水凝胶注射治疗椎间盘退变的最佳时机：基于 T1ρ MRI 的定量分析。
The Optimal Timing of Hydrogel Injection for Treatment of Intervertebral Disc Degeneration: Quantitative Analysis Based on T1ρ MR Imaging.
机构信息
Department of Neurosurgery, People's Hospital of Zhangqiu, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China.
Department of Spine Surgery, Affiliated Dongguan People's Hospital, Southern Medical University, Dongguan, China.
出版信息
Spine (Phila Pa 1976). 2020 Nov 15;45(22):E1451-E1459. doi: 10.1097/BRS.0000000000003667.
STUDY DESIGN
Animal experimental study.
OBJECTIVE
The aim of this study was to investigate the optimal time of hydrogel injection for regenerating intervertebral disc degeneration (IDD) based on T1ρ magnetic resonance imaging (MRI).
SUMMARY OF BACKGROUND DATA
Currently, different approaches are being pursued to regenerate the IDD. However, the optimal timing for the regenerative intervention is unclear.
METHODS
The slowly, progressive IDD models were established in 18 rhesus monkeys. On the basis of the MR T1ρ values of the discs, the rhesus monkeys were divided into severe (T1ρ values: <81 ms), moderate (T1ρ values: 81∼95 ms), and mild (T1ρ values: 96∼110 ms) degeneration groups. Biocompatible hydrogel was injected into the central part of the nucleus pulposus of the discs under fluoroscopic guidance. Treatment effects were investigated using radiography, T1ρ MRI, and histology until 12 months postoperatively.
RESULTS
After injection, the T1ρ values of all the discs increased significantly at 1 month postoperatively, and then remained at approximately 110 ms in the mild and moderate groups during the whole observation period, with no significant difference compared to the values at 1 month (P > 0.05). However, in the severe group, the T1ρ values decreased significantly after 1 month and leveled at approximately 70 ms after 6 months, with significant difference compared to the values at 1 month (P < 0.05). In the mild and moderate groups, there were no significant differences between preoperative histological scores and those at 12 months (P > 0.05). However, the histological score in the severe group at 12 months was significantly higher than the preoperative scores (P < 0.05).
CONCLUSION
This study suggested that the moderate degenerative stage of IDD (T1ρ values from 95 to 80 ms) could be the optimal time for hydrogel injection aimed at the regenerative intervention, based on T1ρ-MR imaging technique and quantitative analysis.
LEVEL OF EVIDENCE
N/A.
研究设计
动物实验研究。
目的
本研究旨在通过 T1ρ 磁共振成像（MRI）探讨水凝胶注射治疗椎间盘退行性变（IDD）的最佳时间。
背景资料概要
目前，人们正在探索不同的方法来再生 IDD。然而，再生干预的最佳时机尚不清楚。
方法
在 18 只恒河猴中建立缓慢、进行性 IDD 模型。根据椎间盘的 MR T1ρ 值，将恒河猴分为严重（T1ρ 值：<81ms）、中度（T1ρ 值：81∼95ms）和轻度（T1ρ 值：96∼110ms）退变组。在透视引导下，将生物相容性水凝胶注入椎间盘髓核中央。术后 12 个月，通过影像学、T1ρ MRI 和组织学检查评估治疗效果。
结果
注射后，所有椎间盘的 T1ρ 值在术后 1 个月均显著升高，在轻度和中度组整个观察期间均维持在约 110ms，与术后 1 个月时相比无显著差异（P>0.05）。然而，在严重组中，T1ρ 值在 1 个月后显著下降，6 个月后稳定在约 70ms，与术后 1 个月时相比有显著差异（P<0.05）。在轻度和中度组中，术前组织学评分与术后 12 个月时的评分无显著差异（P>0.05）。然而，严重组术后 12 个月的组织学评分明显高于术前评分（P<0.05）。
结论
本研究提示，基于 T1ρ-MRI 技术和定量分析，ID D 的中度退变阶段（T1ρ 值为 95∼80ms）可能是水凝胶注射再生干预的最佳时机。
证据水平
N/A。
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