Department of Radiology, The First Hospital of Hunan University of Chinese Medicine, Changsha, 410007, Hunan Province, China.
MR Research, GE Healthcare, Beijing, 100000, China.
Eur Spine J. 2024 Dec;33(12):4544-4554. doi: 10.1007/s00586-024-08535-9. Epub 2024 Oct 25.
This study aimed to investigate the application of quantitative magnetic resonance imaging of paraspinal muscles in assessing the young CNLBP with unilateral symptom.
This prospective study enrolled 107 young individuals with unilateral symptomatic CNLBP (56 cases) and a normal cohort (51 cases). All subjects underwent conventional lumbar sequences, T2 mapping, and IDEAL-IQ scans at 3T. T2 values and fat fraction (FF) of bilateral multifidus (mid-levels of L2-L5 vertebrae) and erector spinae (mid-levels of L1-L4 vertebrae) were measured. CNLBP severity, Japanese Orthopedic Association (JOA) score, and Visual Analogue Scale (VAS) score were recorded. Wilcoxon signed-rank tests were used to compare parameter differences between painful and non-painful sides in the case group. Mann-Whitney U tests were employed to evaluate differences between the case and normal group. Logistic regression analysis was conducted to identify predictive factors and to establish a combined model.
In the case group, erector spinae FF values (L4 level), erector spinae T2 values (L1, L2, and L4 levels), and multifidus T2 values (L4 and L5 levels) were higher on the painful side (P<0.05). Multifidus T2 values (L5 level) and FF values (L2-L5 levels) were higher in the case group compared to the normal group (P<0.05). The optimal performance in differentiating young CNLBP was the combination of L5 level multifidus T2 value with FF (AUC = 91.81%). Negative correlation existed between T2 values and FF of multifidus at L5 level and JOA scores (r=-0.41, P < 0.05), and positive correlation with VAS scores (r = 0.46, P < 0.05).
The combination of T2 value and FF may provide deeper insights into the pathological alterations of paraspinal muscles in young CNLBP, providing an important imaging basis for clinical judgment and preventive treatment of non-painful side in unilateral symptomatic patients.
本研究旨在探讨定量磁共振成像（MRI）在评估单侧症状性青年慢性下腰痛（CNLBP）中的应用。
前瞻性研究纳入 107 例单侧症状性 CNLBP 患者（56 例）和正常对照组（51 例）。所有受试者均在 3T 下进行常规腰椎序列、T2 映射和 IDEAL-IQ 扫描。测量双侧多裂肌（L2-L5 椎体中间水平）和竖脊肌（L1-L4 椎体中间水平）的 T2 值和脂肪分数（FF）。记录 CNLBP 严重程度、日本骨科协会（JOA）评分和视觉模拟评分（VAS）。采用 Wilcoxon 符号秩检验比较病例组患侧和非患侧参数差异。采用 Mann-Whitney U 检验评估病例组和正常组之间的差异。采用逻辑回归分析确定预测因素并建立联合模型。
在病例组中，患侧竖脊肌 FF 值（L4 水平）、竖脊肌 T2 值（L1、L2 和 L4 水平）和多裂肌 T2 值（L4 和 L5 水平）较高（P<0.05）。与正常组相比，病例组多裂肌 T2 值（L5 水平）和 FF 值（L2-L5 水平）较高（P<0.05）。在区分青年 CNLBP 方面，L5 水平多裂肌 T2 值与 FF 的联合表现最佳（AUC=91.81%）。L5 水平多裂肌 T2 值和 FF 与 JOA 评分呈负相关（r=-0.41，P<0.05），与 VAS 评分呈正相关（r=0.46，P<0.05）。
T2 值与 FF 的联合可能为青年 CNLBP 中脊柱旁肌肉的病理改变提供更深入的见解，为单侧症状性患者非患侧的临床判断和预防性治疗提供重要的影像学依据。
