腰椎轴向负荷MRI对腰椎退行性疾病诊断的影响

目的 评估仰卧位轴向负荷MRI对腰椎退行性疾病诊断的影响.方法 对30名健康志愿者及89例腰腿痛患者进行了常规仰卧腰大肌放松体位(PRP)和仰卧位轴向负荷(ACE)MRI.89例腰腿痛患者中慢性下腰痛61例,坐骨神经痛19例,神经性跛行9例.观察、分析下腰椎(L3～4、L4～5、15～S1水平)椎管变化情况.结果 30名志愿者90个椎间盘水平ACE检查发现10名(33.3%)共14个椎间盘水平(15.6%)硬膜囊横截面积(DSCA)缩小15 mm2以上.89例患者267个椎间盘水平ACE检查发现38例(42.7%)55个椎间盘水平(20.6%)DSCA缩小15 mm2以上(平均缩小28 mm2).89例患者中ACE检查还发现有26例32个椎间盘突出程度加重,12例16个椎间盘水平椎间孔狭窄,10例11个水平黄韧带增厚,3例3个水平小关节半脱位,3例3个水平椎体滑脱.89例患者中22例(24.7%)ACE检查提供了更多的有效信息,其中7例(7/9)神经性跛行患者、8例(8/19)坐骨神经痛患者及11.5%(7/61)下腰痛患者ACE检查提供了有效信息.结论 与常规检查方法比较,ACEMRI能提供附加有效信息,能发现更多的隐匿性病变,对诊断腰椎退行性病变具有重要意义.

The diagnostic value of axially loaded magnetic resonance imaging in patients with degenerative disorders of lumbar spine

Objeetive To evaluate the diagnostic value of axially loaded MR imaging with supine position in patients with degenerative disorders of lumbar spine.Methods Thirty asymptomatic volunteers and 89 patients were examined in psoas-relaxed position(PRP)and axially compressed supine position(ACE)of the lumbar spine.Sixty-one patients with low back pain,19 with sciatica and 9 with neurogenic claudication were included in the symptomatic study group.The disc levels from L3 to S1 were examined.Results In 30 asymptomatie volunteers,a significant decrease in dural sac cross-sectional area(DSCA)was found at 14 disc levels(15.6%)in 10 individuals(33.3%)during ACE(>15 mm2).In 89 patients.a significant decrease in DSCA was found at 55 disc levels(20.6%)in 38 patients(42.7%)during ACE(>15 mm2),and the mean decrease was 28 mm2.During ACE,32 disc levels with an increasing severity of disc herniation were noted in 26 patients.16 disc levels with neural foramen stenosis were found in 12 patients,11 disc levels with ligamentum flavum thickening were observed in 10 patients,3 cases facet dislocation and 3 cases lumbar spondylolisthesis were also seen.In 22 of the 89 patients(24.7%).additional valuable information(AVI)was found during ACE,including 7 patients(7/9)with neurogenic claudication,8 patients(8/19)with sciatica,and 11.5%(7/61)of the patients with low back pain.Conclusion As compared with conventional imaging methods,axially loaded imaging provides AVI,and more occult lesions can be found during ACE.ACE MRI is a valuable tool in diagnosing degenerative disorders of lumbar spine.