3D MERGE与3D SPACE STIR序列在腰椎间盘突出症检查中的应用比较.pdf

第41卷第1期2024年1月D01:10.3969/j.issn.1005-202X.2024.01.0043DMERGE与3DSPACESTIR序列在腰椎间盘突出症检查中的应用比较中国医学物理学杂志Chinese Journal of Medical PhysicsVol.41.No.1January 2024医学影像物理-27李兰1,殷小丹,李旭雪1,吴海燕，张滔11.四川省骨科医院医学影像科，四川成都6 10 0 41；2.成都市成华区中医医院放射科，四川成都6 10 0 51【摘要】目的：对比三维多回波恢复梯度回波（3DMERGE）、三维可变反转角快速自旋回波（3DSPACESTIR）序列在腰椎间盘突出症（LDH）检查中的应用效果。方法：选择2 0 2 0 年1月 2 0 2 2 年11月收治的135例LDH患者，回顾性分析患者临床和磁共振成像（MRI）资料，所有患者均接受常规MRI扫描及3DMERGE、3D SPA C EST I R 序列扫描，对比3DMERGE、3D SPA CEST I R 序列测量神经根直径的一致性，评价两种序列的图像质量参数信噪比（SNR）对比噪声比（CNR）图像清晰度评分。结果：3DMERGE和3DSPACESTIR序列测量的L3S1神经根直径比较差异无统计学意义（P 0.0 5），且两组序列测量的L3、L4、L5和S1直径均显示出较高相关性（r=0.957,0.986,0.975，0.9 7 2,P 0.0 5；3DMERGE序列的SNR及CNR均高于3DSPACESTIR序列，神经根显示分级、图像清晰度评分优于3DSPACESTIR序列，差异有统计学意义（P0.05),and the diameters ofL3,L4,L5 and S1 measured by the two sequences showed high correlations(r-0.957,0.986,0.975,0.972,P0.05).Compared with3D SPACE STIR sequence,3D MERGE sequence had higher SNR and CNR,scoredbetter on image definition,and displayed nerve root more clearly(P0.75为一致性好,0.5ICC0.75为一致性一般,ICC0.5为一致性差；采用Pearson进行相关性分析。P0.05）,两组序列测量的L3、L4、L5和S1直径均显示出较高相关性（r分别为0.9 57、0.9 8 6、0.9 7 5、0.972,P0.05),见表1。表1神经根直径测量结果对比（mm，x s)Table 1 Comparison of nerve root diameter measurements(mm,MeanSD)扫描序列3DMERGE3DSPACESTIR值P值n135135L34.810.924.720.870.8260.410L45.081.025.271.121.4570.146L55.231.095.361.140.9580.339S15.481.245.541.360.3790.7052.2图像质量对比一致性检验结果显示,对于SNR、CNR 结果,观察者内ICC值为0.8 4 0.9 6，观察者间ICC值为0.8 1 0.9 4，一致性好。3DMERGE序列的SNR及CNR均高于3DSPACESTIR序列,差异有统计学意义（P0.05）,见表2。表2 图像质量对比（dB，x s）Table 2 Comparison of image quality(dB,Mean+SD)扫描序列CNR3DMERGE1353DSPACESTIR135值P值2.3神经根显示分级和图像清晰度评分对比一致性检验结果显示，对于神经根显示分级和图像清晰度评分结果，观察者内ICC值为0.7 6 0.8 8，观察者间ICC值为0.7 5 0.8 4，一致性好。3DMERGE序列的神经根显示分级、图像清晰度评分优于3D SPACESTIR序列,差异有统计学意义（P0.05），见表3。3讨论nSNR112.2614.4792.7316.2611.9650.001腰骶丛是支配下肢及其信息传导的重要神经通72.8411.98路，位置深，走行迁曲，在不同椎间盘平面上具有不55.4115.32同的前突角度，解剖复杂，神经根周围包裹有大量的10.413动静脉和淋巴组织结构，与周围的神经很难形成对0.001比,难以直接观察及诊断其病变 14。MRI腰骶丛成-30-扫描序列3DMERGE3DSPACESTIRZ值P值中国医学物理学杂志表3神经根显示分级和图像清晰度评分对比 例(%)Table 3 Comparison of nerve root display grading and image definition score cases(%)神经根显示分级图像清晰度评分n1级13582(60.74)13561(45.19)第41卷2级3级43(31.85)10(7.41)5742.22)17(12.59)6.8180.0090分0(0.00)0(0.00)1分2(1.48)6(4.44)2分15(11.11)27(20.00)6.4340.0113分118(87.41)102(75.56)像在直接观察腰骶神经病变中具有重要的临床价值，但常规扫描获得的图像在显示神经根时往往会受到周围组织的干扰，难以清晰显示神经细微结构和走行，仍需选择其他优质序列进行扫描 15。