利用磁共振成像的对比率对青少年腰椎峡部裂运动员骨髓水肿进行定量评估
Quantitative Assessment of Bone Marrow Edema in Adolescent Athletes with Lumbar Spondylolysis Using Contrast Ratio on Magnetic Resonance Imaging.
作者信息
Nakamae Toshio, Kamei Naosuke, Tamura Takayuki, Kanda Tsukasa, Nakanishi Kazuyoshi, Adachi Nobuo
机构信息
Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Department of Clinical Support, Hiroshima University Hospital, Hiroshima, Japan.
出版信息
Asian Spine J. 2021 Oct;15(5):682-687. doi: 10.31616/asj.2020.0173. Epub 2020 Nov 16.
STUDY DESIGN
Prospective cohort study.
PURPOSE
To quantitatively evaluate bone marrow edema (BME) in the pedicle on magnetic resonance imaging (MRI) for adolescent athlete patients with spondylolysis.
OVERVIEW OF LITERATURE
Spondylolysis, a stress fracture of the pars interarticularis, is a common occurrence in adolescent athletes with low back pain. T2-weighed fat-saturated MRI is reportedly useful for the detection of BME in the pedicle in the early stage of spondylolysis; however, to our knowledge, the quantitative assessment of BME in spondylolysis has not been reported.
METHODS
Adolescent athletes with spondylolysis, including those with symptoms of low back pain, were enrolled. The sporting activity of the patients was restricted, and a hard brace was attached to the spine. The BME range of interest was taken on T2-weighed fat-saturated MRI, and the signal intensity (SI) of the BME (SIedema) was measured. The contrast ratio (CR) between the SI of the BME and SI of the spinal cord (SIcord) was calculated per the following formulae: CRedema=(SIedema-SIcord)/(SIedema+SIcord). The CR of the normal pedicle was measured as a control per the following formulae: CRcontrol=(SIcontrol-SIcord)/(SIcontrol+SIcord).
RESULTS
The study enrolled 32 men and one woman; the mean patient age was 15.2 years (range, 12-18 years). The average CR of the edema and normal pedicle at the first visit was 0.506 (range, 0.097-0.804) and 0.137 (range, -0.741 to 0.572), respectively. The CR of the edema was significantly higher as compared to that of the normal pedicle (p<0.01). MRI that was performed 1 month after the first visit showed that the CR of the edema had decreased to 0.204 (range, -0.152 to 0.517). The CR of the edema 1 month thereafter was significantly lower than that at the first visit (p<0.01).
CONCLUSIONS
Quantitative assessment of BME using CR on MRI is useful in the evaluation of the healing process of spondylolysis.
研究设计
前瞻性队列研究。
目的
对患有椎弓根峡部裂的青少年运动员患者，通过磁共振成像（MRI）定量评估椎弓根骨髓水肿（BME）情况。
文献综述
椎弓根峡部裂是关节突间部的应力性骨折，在患有腰痛的青少年运动员中很常见。据报道，T2加权脂肪抑制MRI有助于在椎弓根峡部裂早期检测椎弓根骨髓水肿；然而，据我们所知，尚未有关于椎弓根峡部裂中骨髓水肿定量评估的报道。
方法
纳入患有椎弓根峡部裂的青少年运动员，包括有腰痛症状的患者。限制患者的体育活动，并在脊柱上佩戴硬支具。在T2加权脂肪抑制MRI上获取感兴趣的骨髓水肿范围，并测量骨髓水肿的信号强度（SIedema）。根据以下公式计算骨髓水肿的信号强度与脊髓信号强度（SIcord）之间的对比率（CR）：CRedema = (SIedema - SIcord) / (SIedema + SIcord)。作为对照，根据以下公式测量正常椎弓根的对比率：CRcontrol = (SIcontrol - SIcord) / (SIcontrol + SIcord)。
结果
该研究纳入了32名男性和1名女性；患者的平均年龄为15.2岁（范围为12 - 18岁）。首次就诊时水肿椎弓根和正常椎弓根的平均对比率分别为0.506（范围为0.097 - 0.804）和0.137（范围为 - 0.741至0.572）。水肿椎弓根的对比率显著高于正常椎弓根（p < 0.01）。首次就诊1个月后进行的MRI显示，水肿的对比率已降至0.204（范围为 - 0.152至0.517）。此后1个月水肿的对比率显著低于首次就诊时（p < 0.01）。
结论
在MRI上使用对比率对骨髓水肿进行定量评估，有助于评估椎弓根峡部裂的愈合过程。
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