慢性非特异性下腰痛患者腰椎旁肌结构改变的MRI定量评估

李鑫娅; 刘丹; 韦福利; 袁铭婧; 文瑶

doi:10.16016/j.2097-0927.202306052

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慢性非特异性下腰痛患者腰椎旁肌结构改变的MRI定量评估

临床医学 | 更新时间：2026-01-09

- 慢性非特异性下腰痛患者腰椎旁肌结构改变的MRI定量评估
- Quantitative MRI for structural changes in lumbar paraspinal muscles in patients with chronic non-specific low back pain
- 陆军军医大学学报 2024年46卷第2期页码：181-189
- 作者机构：
  
  402160 重庆，重庆医科大学附属永川医院放射科
- 作者简介：
  
  [刘丹，E-mail：5677676@qq.comLIU Dan, E-mail: 5677676@qq.com
- 基金信息：
  
  永川区科技局自然科学基金项目(2022yc-cxfz30009)
- DOI：10.16016/j.2097-0927.202306052
  中图分类号： R322.74;R441.1;R445.2
- 收稿：2023-06-15，
  
  修回：2023-09-06，
  
  纸质出版：2024-01-30
- 稿件说明：
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李鑫娅, 刘丹, 韦福利, 等. 慢性非特异性下腰痛患者腰椎旁肌结构改变的MRI定量评估[J]. 陆军军医大学学报, 2024,46(2):181-189.

Xinya LI, Dan LIU, Fuli WEI, et al. Quantitative MRI for structural changes in lumbar paraspinal muscles in patients with chronic non-specific low back pain[J]. Journal of Army Medical University, 2024, 46(2): 181-189.
李鑫娅, 刘丹, 韦福利, 等. 慢性非特异性下腰痛患者腰椎旁肌结构改变的MRI定量评估[J]. 陆军军医大学学报, 2024,46(2):181-189. DOI： 10.16016/j.2097-0927.202306052.

Xinya LI, Dan LIU, Fuli WEI, et al. Quantitative MRI for structural changes in lumbar paraspinal muscles in patients with chronic non-specific low back pain[J]. Journal of Army Medical University, 2024, 46(2): 181-189. DOI： 10.16016/j.2097-0927.202306052.

摘要

目的

利用磁共振常规扫描及扩散张量成像技术(diffusion tensor imaging，DTI)定量评估慢性非特异性下腰痛(chronic nonspecific low back pain，CNLBP)患者腰椎旁肌的结构改变，为临床诊治CNLBP提供参考依据。

方法

收集2022年5月至2023年3月就诊于重庆医科大学附属永川医院CNLBP患者45例(CNLBP组)，同期招募健康志愿者28例(对照组)，进行磁共振矢状位及轴位T2WI、DTI扫描，在L3/4、L4/5、L5/S1椎间盘中心层面的轴位T2WI及DTI图像上测得双侧多裂肌、竖脊肌功能横截面积(functional cross sectional area，FCSA)、脂肪浸润率(fatty infiltration rate，FIR)、各向异性分数(fractional anisotropy，FA)及表观弥散系数(apparent diffusion coefficient，ADC)值。同时使用视觉模拟评分(visual analogue scale，VAS)及Oswestry功能障碍指数(Oswestry disability index，ODI)量表评估患者疼痛和功能障碍程度，分析CNLBP组与对照组之间一般资料(年龄、性别、身高、体质量、BMI)及双侧多裂肌、竖脊肌相对功能横截面积(relative functional cross sectional area，RFCSA)、FIR、FA及ADC值的差异。运用多元线性回归分析年龄、性别、BMI及下腰痛与双侧多裂肌、竖脊肌FIR的相关性。采用Spearman检验VAS、ODI评分与双侧多裂肌、竖脊肌RFCSA、FIR、FA、ADC值的相关性。

结果

CNLBP组与对照组的一般资料差异无统计学意义。与对照组比较，CNLBP组双侧多裂肌、竖脊肌RFCSA减小，但差异无统计学意义；CNLBP组双侧多裂肌、竖脊肌FIR增高，差异具有统计学意义(

0.05)。多元线性回归分析显示，年龄与FIR呈正相关，BMI与FIR不具有相关性，女性、下腰痛患者更易发生脂肪浸润。Spearman检验结果显示，ODI评分与双侧多裂肌及竖脊肌RFCSA呈显著负相关(

0.05)，VAS、ODI评分均与双侧多裂肌及竖脊肌FIR呈显著正相关(

0.05)。CNLBP组双侧多裂肌及竖脊肌FA值降低、ADC值增高，L3/4节段右侧多裂肌FA及L4/5、L5/S1节段双侧

多裂肌FA值、ADC值，L4/5、L5/S1节段双侧竖脊肌FA值及L5/S1节段双侧竖脊肌ADC值差异具有统计学意义(

0.05)。

结论

慢性非特异性下腰痛患者腰椎旁肌可出现肌肉萎缩、脂肪浸润增加及肌纤维结构的改变，多模态MRI技术可以观察和定量评估肌肉的结构改变。

Abstract

Objective

To quantitatively assess the structural changes of the lumbar paraspinal muscles in patients with chronic non-specific low back pain (CNLBP) using conventional magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) in order to provide a reference for the clinical diagnosis and treatment of CNLBP.

Methods

A total of 45 CNLBP patients admitted to our hospital from April 2022 to March 2023 were enrolled and assigned into CNLBP group

and another 28 healthy volunteers were recruited and assigned into control group. Sagittal and axial T2WI and DTI MRI scans were performed to all the subjects at the same time. The axial T2WI and DTI images at the L3/4

L4/5 and L5/S1 intervertebral disc levels were used to measure the functional cross-sectional area (FCSA)

fat infiltration rate (FIR)

fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values of the bilateral multifidus and erector spinae muscle. Visual analog scale (VAS) and Oswestry disability index (ODI) were employed to assess the severity of pain and functional impairment in the patients. The general data (age

sex

height

body weight and BMI)

and the relative functional cross-sectional area (RFCSA)

FIR

FA and ADC values of bilateral multifidus and erector spinae muscles were compared between the CNBLP group and the control group. Multiple linear regression was applied to analyze the correlations of age

gender

BMI and lower back pain with the FIR value of bilateral multifidus and erector spinae muscle. Spearman analysis was performed to determine the correlations of VAS and ODI scores with RFCSA

FIR

FA and ADC values of the muscles.

Results

There were no statist

ical differences in the general data between the CNLBP and control groups. The RFCSA values of the bilateral multifidus and erector spinae muscles were decreased in the former group than the latter group

though no significant difference. The CNLBP group had obviously higher FIR values of the 2 muscles than the control group (

0.05). Multiple linear regression analysis showed that age was positively associated with FIR

BMI was not

and the females and the patients with LBP were more likely to develop fatty infiltration. Spearman analysis indicated that the ODI score was negatively correlated with the RFCSA values of the 2 muscles (

0.05)

and both VAS and ODI scores were positively correlated with the FIR values of the 2 muscles (

0.05). A decrease in the FA value and an increase in the ADC value of the 2 muscles were found in the CNLBP group. And the differences in FA of the right multifidus muscle at the L3/4 segment and FA and ADC values of the bilateral multifidus muscle at the L4/5 and L5/S1 segments

and FA values at the L4/5 and L5/S1 segments and ADC values at the L5/S1 segment of the bilateral erector spinae muscle were statistically significant (

0.05).

Conclusion

CNLBP patients are accompanied by muscle atrophy

fat infiltration and changes in muscle fiber structure. Multimodal MRI technology can observe and quantitatively assess these changes in the muscle structure.

关键词

Keywords

references

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