MRI 轴向加载揭示了腰痛患者和对照组之间的后椎间盘区域的异常特征。
Axial loading during MRI reveals deviant characteristics within posterior IVD regions between low back pain patients and controls.
机构信息
Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
出版信息
Eur Spine J. 2018 Nov;27(11):2840-2846. doi: 10.1007/s00586-018-5774-y. Epub 2018 Oct 9.
PURPOSE
To investigate differences in functional intervertebral disk (IVD) characteristics between low back pain (LBP) patients and controls using T2-mapping with axial loading during MRI (alMRI).
METHODS
In total, 120 IVDs in 24 LBP patients (mean age 39 years, range 25-69) were examined with T2-mapping without loading of the spine (uMRI) and with alMRI (DynaWell loading device) and compared with 60 IVDs in 12 controls (mean age 38 years, range 25-63). The IVD T2-value was acquired after 20-min loading in five regions of interests (ROI), ROI1-5 from anterior to posterior. T2-values were compared between loading states and cohorts with adjustment for Pfirrmann grade.
RESULTS
In LBP patients, mean T2-value of the entire IVD was 64 ms for uMRI and 66 ms for alMRI (p = 0.03) and, in controls, 65 ms and 65 ms (p = 0.5). Load-induced T2-differences (alMRI-uMRI) were seen in all ROIs in both patients (0.001 > p < 0.005) and controls (0.0001 > p < 0.03). In patients, alMRI induced an increase in T2-value for ROI1-3 (23%, 18% and 5%) and a decrease for ROI4 (3%) and ROI5 (24%). More pronounced load-induced decrease was detected in ROI4 in controls (9%/p = 0.03), while a higher absolute T2-value was found for ROI5 during alMRI in patients (38 ms) compared to controls (33 ms) (p = 0.04).
CONCLUSION
The alMRI-induced differences in T2-value in ROI4 and ROI5 between patients and controls most probably indicate biomechanical impairment in the posterior IVD regions. Hence, alMRI combined with T2-mapping offers an objective and clinical feasible tool for biomechanical IVD characterization that may deepen the knowledge regarding how LBP is related to altered IVD matrix composition. These slides can be retrieved under Electronic Supplementary Material.
目的
使用 MRI 轴向加载下的 T2 映射（alMRI）研究腰痛（LBP）患者与对照组之间功能椎间盘（IVD）特征的差异。
方法
共对 24 例 LBP 患者（平均年龄 39 岁，范围 25-69 岁）的 120 个 IVD 进行了 T2 映射检查，未对脊柱进行加载（uMRI）和 alMRI（DynaWell 加载装置），并与 12 名对照者的 60 个 IVD 进行了比较（平均年龄 38 岁，范围 25-63 岁）。在 20 分钟的加载后，在五个感兴趣区域（ROI）中获取 IVD T2 值，ROI1-5 从前到后。在调整 Pfirrmann 分级后，比较了加载状态和队列之间的 T2 值。
结果
在 LBP 患者中，uMRI 下整个 IVD 的平均 T2 值为 64ms，alMRI 为 66ms（p=0.03），在对照组中，uMRI 为 65ms，alMRI 为 65ms（p=0.5）。在所有患者（0.001>p<0.005）和对照组（0.0001>p<0.03）的所有 ROI 中均观察到了负荷诱导的 T2 差异（alMRI-uMRI）。在患者中，alMRI 引起 ROI1-3（23%、18%和 5%）的 T2 值增加，ROI4（3%）和 ROI5（24%）的 T2 值减少。在对照组中，ROI4 中的负荷诱导性减少更为明显（9%/p=0.03），而在患者中，alMRI 时 ROI5 的 T2 值绝对值更高（38ms），而对照组为 33ms（p=0.04）。
结论
患者与对照组之间 ROI4 和 ROI5 中的 alMRI 诱导的 T2 值差异很可能表明后 IVD 区域的生物力学受损。因此，alMRI 联合 T2 映射为生物力学 IVD 特征提供了一种客观且具有临床可行性的工具，这可能会加深我们对腰痛与改变的 IVD 基质成分之间关系的认识。这些幻灯片可以在电子补充材料中检索到。
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