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目的采用基于Extended Tofts linear模型动态对比增强MRI(DCE-MRI)定量研究椎间盘退变椎体软骨下骨(VSB)、软骨终板(CEP)的灌注。方法 18例受检者分别行腰椎常规检查及DCE-MRI。记录椎体头、尾侧VSB、CEP感兴趣区灌注参数Ktrans、Kep、Ve值。在腰椎正中矢状位T2WI确定椎间盘Pfirrmann分级。采用单因素方差分析(One-way ANOVA)与Newman-Keuls多重比较检验比较不同分级DCE-MRI各灌注参数值差异,以P<0.05为差异具有统计学意义。结果共纳入研究90个椎间盘。Pfirrmann 1级5个,占5.56%;2级27个,占30.00%;3级21个,占23.33%;4级32个,占35.56%;5级5个,占5.56%。头、尾侧VSB及头、尾侧CEP灌注参数从1~2级先上升,2~3级后下降,4~5级再上升后下降。不同Pfirrmann分级头侧VSB Ktrans值、Kep值、尾侧VSB Kep值、头侧CEP Kep值具有统计学意义(F值分别为2.701、5.036、2.724、2.714,P值均<0.05)。其中Pfirrmann 1级与2级、1级与4级、2级与3级、3级与4级头侧VSB Kep值、Pfirrmann 1级与4级尾侧VSB Kep值及Pfirrmann 2级与3级头侧CEP Kep值差异具有统计学意义(q值分别为4.560、5.059、3.425、4.305、3.996、4.256,P值均<0.05),余两组间VSB、CEP灌注参数值差异均无统计学意义(P值均>0.05)。结论 DCE-MRI定量技术显示在椎间盘退变中,VSB及CEP灌注在Pfirrmann 2级升高,3级降低,4级升高,最后在5级降低。
Objective To quantitatively study the perfusion of subchondral bone (VSB) and cartilage endplate (CEP) in degenerative disc degeneration using dynamic contrast enhanced MRI (DCE-MRI) based on Extended Tofts linear model. Methods Eighteen subjects underwent routine examination of lumbar spine and DCE-MRI. The perfusion parameters Ktrans, Kep and Ve of vertebral head, caudal VSB and CEP were recorded. Medial sagittal T2WI of the lumbar spine to determine the Pfirrmann classification of the disc. One-way ANOVA and Newman-Keuls multiple comparisons were used to compare the perfusion parameters of DCE-MRI with different grading. The difference was significant at P <0.05. Results A total of 90 discs were included in the study. Pfirrmann level 1 5, accounting for 5.56%; Level 2 27, accounting for 30.00%; Level 3 21, accounting for 23.33%; Level 4 32, accounting for 35.56%; 5 5, accounting for 5.56%. The parameters of perfusion of head and tail VSB and caudal and caudal CEP rose from 1 ~ 2, decreased after 2 ~ 3, then increased and then decreased after 4 ~ 5. There were significant differences in the Kep value, Kep value, CEP Kep value in the head side between different Pfirrmann grading head sides (F = 2.701,5.036,2.724,2.714, P <0.05 respectively). Including Pfirrmann 1 and 2, 1 and 4, 2 and 3, 3 and 4 head side VSB Kep value, Pfirrmann 1 and 4 tail VSB Kep value and Pfirrmann 2 and 3 head (P <0.05). There was no significant difference in the value of CEP Kep between the two groups (q values were 4.560,5.059,3.425,4.305,3.996,4.256 respectively, P <0.05) P value> 0.05). Conclusion DCE-MRI quantification shows that in the process of intervertebral disc degeneration, VSB and CEP perfusion increase in Pfirrmann level 2, level 3, level 4, and finally in level 5.