马红菊;张旭胤;POKHAREL SAUGAT;郭银霞;杜永浩;王蓉;牛刚;

• 1:西安交通大学第一附属医院医学影像科
• 2:陕西省西乡县人民医院影像科

摘要(Abstract)：

目的基于Meta分析探讨磁共振扩散加权成像在定量评价早期腰椎间盘退变中的临床应用。材料与方法检索自建库至2019年10月1日在PubMed、EMBASE、the CochraneLibrary、中国知网、万方、维普数据库中发表的运用扩散加权成像评价腰椎间盘退变的相关文献。2名研究者独立按照纳入和排除标椎对检索到的文献进行筛选和数据提取。使用Combie横断面研究评价工具对纳入文献进行质量评价。采用RevMan5.3和Stata15.0软件进行Meta分析。结果纳入文献12篇。Ⅰ级椎间盘共577个,Ⅱ级椎间盘共1704个,Ⅲ级椎间盘共1299个,Ⅳ级椎间盘共1092个,Ⅴ级椎间盘共194个。Ⅰ级椎间盘髓核ADC值高于Ⅱ级椎间盘髓核ADC值,差异有统计学意义[加权均数差(weighted mean difference,WMD)=0.034,95%CI:0.005～0.064,P=0.024];Ⅱ级椎间盘髓核ADC值显著高于Ⅲ级椎间盘髓核ADC值(WMD=0.161,95%CI:0.124～0.197,P<0.0001);Ⅲ级椎间盘髓核ADC值显著高于Ⅳ级椎间盘髓核ADC值(WMD=0.297,95%CI:0.222～0.373,P<0.0001);Ⅳ级椎间盘髓核ADC值显著高于Ⅴ级椎间盘髓核ADC值(WMD=0.293,95%CI:0.176～0.411,P<0.0001)。结论扩散加权成像可以定量评价不同等级的腰椎间盘退变,尤其可以区分早期腰椎间盘退变,为早期诊断腰椎间盘退变提供影像学依据。

关键词(KeyWords)： 扩散加权成像;磁共振成像;表观扩散系数;腰椎间盘退变;Meta分析

Abstract:

Keywords:

基金项目(Foundation): 陕西省重点研发计划一般项目(编号：2020SF-104)~~

作者(Author): 马红菊;张旭胤;POKHAREL SAUGAT;郭银霞;杜永浩;王蓉;牛刚;

Email:

DOI:

