盘源性下腰痛的CT椎间盘造影与MRI表现的相关性研究

发布时间：2018-04-22 22:08

  本文选题：盘源性下腰痛 + 磁共振　； 参考：《浙江大学》2014年硕士论文

【摘要】：研究背景： 下腰痛是初级保健医生遇到的一种常见临床症状,它的一个显著特征是由椎间盘源性疼痛引起的,也有人称之为椎间盘内破裂(internal disc disruption, IDD)。 Crock[2]是这样定义IDD的：椎间盘内部结构髓核的紊乱和纤维环出现裂隙,并特别排除了椎间盘膨出、突出以及椎间盘疝。作为一种疼痛激发试验,椎间盘造影诱发的一致性疼痛是唯一能直接判断患者影像学改变与疼痛相关性的方法,从试验的角度看,椎间盘造影是评价下腰痛的最佳方法。但是,由于其存在有创性、侵入性、X线辐射、椎间盘感染等风险,该项技术从推出开始就存在各种争论。尽管磁共振影像(magnetic resonance imaging, MRI)能确定退变的椎间盘水平,而且在判断椎间盘退变的形态学改变方面具有较高的准确性,但是它在确定责任椎间盘方面并不可靠。一些早期的研究尝试找出椎间盘退变MRI特征性改变与椎间盘造影复制疼痛的相关性,但是结果存在有争议。因此,本研究试图通过CT引导下椎间盘造影(computed tomography discography, CTD)过程中诱发疼痛的反应,研究椎间盘源性腰痛是否与椎间盘造影结果、MRI的影像学结果具有相关性。MRI的结果包括椎间盘退变(Pearce分级)、椎间盘后方的弧形高信号区(highintensityzone, HIZ)、软骨终板及终板下骨髓信号异常(modic变性)等。 目的： 基于CT腰椎间盘造影术(CTD)诱发的一致性疼痛,研究盘源性下腰痛(discogenic low back pain, DLBP)与MRI改变的相关性。 方法： 收集2009年12月至2012年12月间76例下腰痛患者,其中男性52例,女性24例,年龄18-67岁,平均39.3±3.8岁,所有患者在腰椎磁共振检查后行CT腰椎间盘造影来评价下腰痛。MRI主要评价椎间盘的退变(Pearce分级)、HIZ、软骨终板的modic变性。在椎间盘造影过程中,诱发一致性疼痛的椎间盘记录为阳性,反之,诱发不一致的疼痛或者不痛的椎间盘记录为阴性。76例下腰痛患者共计完成209个椎间盘造影,分析CTD分型、对比剂注射剂量、诱发的一致性疼痛与MRI表现的相关性,MR和椎间盘造影与诱发一致性疼痛的结果采用X2检验,对比剂注射剂量与诱发一致性疼痛的结果采用t检验。 结果： 在完成CTD检查的209个椎间盘中,83个诱发一致性疼痛,其它椎间盘诱发不一致疼痛或者不痛。CTDⅢ型椎间盘有36个,其中7个椎间盘诱发一致性疼痛；CTDⅡ型椎间盘有58个,46个椎间盘诱发一致性疼痛；CTDⅣ型椎间盘有26个23个椎间盘诱发一致性疼痛。CTD分型与诱发一致性疼痛有明显的相关性,CTDⅢ型与CTDⅡ型比较(χ2=9.98,P0.01, r=0.57),与CTDⅣ型比较(X2=25.38,P0.01,r=0.62)。阳性和阴性椎间盘对比剂注射剂量有显著的差异(t=6.61,P0.01)。 椎间盘的MRI影像结果与造影诱发的一致性疼痛有显著的相关性。125个椎间盘在MRI上表现为Pearce Ⅰ-Ⅲ级,其中16椎间盘诱发一致性疼痛；84个椎间盘在MRI上表现为PearceⅣ-Ⅴ级,有67个椎间盘诱发一致性疼痛。有39椎间盘相邻终板发生Modic变性,其中32个椎间盘诱发一致性疼痛。48个椎间盘纤维环后缘发现HIZ,其中41个椎间盘诱发一致性疼痛。造影诱发一致性疼痛与MRI上椎间盘改变有明显的相关性,Ⅳ-Ⅴ级退变(χ2=94.09, P0.01, r=0.67), HIZ (χ2=39.93, P0.01, r=0.43),终板Modic变性(χ2=28.93, P0.01, r=0.37) 结论： CT腰椎间盘造影术能定性诊断腰椎间盘内破裂,并进一步确定责任椎间盘。盘源性下腰痛患者的病因可能与CTDⅡ型和CTDIV型椎间盘破裂,MRI上PearceIV-V级椎间盘退变、HIZ出现以及邻近终板发生Modic变性有关。
[Abstract]:Research background:
Low back pain is a common clinical symptom encountered by a primary health care doctor. A significant feature of it is caused by intervertebral disc origin pain and internal disc disruption (IDD). Crock[2] is the definition of IDD: the disorder of the nucleus of the intervertebral disc and the crevice of the fibrous ring, and special exclusion. In addition to intervertebral disc swelling, herniation and intervertebral herniation. As a pain stimulation test, conformance pain induced by discography is the only way to directly determine the correlation between image changes and pain. From an experimental point of view, discography is the best way to evaluate low back pain. However, it is invasive and invasive. There are various controversies on the risk of sex, X-ray radiation, intervertebral disc infection and so on. Although magnetic resonance imaging (MRI) can determine the level of degenerative intervertebral disc and have high accuracy in judging the morphological changes of disc degeneration, it is in the determination of the responsible intervertebral disc. Unreliable. Some early studies have tried to identify the correlation between MRI characteristic changes in intervertebral disc degeneration and disc contrast replication pain, but the results are controversial. Therefore, this study attempted to study the pain induced by the CT guided computed tomography discography (CTD) and the study of discogenic low back pain. Whether or not with the results of disc angiography, the results of MRI's imaging findings were associated with.MRI, including disc degeneration (Pearce classification), the arc high signal area (highintensityzone, HIZ) behind the disc, and cartilage endplate and abnormality of bone marrow signal (Modic denaturation) at the end of the end of the plate.
Objective:
Based on the consistency pain induced by CT lumbar discography (CTD), the correlation between discogenic low back pain (DLBP) and MRI changes was studied.
Method锛，

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