T2WI)高信号区(HIZ)及椎间盘体素内不相干运动弥散加权成像(IVIM-DWI)定量参数变化,并探究其临床意义。方法选取2023年1月至2024年1月于我院进行腰椎MRI检查的72例患者,获得其L1/L2~L5/S1的椎间盘HIZ征象及IVIM-DWI定量参数,同时根据Pfirrmann分级标准将对应的椎间盘进行退行性变程度分级。对比不同Pfirrmann分级椎间盘的HIZ征象及IVIM-DWI定量参数,采用Spearman相关检验分析HIZ征象及IVIM-DWI定量参数与Pfirrmann分级的相关性。结果不同Pfirrmann分级椎间盘的有HIZ征象占比比较有统计学差异,体现为Ⅰ级<Ⅱ级<Ⅲ级<Ⅳ级(P<0.05),Ⅴ级与其余分级比较无统计学差异(P>0.05)。不同Pfirrmann分级椎间盘的前纤维环ADC、髓核ADC、后纤维环ADC、前纤维环D值、髓核D值、后纤维环D值、髓核f值、后纤维环f值比较有统计学差异(P<0.05),前纤维环D值、髓核D值、后纤维环D值、前纤维环f值比较无统计学差异(P>0.05)。Spearman相关检验分析显示,HIZ征象与Pfirrmann分级呈显著正相关(r=0.577,P<0.05);前纤维环ADC、髓核ADC、后纤维环ADC、前纤维环D值、髓核D值、后纤维环D值与Pfirrmann分级呈显著负相关(P<0.05),髓核f值、后纤维环f值与Pfirrmann分级呈显著正相关(P<0.05)。结论腰椎间盘退行性变患者T2WI HIZ征象及IVIM-DWI定量参数ADC、D值、f值与椎间盘Pfirrmann分级密切相关,有助于腰椎间盘退行性变的临床诊断。

Objective To analyze the changes of of T2-weighted imaging(T2WI)high intensity zone(HIZ)and intervertebral disc intravoxel incoherent motion diffusion weighted imaging(IVIM-DWI)quantitative parameters in patients with lumbar intervertebral disc degeneration,and to explore the clinical significance.Methods 72 patients who received lumbar MRI in the hospital were selected from January 2023 to January 2024.The HIZ sign and IVIM-DWI quantitative parameters of L1/L2-L5/S1 intervertebral discs were obtained.Degeneration degree grading was performed on the corresponding intervertebral discs according to the Pfirrmann grading standard.The HIZ sign and IVIM-DWI quantitative parameters of intervertebral discs with different Pfirrmann grades were compared.Spearman correlation test was used to analyze the correlation between HIZ sign and IVIM-DWI quantitative parameters and Pfirrmann grading.Results The proportion of HIZ sign in intervertebral discs with different Pfirrmann grades was statistically different,which was reflected as grade I<grade II<grade III<grade IV(P<0.05),and there was no statistically significant difference between grade V and the rest of the grades(P>0.05).There were statistical differences in ADC of anterior annulus fibrosus,ADC of nucleus pulposus,ADC of posterior annulus fibrosus,D value of anterior annulus fibrosus,D value of nucleus pulposus,D value of posterior annulus fibrosus,f value of nucleus pulposus and f value of posterior annulus fibrosus among different Pfirrmann grades(P<0.05),but no statistical differences were shown in D value of anterior annulus fibrosus,D value of nucleus pulposus,D value of posterior annulus fibrosus and f value of anterior annulus fibrosus(P>0.05).Spearman correlation analysis suggested that HIZ sign was positively correlated with Pfirrmann grading(r=0.577,P<0.05).ADC of anterior annulus fibrosus,ADC of nucleus pulposus,ADC of posterior annulus fibrosus,D value of anterior annulus fibrosus,D value of nucleus pulposus and D value of posterior annulus fibrosus were significantly negatively correlated with Pfirrmann grading(P<0.05),and f value of nucleus pulposus and f value of posterior annulus fibrosus were significantly positively correlated with Pfirrmann grading(P<0.05).Conclusion T2WI HIZ sign and IVIM-DWI quantitative parameters ADC,D value and f value of lumbar intervertebral disc degeneration patients are closely related to the Pfirrmann grading of intervertebral disc,which is helpful for the clinical diagnosis of lumbar intervertebral disc degeneration.