Belykh Evgenii, Kalinin Andrey A, Patel Arpan A, Miller Eric J, Bohl Michael A, Stepanov Ivan A, Bardonova Liudmila A, Kerimbaev Talgat, Asantsev Anton O, Giers Morgan B, Preul Mark C, Byvaltsev Vadim A
Laboratory of Neurosurgery, Irkutsk Scientific Center of Surgery and Traumatology, Irkutsk, Russia.
Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia.
PLoS One. 2017 Aug 28;12(8):e0183697. doi: 10.1371/journal.pone.0183697. eCollection 2017.
To assess the utility of apparent diffusion coefficient (ADC) maps for the assessment of patients with advanced degenerative lumbar spine disease and describe characteristic features of ADC maps in various degenerative lumbar spinal conditions.
T1-weighted, T2-weighted and diffusion weighted (DWI) MR images of 100 consecutive patients admitted to the spinal surgery service were assessed. ADC maps were generated from DWI images using Osyrix software. The ADC values and characteristic ADC maps were assessed in the regions of interest over the different pathological entities of the lumbar spine.
The study included 452 lumbar vertebral segments available for analysis of ADCs. Characteristic ADC map features were identified for protrusion, extrusion and sequester types of lumbar disk herniations, spondylolisthesis, reactive Modic endplate changes, Pfirrmann grades of IVD degeneration, and compromised spinal nerves. Compromised nerve roots had significantly higher mean ADC values than adjacent (p < 0.001), contralateral (p < 0.001) or adjacent contralateral (p < 0.001) nerve roots. Compared to the normal bone marrow, Modic I changes showed higher ADC values (p = 0.01) and Modic 2 changes showed lower ADC values (p = 0.02) respectively. ADC values correlated with the Pfirrmann grading, however differed from herniated and non-herniated disks of the matched Pfirrmann 3 and 4 grades.
Quantitative and qualitative evaluation of ADC mapping may provide additional useful information regarding the fluid dynamics of the degenerated spine and may complement standard MRI imaging protocol for the comprehensive assessment of surgical patients with lumbar spine pathology. ADC maps were advantageous in differentiating reactive bone marrow changes, and more precise assessment of the disk degeneration state. ADC mapping of compressed nerve roots showed promise but requires further investigation on a larger cohort of patients.
评估表观扩散系数（ADC）图在评估晚期退行性腰椎疾病患者中的效用，并描述不同退行性腰椎疾病状态下ADC图的特征。
对100例连续入住脊柱外科的患者的T1加权、T2加权和扩散加权（DWI）磁共振成像进行评估。使用Osyrix软件从DWI图像生成ADC图。在腰椎不同病理实体的感兴趣区域评估ADC值和特征性ADC图。
该研究包括452个可用于分析ADC的腰椎椎体节段。确定了腰椎间盘突出症的突出、脱出和游离型、椎体滑脱、反应性Modic终板改变、椎间盘退变的Pfirrmann分级以及受压脊神经的特征性ADC图特征。受压神经根的平均ADC值显著高于相邻（p < 0.001）、对侧（p < 0.001）或相邻对侧（p < 0.001）神经根。与正常骨髓相比，Modic I型改变显示较高的ADC值（p = 0.01），Modic 2型改变显示较低的ADC值（p = 0.02）。ADC值与Pfirrmann分级相关，但与匹配的Pfirrmann 3级和4级的突出和未突出椎间盘不同。
ADC图的定量和定性评估可能为退变脊柱的流体动力学提供额外有用信息，并可补充标准MRI成像方案，用于对腰椎疾病手术患者进行全面评估。ADC图在区分反应性骨髓改变和更精确评估椎间盘退变状态方面具有优势。受压神经根的ADC图显示出前景，但需要在更大的患者队列中进一步研究。
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