3DMERGE序列由GE公司开发，其在一次小角度射频脉冲激发后，可在数个回波时间内多次、重复采集单个回波的梯度回波，相较于常规序列采集速度更快，信噪比、空间分辨力更强，并减少磁敏感伪影,可获得准确的图像信息 16 。Tomasi等 17 研究显示，3DMERGE序列可清晰显示大脑皮层解剖结构，帮助临床医师了解患者颅内神经病变情况，可为神经外科手术方案的制定提供有效的参考信息。李冲等 18 研究也表明，3DMERGE序列能够清晰显示慢性进行性皮质脱髓鞘脑病患者腰骶丛神经形态用于疾病诊断。3D SPACE STIR序列为重 T,脂肪抑制序列,其利用小角度非选择性回聚脉冲可实现零间隔扫描，获得连续性、高分辨率的各向同性三维容积数据，可对血管和神经从任意方向进行重建观察，也是神经成像技术中一个较新的序列 19 。Zhang等 2 0 1报道指出，3DSPACESTIR序列具有均匀、稳定的脂肪抑制和血管抑制效果,相较于常规序列可有效增加腰骶丛及其小分支的可视化效果，为腰骶病变患者的治疗决策提供指导。上述研究均表明3DMERGE序列、3DSPACESTIR序列在神经成像显示方面均具有优势，但二者在LDH腰骶丛神经显示方面的效果差异情况尚无定论。本研究比较3DMERGE、3DSPACESTIR序列在LDH患者腰椎成像中的差异发现，二者测量所得L3-S1神经根直径无明显差异，且二者所测直径具有较高相关性，表明两种序列均可准确测量LDH患者神经根直径。孔等 2 1 研究显示,MRI中不同的3D扫描序列在测量腰椎病变患者神经根直径方面具有较高一致性，与本研究结果类似。针对图像质量方面，本研究结果显示，3DMERGE、3D SPA C EST I R 序列中，3DMERGE序列的SNR及CNR更高，神经根显示分级和图像清晰度评分更好,表明在LDH患者腰骶丛神经成像中,3DMERGE序列较3DSPACESTIR序列的图像质量更高，可更清晰直观显示腰骶丛神经解剖结构及病变情况。3DMERGE序列扫描对采集的多个梯度回波使用相同相位编码进行多次编码并平均，回波均填充于K空间的同一相位编码线上，可提高图像SNR，增加神经显示率，更清晰地显示神经解剖结构 2-2 3。而国内外均有研究表明，3DSPACESTIR序列虽可有效抑制脂肪、血管信号,降低T,衰减效应，减轻磁敏感伪影，但其血管信号抑制效果不如3DMERGE序列，且易受到周围肌肉、淋巴结等组织的干扰，会使神经根与周围组织对比度降低，影响成像质量，这也可能是本研究中3DSPACESTIR序列图像质量不如3DMERGE序列的原因 2 42 5。此外,3DMERGE序列扫描时间为5min内，而3DSPACESTIR序列扫描时间超过10 min,针对存在腰部疼痛的LDH患者，显然用时短的序列更能避免减轻患者长时间制动的不适，提高检查效率。综上所述,在LDH患者MRI检查中,3DMERGE、3DSPACESTIR序列均可准确测量神经根直径，而3DMERGE序列具有更高SNR，图像质量更好。但本研究为单中心回顾性分析，研究结论存在其局限性,有待改进。【参考文献】1廖雪英，杜娟，曾兴玲,等.椎间孔镜手术治疗腰椎间盘突出症疗效及对患者炎性因子的影响 J.西部医学,2 0 2 1,33(11):16 7 9-16 8 2.Liao XY,Du J,Zeng XL,et al.Efficacy of intervertebral foraminalendoscopic surgery in the treatment of lumbar disc herniation and itsinfluence on inflammatory factorsJ.Medical Journal of West China,2021,33(11):1679-1682.2 PPan M,Li Q,Li S,et al.Percutaneous endoscopic lumbar dis-cectomy:indications and complicationsJ.Pain Physician,2020,23(1):49-56.3Yin G,Wang C,Liu SQ.Comparative analysis of the therapeuticefficiency and radiographic measurement between the transforaminalapproach and interlaminar approach in percutaneous endoscopicdiscectomyJ.Turk Neurosurg,2021,31(6):857-865.4 Jiang Y,Zuo R,Yuan S,et al.Prognosis evaluation of MRI combinedwith magnetic resonance myelography on lumbar disc herniation aftertransforaminal endoscopic discectomy J.Comput Math MethodsMed,2022,2022:2895575.第1期5孙兵,郭恒,王乐凯,等.以完全性囊变为表现的椎管内神经鞘瘤1例 J.