PROSET序列诊断腰椎间盘突出症责任病灶的价值

doi:10.3877/cma.j.issn.2095-2015.2022.02.005

目的

探讨PROSET序列对腰椎间盘突出症（LDH）受压责任神经根的诊断价值。

方法

回顾性分析2020年9月至2021年5月牡丹江医学院附属红旗医院收治的有单个神经根受压症状和体征的LDH患者80例，分别采用MRI常规扫描和PROSET序列诊断责任受压神经根。分析MRI常规扫描、PROSET序列诊断责任受压神经根的结果与临床诊断结果的一致性；以临床诊断结果作为"金标准"，分别计算MRI常规扫描、PROSET序列诊断责任受压神经根的敏感度、特异度、准确性、阳性预测值和阴性预测值。

结果

本组80例患者中，44例患者临床表现为L5神经根受压，36例患者临床表现为S1神经根受压；MRI常规扫描显示43例患者L5神经根受压，38例患者S1神经根受压；PROSET序列显示45例患者L5神经根受压，36例患者S1神经根受压。Kappa检验结果显示，MRI常规扫描诊断L5、S1神经根受压与临床诊断结果的一致性为中等（Kappa=0.572、0.698），而PROSET序列诊断L5、S1神经根受压与临床诊断结果的一致性较好（Kappa=0.873、0.899）。MRI常规扫描诊断L5神经根受压的敏感度、特异度、准确性、阳性预测值和阴性预测值分别为79.5%、77.8%、78.8%、81.4%和75.7%；PROSET序列诊断L5神经根受压的敏感度、特异度、准确性、阳性预测值和阴性预测值分别为95.5%、91.7%、93.8%、93.3%和94.3%。_PROSET序列诊断S1、L5神经根受压的敏感度、特异度、准确性、阳性预测值及阴性预测值均高于MRI常规扫描。MRI常规扫描、PROSET序列诊断S1神经根受压的敏感度、特异度、准确性、阳性预测值及阴性预测值均高于其诊断L5神经根受压。

结论

PROSET序列在LDH责任受压神经根的定位上较有优势，可以辅助MRI常规扫描。

关键词: 腰椎间盘突出症, 磁共振成像, PROSET序列, 神经根受压

Objective

To investigate the diagnostic value of water excitation (PROSET) sequence in the compressed responsible nerve roots of lumbar disc herniation (LDH).

Methods

A total of 80 patients of LDH with symptoms and signs of single nerve root compression treated in Hongqi Hospital Affiliated to Mudanjiang Medical College from September 2020 to May 2021 were analyzed retrospectively. Magnetic resonance imaging (MRI) conventional scanning and PROSET sequence were used to diagnose responsible compressed nerve roots respectively. The consistency between the results of MRI routine scanning and PROSET sequence in the diagnosis of responsible compressed nerve root and clinical diagnosis was analyzed. Taking the clinical diagnosis results as the 'gold standard', the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of MRI routine scanning and PROSET sequence were calculated respectively.

Results

Among the 80 patients, 44 patients showed L5 nerve root compression and 36 patients showed S1 nerve root compression. Conventional MRI scan showed that L5 nerve root was compressed in 43 patients and S1 nerve root was compressed in 38 patients. PROSET sequence showed L5 nerve root compression in 45 patients and S1 nerve root compression in 36 patients. Kappa test showed that the consistency between the diagnosis of L5 and S1 nerve root compression by routine MRI and the clinical diagnosis was medium (Kappa=0.572, 0.698), while the consistency between the diagnosis of L5 and S1 nerve root compression by PROSET sequence and the clinical diagnosis was good (Kappa=0.873, 0.899). The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of MRI in the diagnosis of L5 nerve root compression were 79.5%, 77.8%, 78.8%, 81.4% and 75.7% respectively. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of PROSET sequence in the diagnosis of L5 nerve root compression were 95.5%, 91.7%, 93.8%, 93.3% and 94.3% respectively. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of PROSET sequence in the diagnosis of S1 and L5 nerve root compression were higher than those of MRI. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of MRI routine scanning and PROSET sequence in the diagnosis of S1 nerve root compression were higher than those in the diagnosis of L5 nerve root compression.

