盘源性腰痛的CT及MRI诊断对照分析

目的比较分析CT腰椎间盘造影及MRI对椎间盘源性腰痛的诊断价值。方法以2014年1月-2015年6月就诊的50例疑似椎间盘源性腰痛患者为研究对象,均行MRI、CT平扫及CT椎间盘造影(CTD)检查,比较MRI与CT椎间盘造影对Modic征、HIZ改变及纤维环破裂分型等诊断结果。结果CT椎间盘造影共80个,CTD分型:I型34个,II型22个,III型14个,IV型10个,其中一致性疼痛共31个(38.7%)。MRI上有纤维环后缘高信号区(HIZ)者15个,无HIZ者64个,HIZ对疼痛预测敏感度、特异度分别为29.0%、87.8%。CTD显示Modic征腰椎间盘共12个,其中一致性疼痛11个,不一致疼痛或不同1例。MRI上IV-V级椎间盘退变32个,其中CTD一致性疼痛26个(81.3%),MRI上IV-V级退变一致性疼痛率明显高于I-III级退变患者(P0.01)。结论CT椎间盘造影对椎间盘源性腰痛纤维环破裂情况可清晰显示,MRI典型影像征象为HIZ、IV-V级椎间盘退变,预测一致性疼痛与CTD分型关系有利于MRI进一步确定责任椎间盘。

Cross-check Analysis of CT and MRI in the Diagnosis of Discogenic Low Back Pain

ObjectiveTo compare and analyze the diagnostic value of CT discography and MRI in discogenic low back pain.Methods50 cases of patients with suspected discogenic low back pain treated in hospital from January 2014 to June 2015 were selected as the research objects. MRI, CT plain scan and CT discography (CTD) were performed. The diagnostic results of MRI and CT discography in the diagnosis of Modic signs, changes of HIZ and fibrous ring rupture typing were compared. Results There were 80 CT discography. CTD typing: 34 type I, 22 type II, 14 type III and 10 type IV. There were 31 concordant pain (38.7%). 15 patients with HIZ and 64 without HIZ were on MRI and the sensitivity and specificity of HIZ in predicting pain were 29.0% and 87.8%, respectively. CTD showed a total of 12 lumbar intervertebral disc of Modic signs, of which 11 were concordant pain and 1 case was not concordant pain or different. There were 32 grade IV~V lumbar intervertebral disc degeneration on MRI, of which 26 were CTD concordant pain (81.3%). The rate of grade IV~V degeneration concordant pain on MRI was significantly higher than that of patients with grade I ~ III degeneration (P < 0.01).Conclusion CT discography can clearly show discogenic low back pain with fibrous ring rupture. The typical imaging features of MRI are HIZ and grade IV~V lumbar intervertebral disc degeneration. Prediction of the relationship between concordant pain and CTD typing is helpful for the further determination of MRI of intervertebral disc.