成都医学院学报,2 0 2 2,17(4):542-544.Sun B,Guo H,Wang LK,et al.Spinal schwannoma presenting ascomplete cystic change:a case report J.Journal of Chengdu MedicalCollege,2022,17(4):542-544.6 Li B,Li H,Dong L.Quantitative comparisons between relaxationenhanced compressed sensing 3D MERGE and conventional 3DMERGE for vessel wall imaging in equal scan time:preliminarystudiesJ.Sci China Life Sci,2019,62(12):1683-1691.7 Cao X,Tang Y,Pan L,et al.Assessment of carotid atheroscleroticplaque using 3D motion-sensitized driven-equilibrium prepared rapidgradient echo:a comparative studyJ.Quant Imaging Med Surg,2021,11(6):2744-2755.8 Lao Q,Jia Y,Zhao K,et al.Value of high-resolution MRI in thediagnosis of brachial plexus injury in infants and young childrenJ.IntJ Gen Med,2022,15:5673-5680.9李强，赵红金，宋绪荣，等.3.0 TMR三维成像序列在腰骶神经根成像上的应用 J.中国矫形外科杂志，2 0 19,2 7(8)：7 40-7 43.Li Q,Zhao HJ,Song XR,et al.Application of 3.0T MR 3D imagingsequence for displaying lumbosacral nerve rootJ.Orthopedic Journalof China,2019,27(8):740-743.10 中华医学会骨科学分会脊柱外科学组，中华医学会骨科学分会骨科康复学组.腰椎间盘突出症诊疗指南 J.中华骨科杂志,2 0 2 0,40(8):477-487.Chinese Orthopaedic Association of Spinal Surgery Group,ChineseOrthopaedic Association of Orthopaedic Rehabilitation Group.Clinical practice guideline for diagnosis and treatment of lumbar discherniationJ.Chinese Journal of Orthopaedics,2020,40(8):477-487.11 Bratke G,Rau R,Kabbasch C,et al.Speeding up the clinical routine:compressed sensing for 2D imaging of lumbar spine disc herniationJ.Eur J Radiol,2021,140:109738.12 Nordberg CL,Boesen M,Fournier GL,et al.Positional changes inlumbar disc herniation during standing or lumbar extension:a cross-sectional weight-bearing MRI studyJ.Eur Radiol,2021,31(2):804-812.13张佳文,黄斯灵，刘扬，等.磁共振三维成像3D-SPACE-STIR、3D-SPACE-T,WI序列及图像融合技术对复杂性肛瘘的诊断价值 J.临床放射学杂志，2 0 2 0,39(3):50 1-50 5.Zhang JW,Huang SL,Liu Y,et al.The diagnostic value of MR 3D-SPACE-STIR,3D-SPACE-T,WI sequence and image fusion T,-1echnology in complex anal fistulaJ.Journal of Clinical Radiology,2020,39(3):501-505.14 Berra LV,Di Rita A,Longhitano F,et al.Far lateral lumbar discherniation part 1:imaging,neurophysiology and clinical featuresJ.World J Orthop,2021,12(12):961-969.15罗维斯，董斐然，刘志方.MR3D-FIESTA序列对腰椎间盘突出症腰骶神经根受压程度的评估价值 J.海南医学,2 0 2 2,33(14):18 35-1838.Luo WS,Dong FR,Liu ZF.Application value of MR 3D-FIESTAsequence in evaluating the compression degree of lumbosacral nerveroot in lumbar disc herniationJ.Hainan Medical Journal,2022,33(14):1835-1838.16 Zhang J,Ding S,Zhao H,et al.Evaluation of chronic carotid artery李兰,等.3DMERGE与3DSPACESTIR序列在腰椎间盘突出症检查中的应用比较J.Eur Radio,2020,30(11):5805-5814.17 Tomasi SO,Umana GE,Scalia G,et al.Importance of veins forneurosurgery as landmarks against brain shifting phenomenon:ananatomical and 3D-MPRAGE MR reconstruction of superficialcortical veinsJ.Front Neuroanat,2020,14:596167.18李冲,杨杨,朱恂，等.