Predictive value of enhanced magnetic resonance imaging for pathological classification and prognosis of conservative treatment in patients with lumbar disc herniation
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摘要:目的
探讨增强核磁共振成像(MRI)对腰椎间盘突出症患者病理分型及保守治疗转归的预测价值。
方法回顾性分析2021年9月—2022年9月在本院接受保守治疗的105例腰椎间盘突出症患者的临床资料。所有患者入院时及末次检查时均给予增强MRI检查，采用受试者工作特征(ROC)曲线分析增强MRI参数[环边最大厚度(Tr)、环边增强范围(Er)、突出物体积]对腰椎间盘突出症患者病理分型的诊断效能。随访8个月，根据保守治疗后复发情况将患者分为复发组和未复发组，比较2组患者Oswestry功能障碍指数问卷(ODI)评分、腰疼视觉模拟评分表(VAS)评分、增强MRI参数水平。采用ROC曲线分析Tr、Er及突出物体积对转归的预测价值。
结果脱出型患者Tr、Er水平高于游离型患者，差异有统计学意义(P < 0.05); Tr联合Er预测腰椎间盘突出症病理分型的曲线下面积(AUC)为0.854, 敏感度为84.21%, 特异度为76.12%。治疗后，未复发组ODI评分及腰疼VAS评分低于复发组, Tr、Er高于复发组，差异均有统计学意义(P < 0.05)。Tr联合Er预测腰椎间盘突出症保守治疗转归的AUC为0.802, 敏感度为96.55%, 特异度为53.95%。
结论增强MRI评估腰椎间盘突出症患者病理分型及保守治疗转归具有良好的价值。
Abstract:ObjectiveTo explore the predictive value of enhanced magnetic resonance imaging (MRI) for pathological classification and prognosis of conservative treatment in patients with lumbar disc herniation.
MethodsClinical materials of 105 patients with conservative treatment for lumbar disc herniation in the hospital from September 2021 to September 2022 were retrospectively analyzed. All the patients underwent enhanced MRI at the time points of hospital admission and the final examination. Receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic efficacy of enhanced MRI parameters [maximal rim thickness (Tr), rim enhancement range (Er), and herniated volume] in the pathological classification of lumbar disc herniation. Patients were followed up for 8 months and divided into recurrence and non-recurrence groups based on recurrence after conservative treatment. The Oswestry Disability Index (ODI) score, the Visual Analogue Scale (VAS) score for low back pain, and levels of enhanced MRI parameters were compared between the two groups. ROC curve analysis was conducted to assess the predictive value of Tr, Er and herniated volume for the prognosis.
ResultsThe levels of Tr and Er in the extrusion patients were significantly higher than those in the sequestration patients (P < 0.05). The area under the curve (AUC) for the prediction of pathological classification of lumbar disc herniation by Tr combined with Er was 0.854, with a sensitivity of 84.21% and a specificity of 76.12%. After treatment, the ODI score and VAS score for low back pain in the non-recurrence group were significantly lower than those in the recurrence group, while Tr and Er were significantly higher in the non-recurrence group (P < 0.05).The AUC for the prediction of the prognosis of conservative treatment for lumbar disc herniation by Tr combined with Er was 0.802, with a sensitivity of 96.55% and a specificity of 53.95%.
ConclusionEnhanced MRI has good value in assessing the pathological classification and prognosis of conservative treatment in patients with lumbar disc herniation.
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图 2 MRI影像图
A、B、C: MRI平扫图，腰曲变直，各椎缘不同程度增生，部分椎体信号不均, L3~4向后轻微突出, L4~5向左后方突出, L5~S1向左后下方突出，硬膜囊受压，椎间孔变窄，未见明显膨出，圆锥及马尾未见明显异常信号; D、E、F: 增强MRI图像，腰曲变直，各椎缘不同程度增生，部分椎体信号不均, L3~4向后轻微突出, L4~5向左后方突出, L5~S1向左后下方突出，边缘环状强化，硬膜囊受压，椎间孔变窄，未见明显膨出，圆锥及马尾未见明显异常信号。
表 1 脱出组与游离组患者增强MRI参数比较(x±s)
组别 n Tr/mm Er/% 突出物体积/mm2 脱出组 67 1.33±0.16 72.38±6.94 2 574.38±40.95 游离组 38 1.14±0.11* 65.44±6.71* 2 587.49±42.88 Tr: 环边最大厚度; Er: 环边增强范围。与脱出组比较, *P < 0.05 
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表 2 Tr、Er对腰椎间盘突出症病理分型的预测价值
指标 AUC P 最佳截断值 敏感度/% 特异度/% Tr 0.848 < 0.001 1.26 mm 86.84 68.66 Er 0.768 < 0.001 71.79 % 84.21 73.13 二者联合 0.854 < 0.001 — 84.21 76.12
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表 3 复发组与未复发组治疗效果比较(x±s)
分 组别 n ODI评分 腰疼VAS评分 治疗前 治疗后 治疗前 治疗后 未复发组 76 65.78±7.12 33.89±3.51* 5.86±1.13 3.15±1.02* 复发组 29 66.14±7.25 37.37±4.06*# 5.97±1.17 3.84±1.06*# ODI: Oswestry功能障碍指数问卷; VAS: 视觉模拟评分表。与治疗前比较, * P < 0.05; 与未复发组比较, #P < 0.05。
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表 4 复发组与未复发组增强MRI参数比较(x±s)
组别 n Tr/mm Er/% 突出物体积/mm2 未复发组 76 1.30±0.16 71.66±7.11 2 576.62±41.32 复发组 29 1.15±0.13* 65.16±6.89* 2 585.69±43.88 Tr: 环边最大厚度; Er: 环边增强范围。与未复发组比较, * P < 0.05。
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表 5 Tr、Er对腰椎间盘突出症保守治疗转归的预测
指标 AUC P 最佳截断值 敏感度/% 特异度/% Tr 0.760 < 0.001 1.32 mm 96.55 50.00 Er 0.743 < 0.001 72.93 % 86.21 56.58 二者联合 0.802 < 0.001 — 96.55 53.95
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