摘要
目的 探讨腰椎管狭窄症(LSS)伴马尾神经冗余征(RNRs)的MRI特征.方法 选取就诊的 210 例LSS患者,均行MRI检查,记录RNRs评估结果、RNRs分型结果及椎管狭窄参数(正中矢状径、有效矢状径、有效截面积)值.对比RNRs阳性和RNRs阴性LSS患者基线资料及椎管狭窄参数、不同分型RNRs阳性患者椎管狭窄参数及通过受试者工作特征曲线(ROC曲线)椎管狭窄参数评估LSS患者伴发RNRs的价值.结果 210 例LSS患者中RNRs阳性 52 例,其中"藤索型"28 例,"葡萄串珠"型 13 例,"蛇纹石"型 11 例;RNRs阴性158 例.RNRs阳性组年龄大于RNRs阴性组,多椎管狭窄占比高于RNRs阴性组,Pfirrmann分级高于RNRs阴性组,正中矢状径、有效矢状径、有效截面积值小于RNRs阴性组,差异有统计学意义(P<0.05).三种分型RNRs阳性患者正中矢状径、有效矢状径、有效截面积对比,差异有统计学意义(P<0.05).ROC曲线显示正中矢状径、有效矢状径、有效截面积单独及联合评估LSS患者伴发RNRs的曲线下面积(AUC)分别为 0.641、0.723、0.691、0.802,联合评估价值最高.结论 "藤索"型、"葡萄串珠"型、"蛇纹石"型为RNRs的特异性MRI征象,且年龄大、多椎管狭窄及Pfirrmann分级高的LSS患者发生RNRs风险较高.
Abstract
Objective To analyze the magnetic resonance imaging(MRI)features of patients with lumbar spinal stenosis(LSS)accompanied by redundant nerve roots(RNRs).Methods 210 LSS patients who went to the hospital from January 2022 to December 2022 were selected as the study subjects,all of whom underwent MRI examination.The RNR evaluation results,RNR classification results,and spinal stenosis parameters in terms of median sagittal diameter,effective sagittal diameter,effec-tive cross-sectional area were recorded.The baseline data and spinal stenosis parameters of LSS patients with RNRs positive and RNRs negative were compared.The spinal stenosis parameters of patients with different types of RNRs positive were compared.The value of RNRs in LSS patients was evaluated by receiver operating characteristic curve(ROC curve).Results Among 210 LSS patients,52 cases were positive for RNRs,including 28 cases of"Vine Cord"type,13 cases of"Grape Bead"type,and 11 cases of"Serpentine"type.158 cases were negative for RNRs.The age of the RNRs positive group was older than that of the RNRs negative group,and the proportion of multiple spinal stenosis was higher than that of the RNRs negative group.The Pfir-mann grade was higher than that of the RNRs negative group,and the values of the median sagittal diameter,effective sagittal di-ameter,and effective cross-sectional area were smaller than those of the RNRs negative group,with statistical significant differ-ences(P<0.05).The differences in median sagittal diameter,effective sagittal diameter,and effective cross-sectional area among the three types of RNRs positive patients were statistically significant(P<0.05).ROC curve was drawn,and the results showed that the area under the curve(AUC)for median sagittal diameter,effective sagittal diameter,and effective cross-sectional area alone and in combination to evaluate concomitant RNRs in LSS patients were 0.641,0.723,0.691,and 0.802,re-spectively,with the highest combined evaluation value.Conclusion"Vine rope"type,"grape string bead"type,and"serpen-tine"type are specific MRI signs of RNRs,and LSS patients with older age,multiple spinal stenosis,and high Pfirmmann grade have a higher risk of RNRs.Regular MRI evaluation should be conducted to determine whether RNRs have occurred,and early detection and treatment are expected to improve prognosis.
基金项目
江苏省卫生健康委老年健康科研项目(LKM2022082)
NETL
NSTL
万方数据