腰骶丛MRI形态学成像在诊断CIDP患者中的价值 J.中国医学计算机成像杂志，2 0 17,2 3(6)：549-552.Li C,Yang Y,Zhu X,et al.Diagnostic value of magnetic resonanceimaging in lumbosacral plexus of CIDP patients J.ChineseComputed Medical Imaging,2017,23(6):549-552.19毛丽娟，何绍富，王朝阳，等.对比增强3DSTIRSPACE序列对子宫内膜异位症患者骶丛神经异常的显示 J.中山大学学报(医学科学版),2 0 2 1,42(1):6 6-7 2.Mao LJ,He SF,Wang CY,et al.Contrast enhanced 3D STIR SPACEsequence in displaying sacral nerve plexus abnormalities in pelvicendometriosisJ.Journal of Sun Yat-sen University(Medical ScienceEdition),2021,42(1):66-72.20 Zhang Y,Kong X,Zhao Q,et al.Enhanced MR neurography of thelumbosacral plexus with robust vascular suppression and improveddelineation of its small branches J.Eur J Radiol,2020,129:109128.21孔，孔超，鲁世保，等.3DMEDIC和3DSPACE磁共振神经成像在腰丛神经根的一致性对比研究 J.首都医科大学学报,2 0 2 1,42(1):131-137.Kong Z,Kong C,Lu SB,et al.A comparative study on the consistencyof 3D MEDIC and 3D SPACE magnetic resonance neurographyimaging in lumbosacral plexus nerve roots J.Journal of CapitalMedical University,2021,42(1):131-137.22 Higashihira S,Kobayashi N,Oishi T,et al.Comparison between 3-dimensional multiple-echo recombined gradient echo magneticresonance imaging and arthroscopic findings for the evaluation ofacetabular labrum tearJJ.Arthroscopy,2019,35(10):2857-2865.23黄国飚，郑颖，范先毅，等.CS-3DMERGE技术评估急性脑梗死及颈动脉粥样硬化的价值观察 J.影像科学与光化学,2 0 2 2,40(3):540-544.Huang GB,Zheng Y,Fan XY,et al.The value observation of acutecerebral infarction and carotid atherosclerosis by CS-3D MERGEtechnique assessmentJ.Imaging Science and Photochemistry,2022,40(3):540-544.24 Kinger NP,Chien LC,Sharma PS,et al.Comparison of 3Dconstructive interference in steady state(CISS)and T,samplingperfection with application optimized contrasts using different flipangle evolution MR imaging of the intracranial trigeminal nerveand central skull base neuroforamina J.Neuroradiol J,2022,35(6):678-683.25】赵凌云，刘琴，谈晓飞，等，优化MRI重T,3D-SPACE-STIR序列在臂丛神经扫描中的临床应用价值 J.放射学实践,2 0 19,34(5):56 0-564.Zhao LY,Liu Q,Tan XF,et al.Feasibility study of optimized heavy T23D-SPACE-STIR MRI sequence in brachial plexus scanning J.Radiologic Practice,2019,34(5):560-564.（编辑：陈丽霞）31occlusion by non-contrast 3D-MERGE MR vessel wall imaging:comparison with 3D-TOF-MRA,contrast-enhanced MRA,and DSA