Xu Wei, Xiong Meng-Yun, Wang Yi, Yu Qi-Feng, Ye Xiao-Jian, Wang Si-Lian, Li Zhi-Kun
Department of Orthopedics, Shanghai Tongren Hospital, Shanghai 200336, China.
Department of Imaging, Shanghai Tongren Hospital, Shanghai 200336, China.
World J Orthop. 2025 Mar 18;16(3):103169. doi: 10.5312/wjo.v16.i3.103169.
Posterior lumbar interbody fusion has good clinical results, but adjacent segment disease (ASD) affects its long-term efficacy. In patients with L4-5 fusion who were followed up for more than 10 years, the ASD incidence was 33.3%. Magnetic resonance imaging (MRI) is key for ASD diagnosis, but metal artifacts from internal fixation limit its use; therefore, removing the artifacts is crucial for ASD diagnosis and treatment.
To evaluate the value of WARP MRI for patients with lumbar ASD.
In our hospital, the lumbar spines of patients with ASD were assessed lumbar MRI, including conventional sequences and sequences for artifacts. A PACS workstation was used for image measurement, analysis, and assessment, which mainly included measurement of the internal fixation implant artifact area, evaluation of the visibility of the anatomical structures surrounding the implant, and diagnostic assessment of ASD in the section. Conventional MRI data sequences and artifacts to sequence the contrast analysis of the MRI data.
A total of 30 patients with ASD after lumbar fusion and internal fixation were included in the study; the patients included 13 male and 17 female patients and were aged 66.03 ± 5.83 years. The metal artifact area of the WARP T2-tirm sequence was significantly smaller than that of the conventional STIR sequence [(20.85 ± 6.27) cm² (50.56 ± 8.55) cm², < 0.01]. The WARP T2-tirm sequence was observed around the implants, pedicles, intervertebral foramen, and vertebral bodies, and the conventional STIR sequence clearly displayed nerve roots within the intervertebral foramen. In all 30 patients, all adjacent segments of the WARP T2-tirm sequence could be clearly observed (above Grade 4), whereas it was difficult to observe these segments in the conventional STIR sequence due to the presence of more severe metal artifacts.
WARP sequences can significantly reduce the artifact area in the sagittal and cross-sectional images of titanium alloy spinal fixation, providing a good imaging reference for the diagnosis of ASD.
腰椎后路椎间融合术具有良好的临床效果，但相邻节段疾病（ASD）会影响其长期疗效。在接受L4 - 5融合术且随访超过10年的患者中，ASD发生率为33.3%。磁共振成像（MRI）是ASD诊断的关键，但内固定产生的金属伪影限制了其应用；因此，去除伪影对ASD的诊断和治疗至关重要。
评估WARP MRI对腰椎ASD患者的价值。
在我院，对ASD患者的腰椎进行MRI评估，包括常规序列和伪影序列。使用PACS工作站进行图像测量、分析和评估，主要包括测量内固定植入物伪影面积、评估植入物周围解剖结构的可视性以及对该节段ASD进行诊断评估。对常规MRI数据序列和伪影序列的MRI数据进行对比分析。
本研究共纳入30例腰椎融合内固定术后ASD患者；患者包括13例男性和17例女性，年龄为66.03±5.83岁。WARP T2 - tirm序列的金属伪影面积明显小于常规STIR序列[（20.85±6.27）cm² 比（50.56±8.55）cm²，P < 0.01]。在植入物、椎弓根、椎间孔和椎体周围观察到WARP T2 - tirm序列，常规STIR序列能清晰显示椎间孔内的神经根。在所有30例患者中，WARP T2 - tirm序列的所有相邻节段均可清晰观察到（4级以上），而在常规STIR序列中由于存在更严重的金属伪影，这些节段难以观察到。
WARP序列可显著减少钛合金脊柱内固定矢状面和横断面图像中的伪影面积，为ASD的诊断提供良好的影像学参考。
