磁共振单体素波谱成像技术评估退行性脊柱畸形患者多裂肌退变程度的初步临床研究

doi:10.3877/cma.j.issn.2096-0263.2024.03.003

中华老年骨科与康复电子杂志 ›› 2024, Vol. 10 ›› Issue (03) : 139 -145. doi: 10.3877/cma.j.issn.2096-0263.2024.03.003

脊柱专题

磁共振单体素波谱成像技术评估退行性脊柱畸形患者多裂肌退变程度的初步临床研究

陈春华¹, 张承旻¹, 陈灿²^,^†(

), 罗飞¹^,^†(

)

^1. 400038　重庆，陆军军医大学学院附属西南医院骨科
^2. 400038　重庆，陆军军医大学学院附属西南医院骨科；400038　重庆，陆军军医大学陆军卫勤训练基地战救技能训练教研室

收稿日期:2023-11-01 出版日期:2024-06-05
通信作者: 陈灿, 罗飞
基金资助:
重庆市科卫联合医学科研项目(2023ZDXM018); 陆军军医大学优秀人才库重点扶持对象个性化培养方案(XZ-2019-505-021)

Preliminary clinical study on the evaluation of multifidus muscle degeneration in patients with degenerative spinal deformities using single-voxel magnetic resonance spectroscopy imaging technology

Chunhua Chen¹, Chengmin Zhang¹, Can Chen²^,^†(), Fei Luo¹^,^†()

^1. Department of Orthopedics, The First Affiliated Hospital of Army Medical University, Chongqing 400038, China
^2. Department of Orthopedics, The First Affiliated Hospital of Army Medical University, Chongqing 400038, China; Department for Combat Casualty Care Training, Training Base for Army Health Care, Army Medical University, Chongqing 400038, China

Received:2023-11-01 Published:2024-06-05
Corresponding author: Can Chen, Fei Luo

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引用本文：

陈春华, 张承旻, 陈灿, 罗飞. 磁共振单体素波谱成像技术评估退行性脊柱畸形患者多裂肌退变程度的初步临床研究[J]. 中华老年骨科与康复电子杂志, 2024, 10(03): 139-145.

Chunhua Chen, Chengmin Zhang, Can Chen, Fei Luo. Preliminary clinical study on the evaluation of multifidus muscle degeneration in patients with degenerative spinal deformities using single-voxel magnetic resonance spectroscopy imaging technology[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2024, 10(03): 139-145.

目的

探索磁共振单体素波谱（SMRS）成像技术定量评估退行性脊柱畸形患者多裂肌退变程度的技术方法，并探究多裂肌退变程度与脊柱矢状面失衡程度的关联。

方法

公开招募31例退行性脊柱畸形（DSD）患者（DSD组）以及30例健康志愿者（对照组）作为研究对象，所有受试者均行SMRS序列扫描并拍摄脊柱全长正侧位X片。磁共振扫描部位为L_4\5椎间盘层面的双侧多裂肌，观察指标包括：脂肪分数（FF）、水脂比（W\F）、脂肪波峰下面积（FP）、不对称程度（DOA）。通过ROC曲线计算上述指标曲线下面积，观察两组人群多裂肌退变特点及其与矢状面平衡的关联。

结果

畸形组FF、FP、DOA高于对照组（P<0.05），畸形组W\F低于对照组（P<0.05），双侧多裂肌FF、FP、DOA、W\F的ROC曲线下面积分别为0.651、0.349、0.694、0.662，畸形组人群双侧多裂肌各退变指标与脊柱矢状面失衡程度未见明显相关性（P>0.05）。

结论

SMRS序列可以用于定量评估多裂肌退变情况，双侧多裂肌DOA可作为评估退行性脊柱畸形患者椎旁肌退变程度的敏感指标；多裂肌退变程度与脊柱矢状面失衡程度缺乏关联，前者可能是退行性脊柱畸形的独立影响因素。

关键词: 退行性脊柱畸形, 多裂肌, 磁共振单体波谱

Objective

To explore the technical method of using single voxel MR spectroscopy (SMRS) imaging technology to quantitatively evaluate the degree of multifidus muscle degeneration in patients with degenerative spinal deformities, and explore the correlation between multifidus muscle degeneration and spinal sagittal imbalance.

Methods

31 patients with degenerative spinal deformity (DSD) (DSD group) and 30 healthy volunteers (control group) were publicly recruited as research subjects. All subjects underwent SMRS sequence scanning and underwent full length anteroposterior and lateral X-rays of the spine. The magnetic resonance imaging scan was performed on bilateral multifidus muscles at the L4-5 intervertebral disc level, with observed indicators including fat fraction (FF), water fat ratio (W/F), fat peak (FP), and degree of asymmetry (DOA). Calculate the area under the above indicator curve using the ROC curve, and observe the characteristics of multifidus muscle degeneration and its correlation with sagittal balance in two groups of people.

Results

The FF, FP, and DOA levels in the DSD group were higher than those in the control group (P<0.05), while the W F levels in the DSD group were lower than those in the control group (P<0.05). The areas under the ROC curves of bilateral multifidus muscle FF, FP, DOA, and W F were 0.651, 0.349, 0.694, and 0.662, respectively. There was no significant correlation between the various degeneration indicators of bilateral multifidus muscle in the DSD group and the degree of spinal sagittal imbalance (P>0.05).

