MRI 硬膜囊区域划分测量和中央型腰椎管狭窄症临床相关性分析

目的：采用区域划分法将腰椎MRI中硬膜囊划分为三个区域，测量其面积，且评估与中央型腰椎管狭窄症（LSCS）的临床相关性。方法本项目共有LSCS病例资料126例，自愿完成VAS、ODI问卷和行走距离调查，且行腰椎MRI检查，T2WI横断面影像中，测量整个硬膜囊的面积，然后将硬膜囊分为左、中、右三个区域，分别测量这三个区域的面积。组间和组内差异用方差分析，所有影像学测量数据和患者基本资料用Spearman检验（rs值表示），和VAS、ODI、行走距离关系用Pearson检验（r值表示），P＜0.05有统计学意义，rs值和r值绝对值越接近1，关联性越强。结果所有测量数据的组间和组内均无差异（P＞0.05），整个硬膜囊面积、硬膜囊中间部分面积与VAS、ODI评分均无意义（P＞0.05），左侧硬膜囊的面积与腰疼VAS评分（r＝-0.397）、ODI评分（r＝-0.404）有一定的关联（P＜0.05），右侧硬膜囊面积和腰疼VAS评分（r＝-0.422）、腿疼VAS评分（r＝-0.392）、ODI评分（r＝-0.423）、行走距离（r＝-0.393）均有一定的关联（P＜0.05），当左右两侧硬膜囊面积在0～25 mm2区间，和 ODI联系变得更加紧密（r＝-0.621，-0.625；P＜0.05）。结论区域划分测量法可以提高影像学和LSCS临床关联性，腰椎MRI中整个硬膜囊面积无明显LSCS临床相关性，硬膜囊左右两侧区域和LSCS临床之间有紧密联系。

Clinical correlation of division measurement of dural sac in MRI with lumbar spinal central stenosis

Objective In MRI imaging, the dural sac were divided into three different regions, and study their clinical relevance with lumbar spinal central stenosis（LSCS）. Methods Oswestry disability index （ODI）, visual analog scale （VAS）, walking distance and MRI were completed voluntarily by all these 126 patients. The whole dural cross-sectional area were measured in MRI T2 weighted transaxial images. Then, the dural sac was divided into three different regions, which were defined as left, right and middle area and measured them respectively. Intra- and interobserver reliability were assessed by ANOVA （P value）. Spearman correlation coefficients（rs value） were used to assess the correlations between the areas and LSCS baseline characteristics. The correlations between the areas and ODI, VAS or walking distance were investigated by Pearson correlation coefficient （r value）. Results Intra- and interobserver reliability had no statistical significance （P〉0.05）. A negative appearance was identified in the whole and middle dural cross-sectional area （P〉0.05）. The correlations between the areas and LSCS baseline characteristics had no statistical significance （P〉0.05）. The left region of dural sac in MRI had relationship with VAS of back pain （r=-0.397） and ODI （r=-0.404）. The right region of dural sac in MRI correlated with VAS （back pain： r=-0.422, leg pain： r=-0.392）, ODI （r=-0.443） and walking distance （r=-0.393）, especially when either area was lower than 25 mm2, the correlations with ODI were more significantly （r=-0.621 and -0.635, respectively, P〈0.01）. Conclusion Region division can improve correlation of radiological methods with LSCS clinical symptoms, while the whole region of dural sac could not detect. The left and right region of dural sac in MRI T2 weighted transaxial images significantly correlated with theseverity of LSCS symptoms.