Department of Radiology, The Traditional Chinese Medicine Hospital of Taian, No. 58 Dongyue Street, Taian District, Taian, 271000, Shandong Province, China.
Department of Spine Surgery, The Traditional Chinese Medicine Hospital of Taian, No. 58 Dongyue Street, Taian District, Taian, 271000, Shandong Province, China.
Eur Spine J. 2023 Dec;32(12):4397-4404. doi: 10.1007/s00586-023-07933-9. Epub 2023 Sep 18.
The purpose of the study was to investigate several potential imaging biomarkers of CLBP that may be useful for diagnosis and treatment efficacy evaluation. Proton magnetic resonance spectroscopy (H-MRS) was used to detect the content and ratio of creatine (Cr), choline (Cho), and lipid (Lip) in the multifidus muscle (Mm) in patients with CLBP and to test for relationships between these metabolites and pain severity and duration.
Sixty patients with CLBP (experimental group) and sixty-nine asymptomatic volunteers (control group) underwent routine diagnostic magnetic resonance imaging of the lumbar spine. H-MRS was acquired with single-voxel MR spectroscopy. The MRS region of interest for measuring Cho, Cr, and Lip concentrations was determined at the L4/5 multifidus muscle (Mm), bilaterally. The contents and ratios of Cr, Cho, and Lip in bilateral and ipsilateral-to-pain (or matched control side) Mm were obtained, and the integral ratios of different metabolites obtained by using Cr as an internal reference were statistically analyzed.
There were no significant within-group differences in the contents and ratios of Lip, Cr, Cho, Lip/Cr, and Cho/Cr between the left and right Mm of the healthy control group (p > 0.05) or the CLBP group (p > 0.05). The CLBP group showed a much higher Lip and Lip/Cr ratio in the bilateral Mm compared to the healthy control group (p < 0.05) but there were no between-group differences in Cr, Cho, or the Cho/Cr ratio (p > 0.05). The severity of CLBP was correlated with Lip (p < 0.05).
Using H-MRS, we demonstrated higher Lip and Lip/Cr ratios in the Mm of patients with CLBP, compared to asymptomatic controls. Mm Lip was correlated with CLBP intensity. An increase in Lip in the Mm may be a characteristic finding in CLBP and may offer a useful prognostic marker for guiding rehabilitation strategies.
本研究旨在探讨几种可能有助于 CLBP 诊断和治疗效果评估的潜在影像生物标志物。质子磁共振波谱（H-MRS）用于检测 CLBP 患者多裂肌（Mm）中肌酸（Cr）、胆碱（Cho）和脂质（Lip）的含量和比例，并检测这些代谢物与疼痛严重程度和持续时间之间的关系。
60 例 CLBP 患者（实验组）和 69 例无症状志愿者（对照组）行腰椎常规磁共振成像检查。采用单体素磁共振波谱法采集 H-MRS。在 L4/5 多裂肌（Mm）双侧确定 Cho、Cr 和 Lip 浓度的 MRS 感兴趣区。获得双侧和患侧（或配对对照组侧）多裂肌（Mm）中 Cr、Cho 和 Lip 的含量和比值，并对不同代谢物的积分比值进行统计学分析。
健康对照组（p>0.05）或 CLBP 组（p>0.05）双侧 Mm 中 Lip、Cr、Cho、Lip/Cr 和 Cho/Cr 的含量和比值无组内差异。CLBP 组双侧 Mm 的 Lip 和 Lip/Cr 比值明显高于健康对照组（p<0.05），但 Cr、Cho 或 Cho/Cr 比值无组间差异（p>0.05）。CLBP 的严重程度与 Lip 相关（p<0.05）。
与无症状对照组相比，CLBP 患者多裂肌的 H-MRS 显示 Lip 和 Lip/Cr 比值升高。多裂肌的 Lip 与 CLBP 的严重程度相关。多裂肌 Lip 的增加可能是 CLBP 的特征性表现，并可能为指导康复策略提供有用的预后标志物。