Conclusion

The SMRS sequence can be used to quantitatively evaluate the degree of multifidus muscle degeneration, and bilateral multifidus muscle DOA can be a sensitive indicator for evaluating the degree of paravertebral muscle degeneration in patients with degenerative spinal deformities; There is a lack of correlation between the degree of multifidus degeneration and the degree of spinal sagittal imbalance, and the former may be an independent influencing factor for degenerative spinal deformities.

Key words: Degenerative spinal deformity, Multifidus muscle, Single-voxel MR spectroscopy

图1 磁共振波谱序列定量评估多裂肌退变谱线图及计算示例。A：双侧多裂肌水波峰和脂肪波峰；B：左侧：水波峰下面积为222.91，脂肪波峰下面积为382.67；右侧：水波峰下面积为225.81，脂肪波峰下面积为563.47，多裂肌退变定量评估指标：FF=67.8%、W/F=0.474、FP=473.07、DOA=19.1%

表1 两组人群一般资料比较

组别	例数	性别（例，男\女）	年龄（岁，±s）	身高（cm，±s）	体重（Kg，±s）	BMI（Kg/m²，±s）
DSD组	31	5\26	63.3±8.1	151.8±7.0	58.7±8.9	25.4±3.2
对照组	30	6\24	61.5±7.2	153.7±7.6	56.9±6.8	24.1±2.9
统计值		0.155	0.911	-1.016	0.922	1.702
P值		0.694	0.366	0.314	0.360	0.094

表1 两组人群一般资料比较

组别	例数	性别（例，男\女）	年龄（岁，±s）	身高（cm，±s）	体重（Kg，±s）	BMI（Kg/m²，±s）
DSD组	31	5\26	63.3±8.1	151.8±7.0	58.7±8.9	25.4±3.2
对照组	30	6\24	61.5±7.2	153.7±7.6	56.9±6.8	24.1±2.9
统计值		0.155	0.911	-1.016	0.922	1.702
P值		0.694	0.366	0.314	0.360	0.094

图2 SMRS评估双侧多裂肌退变情况比较

表2 SMRS评估两组人群双侧（凹凸\左右）多裂肌退变情况比较（

±s）

组别	例数	指标	水波峰下面积	脂肪波峰下面积	脂肪分数（%）	水脂比（%）
DSD组	31	凸侧	188.9±85.4	428.5±335.7	0.65±0.14	0.63±0.43
		凹侧	221.9±193.9	442.4±384.2	0.62±0.17	0.83±0.88
		统计值	-0.035	-0.289	0.806	-0.500
		P值	0.972	0.773	0.423	0.617
对照组	30	左侧	169.6±66.7	244.3±172.5	0.54±0.15	1.07±1.00
		右侧	168.9±79.3	269.1±198.9	0.57±0.16	1.00±0.93
		统计值	-0.414	-0.414	-0.798	-0.798
		P值	0.679	0.679	0.425	0.425

表2 SMRS评估两组人群双侧（凹凸\左右）多裂肌退变情况比较（

±s）

组别	例数	指标	水波峰下面积	脂肪波峰下面积	脂肪分数（%）	水脂比（%）
DSD组	31	凸侧	188.9±85.4	428.5±335.7	0.65±0.14	0.63±0.43
		凹侧	221.9±193.9	442.4±384.2	0.62±0.17	0.83±0.88
		统计值	-0.035	-0.289	0.806	-0.500
		P值	0.972	0.773	0.423	0.617
对照组	30	左侧	169.6±66.7	244.3±172.5	0.54±0.15	1.07±1.00
		右侧	168.9±79.3	269.1±198.9	0.57±0.16	1.00±0.93
		统计值	-0.414	-0.414	-0.798	-0.798
		P值	0.679	0.679	0.425	0.425

表3 MRS评估两组人群多裂肌退变情况比较（

±s）

组别	例数	平均脂肪分数（%）	平均水脂比（%）	平均脂肪波峰下面积	不对称程度（%）
DSD组	31	0.64±0.15	0.69±0.53	435.4±322.5	0.22±0.18
对照组	30	0.56±0.15	1.02±0.94	256.7±182.0	0.12±0.09
差异度		12.5%	32.4%	41.0%	45.5%
统计值		-2.020	-2.020	-2.178	-2.597
P值		0.043	0.043	0.029	0.009

表3 MRS评估两组人群多裂肌退变情况比较（

±s）

组别	例数	平均脂肪分数（%）	平均水脂比（%）	平均脂肪波峰下面积	不对称程度（%）
DSD组	31	0.64±0.15	0.69±0.53	435.4±322.5	0.22±0.18
对照组	30	0.56±0.15	1.02±0.94	256.7±182.0	0.12±0.09
差异度		12.5%	32.4%	41.0%	45.5%
统计值		-2.020	-2.020	-2.178	-2.597
P值		0.043	0.043	0.029	0.009

图3 左：双侧多裂肌平均脂肪分数、平均脂肪波峰下面积、平均水脂比的ROC曲线；右：双侧多裂肌退变不对称程度的ROC曲线

表4 DSD组多裂肌退变情况与SVA的相关性

指标	统计值	平均脂肪分数（FF）	平均水脂比（W\F）	平均脂肪波峰下面积（FP）	不对称程度（DOA）
SVA	r	-0.046	0.046	-0.102	-0.069
SVA	P	0.806	0.806	0.586	0.712

表4 DSD组多裂肌退变情况与SVA的相关性

指标	统计值	平均脂肪分数（FF）	平均水脂比（W\F）	平均脂肪波峰下面积（FP）	不对称程度（DOA）
SVA	r	-0.046	0.046	-0.102	-0.069
SVA	P	0.806	0.806	0.586	0.712

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