参考文献(References)：

• [1]Abou Khadrah RS,Dawoud MF,Abo-Elsafa AA,et al.Advanced trends in magnetic resonance imaging in assessment of lumbar intervertebral degenerative disk disease.Egyptian J Radiol&Nuclear Med,2019,50:101.DOI:10.1186/s43055-019-0042-7.
• [2]Byvaltsev VA,Stepanov IA,Kalinin AA,et al.The use of apparent diffusion coefficient in diagnosis of lumbar intervertebral disk degeneration in patients with middle and old age by diffusion-weighted MRI.Advances in Gerontol,2018,31(1):103-109.
• [3]Shen S,Wang H,Zhang J,et al.Diffusion weighted imaging,diffusion tensor imaging,and T2*mapping of lumbar intervertebral disc in young healthy adults.Iranian J Radiol,2016,13(1):1-9.DOI:10.5812/iranjradiol.30069.
• [4]Cui YZ,Yang XH,Liu PF,et al.Preliminary study on diagnosis of lumbar disc degeneration with magnetic resonance T1p,T2 mapping and DWI quantitative detection technologies.Eur Rev Med Pharmacol Sci,2016,20(16):3344-3350.
• [5]Pfirrmann CW,Metzdorf A,Zanetti M,et al.Magnetic resonance classification of lumbar intervertebral disc degeneration.Spine,2001,26(17):1873-1878.
• [6]Niu G,Yang J,Wang R,et al.MR imaging assessment of lumbar intervertebral disk degeneration and age-related changes:Apparent diffusion coefficient versus T2 quantitation.Am J Neuroradiol,2011,32(9):1617-1623.DOI:10.3174/ajnr.A2556.
• [7]Maasumi K,Tehranzadeh J,Muftuler LT,et al.Assessment of the correlation between apparent diffusion coefficient and intervertebral disk degeneration using 3 Tesla MRI.Neuroradiol J,2011,24(4):593-602.DOI:10.1177/197140091102400416.
• [8]Resorlu M,Gokmen F,Resorlu H,et al.Association between apparent diffusion coefficient and intervertebral disc degeneration in patients with ankylosing spondylitis.Int J Clin Exper Med,2015,8(1):1241-1246.
• [9]Wang W,Hou J,Lv D,et al.Multimodal quantitative magnetic resonance imaging for lumbar intervertebral disc degeneration.Exper Therapeutic Med,2017,14(3):2078-2084.DOI:10.3892/etm.2017.4786.
• [10]Huang YQ,Zhao XM,Wu QH,et al.Comparative study of MR T2relaxation time and apparent diffusion coefficient for assessing lumbar intervertebral disc degeneration.Radiol Prac,2016,31(8):773-777.黄耀渠,赵晓梅,伍琼慧,等.磁共振T2弛豫时间和ADC评估腰椎间盘退变的对比研究.放射学实践,2016,31(8):773-777.
• [11]Li JJ.Analysis of clinical value of MRI apparent diffusion coefficient in diagnosis of lumbar intervertebral disc degeneration.Chin Health Care&Nutrition,2017,27(27):404-405.DOI:10.3969/j.issn.1004-7484.2017.27.656.李晶晶.MRI表观弥散系数值用于腰椎间盘退变诊断的临床价值分析.中国保健营养,2017,27(27):404-405.DOI:10.3969/j.issn.1004-7484.2017.27.656.
• [12]Ma XH,Zhang W,Liu D,et al.Comparative study on 1.5 T and 3.0 TMRI diffusion weighted imaging in diagnosis of lumbar intervertebral disc degeneration.Hebei Med J,2015,37(7):981-984.DOI:10.3969/j.issn.1002-7386.2015.07.005.马晓晖,张伟,刘栋,等.1.5 T与3.0 T MRI弥散加权成像对腰椎间盘退变诊断价值的比较.河北医药,2015,37(7):981-984.
• [13]Zhang QB,Li W,Cao Y,et al.The value of apparent diffusion coefficient in the evaluation of degeneration of intervertebral disc in patients with low back pain.J Prac Orthopaedics,2018,24(6):564-569.张青波,李伟,曹云,等.表观弥散系数在腰痛患者腰椎间盘退变评估中的应用价值.实用骨科杂志,2018,24(6):564-569.
• [14]Zhao CY,Chen XC,Liu M,et al,The value of MRI apparent diffusion coefficient in the diagnosis of lumbar disc degeneration.Zhejiang Med J,2015,37(15):1263-1265.赵才勇,陈兴灿,刘淼,等.MRI表观弥散系数用于腰椎间盘退变诊断的价值.浙江医学,2015,37(15):1263-1265.
• [15]Zhao J,Guo ZP,Wang LF,et al.Correlation between apparent diffusion coefficient and disc degeneration grade of 3.0 T MR diffusion-weighted imaging of lumbar spine in patients with low back pain.Chin J Spine&Spinal Cord,2013,23(12):1074-1078.赵建,郭智萍,王林峰,等.腰痛患者腰椎3.0 T MR弥散加权成像腰椎间盘表观弥散系数与椎间盘退变分级的相关性.中国脊柱脊髓杂志,2013,23(12):1074-1078.
• [16]Zhou XX,Wang J.Correlation between 3.0 T MRI diffusion-weighted imaging and Pfirrmann classification of intervertebral disc degeneration.Zhejiang Med J,2018,20(5):793-795.周晓璇,王健.3.0 T磁共振弥散加权成像与椎间盘退变Pfirrmann分级的相关性.浙江临床医学,2018,20(5):793-795.
• [17]Zhu XF,Duan XX,Li WZ.Comparison of 1.5 T and 3.0 T MRIdiffusion-weighted imaging in the diagnosis of lumbar disc degeneration.J Clin&Exper Med,2017,16(24):2478-2481.朱秀芳,段新秀,李文早.1.5 T与3.0 T MRI弥散加权成像对腰椎间盘退变诊断价值的比较.临床和实验医学杂志,2017,16(24):2478-2481.
• [18]Niinim鋕i J,Korkiakoski A,Parviaien O,et al.Association of lumbar artery narrowing,degenerative changes in disc and endplate and apparent diffusion in disc on postcontrast enhancement of lumbar intervertebral disc.MAGMA,2009,22(2):101-109.DOI:10.1016/j.mri.2008.10.005.
• [19]Rajasekaran S,Babu JN,Arun R,et al.ISSLS prize winner:A study of diffusion in human lumbar discs:a serial magnetic resonance imaging study documenting the influence of the endplate on diffusion in normal and degenerate discs.Spine,2004,29(23):2654-2667.DOI:10.1097/01.brs.0000148014.15210.64.
• [20]Wen Q,Meng FH,Qian T,et al.The value of 1.5 T magnetic resonance T2 quantitative measurement in the evaluation of degeneration of lumbar intervertebral disc.Chin J Bone Joint,2016,5(8):582-587.温群,孟凡华,钱亭,等.1.5 T磁共振T2值定量测定在评价腰椎间盘退行性变中的价值研究.中国骨与关节杂志,2016,5(8):582-587.