Conclusion

PROSET sequence has advantages in the localization of responsible compressed nerve roots in LDH, and can assist in routine MRI scanning.

Key words: Lumbar disc herniation, Water excitation (PROSET) sequence, Magnetic resonance imaging, Nerve root compression

表1 MRI常规扫描诊断L5神经根受压与临床诊断结果对比（例）

MRI常规扫描	临床诊断		合计
MRI常规扫描	阳性	阴性	合计
L5神经根受压	35	8	43
L5神经根未受压	9	28	37
合计	44	36	80

表1 MRI常规扫描诊断L5神经根受压与临床诊断结果对比（例）

MRI常规扫描	临床诊断		合计
MRI常规扫描	阳性	阴性	合计
L5神经根受压	35	8	43
L5神经根未受压	9	28	37
合计	44	36	80

表2 PROSET序列诊断L5神经根受压与临床诊断结果对比（例）

PROSET序列	临床诊断		合计
PROSET序列	阳性	阴性	合计
L5神经根受压	42	3	45
L5神经根未受压	2	33	35
合计	44	36	80

表2 PROSET序列诊断L5神经根受压与临床诊断结果对比（例）

PROSET序列	临床诊断		合计
PROSET序列	阳性	阴性	合计
L5神经根受压	42	3	45
L5神经根未受压	2	33	35
合计	44	36	80

表3 MRI常规扫描诊断S1神经根受压与临床诊断结果对比（例）

MRI常规扫描	临床诊断		合计
MRI常规扫描	阳性	阴性	合计
S1神经根受压	31	7	38
S1神经根未受压	5	37	42
合计	36	44	80

表3 MRI常规扫描诊断S1神经根受压与临床诊断结果对比（例）

MRI常规扫描	临床诊断		合计
MRI常规扫描	阳性	阴性	合计
S1神经根受压	31	7	38
S1神经根未受压	5	37	42
合计	36	44	80

表4 PROSET序列诊断S1神经根受压与临床诊断结果对比（例）

PROSET序列	临床诊断		合计
PROSET序列	阳性	阴性	合计
S1神经根受压	34	2	36
S1神经根未受压	2	42	44
合计	36	44	80

表4 PROSET序列诊断S1神经根受压与临床诊断结果对比（例）

PROSET序列	临床诊断		合计
PROSET序列	阳性	阴性	合计
S1神经根受压	34	2	36
S1神经根未受压	2	42	44
合计	36	44	80

图1 患者，女性，74岁，临床诊断为左侧S1神经根受压。图A、B为MRI常规扫描轴位及矢状位显示L5/S1椎间盘信号减低，轻度膨出，S1神经根未见明显受压移位；图C为PROSET序列显示L5/S1椎间盘极外侧突出（箭头所示），左侧L5神经根受压增粗上移

图2 患者，女性，31岁，临床诊断左侧S1神经根受压。图A、B为MRI常规扫描轴位及矢状位显示椎间盘轻度膨出未与神经根接触，双侧神经根对称形态正常；图C为PROSET序列原始冠状位显示左侧S1神经根受压增粗（箭头所示）

图3 患者，男性，79岁，临床诊断为左侧L5神经根受压。图A、B为MRI常规扫描显示L4/L5椎间盘突出，压迫左侧L5神经根（箭头所示），神经根较对侧增粗;图C为PROSET序列原始冠状位未见左侧L5神经根受压增粗移位

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Value of water excitation (PROSET) sequence in the diagnosis of responsible lesions in lumbar disc herniation

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Value of water excitation (PROSET) sequence in the diagnosis of responsible lesions in lumbar disc herniation