目的 建立一套在腰椎MRI短時間反轉恢復（short time inversion recovery，STIR）序列圖像上評價腰椎間盤退變程度的改良STIR序列八級分級系統(tǒng)，并檢驗其效度及可重復性。 方法根據改良Pfirrmann八級分級系統(tǒng)及MRI檢查結果建立并優(yōu)化一套基于STIR序列圖像的腰椎間盤矢狀位分級系統(tǒng)。以2011年4月－2012年2月收治的60例腰椎間盤退行性變患者作為研究對象，其中男32例，女28例；年齡17～85歲，平均50歲。對每例研究對象5個腰椎間盤（L1、2～L5、S1）行T2加權像及STIR序列掃描。由3位分級者獨立分級后再共同分級，分級者之間的效度及可重復性采用一致率和Kappa系數進行分析。 結果共同分級示，所有椎間盤中無1級椎間盤，2級83個（27.7%），3 級 87個（29.0%），4級 66個（22.0%），5級 31個（10.3%），6級 15個（5.0%），7級 12個（4.0%），8級 6個（2.0%）。分級者自身達極強一致性（Kappa值0.822～0.952），組間達高度至極強一致性（Kappa值0.749～0.843）。分級者兩次分級與共同分級比較，分級一致率為82.7%～92.7%，平均85.6%；13.9%的分級差異發(fā)生于相鄰1個級別，0.5%為相鄰2個或以上 級別。 結論對于腰椎間盤退變程度可以采用改良STIR序列八級分級系統(tǒng)，提高了不同退變程度椎間盤分級的準確度。
引用本文： 潘文琦,王建,劉杰,陸焱,黃博. 腰椎間盤退行性變的改良MRI短時間反轉恢復序列八級分級系統(tǒng). 中國修復重建外科雜志, 2012, 26(12): 1430-1434. doi: 復制
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- 1. Kettler A, Wilke HJ. Review of existing grading systems for cervical or lumbar disc and facet joint degeneration. Eur Spine J, 2006, 15(6): 705-718.
- 2. Pfirrmann CW, Metzdorf A, Zanetti A, et al. Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine, 2001, 26(17): 1873-1878.
- 3. Griffith JF, Wang YX, Antonio GE, et al. Modified Pfirrmann grading system for lumbar intervertebral disc degeneration. Spine (Phila Pa 1976), 2007, 32(24): E708-712.
- 4. Thompson JP, Pearce RH, Schechter MT, et al. Preliminary evaluation of ascheme for grading the gross morphology of the human intervertebral disc. Spine (Phila Pa 1976), 1990, 15(5): 411-415.
- 5. Adams MA, Dolan P, Hutton WC. The stages of disc degeneration as revealed by discograms. J Bone Joint Surg (Br), 1986, 68(1): 36-41.
- 6. Landis RJ, Koch GG. The measurement of observer agreement for categorical data. Biometrics, 1977, 33(1): 159-174.
- 7. Saifuddin A, Renton P, Taylor BA. Effects on the vertebral end-plate of uncomplicated lumbar discography: an MRI study. Eur Spine J, 1998, 7(1): 36-39.
- 8. Kapoor SG, Huff J, Cohen SP. Systematic review of the incidence of discitis after cervical discography. Spine J, 2010, 10(8): 739-745.
- 9. Antoniou J, Steffen T, Nelson F, et al. The human lumbar intervertebral disc: evidence for changes in the biosynthesis and denaturation of the extracellular matrix with growth, maturation, ageing, and degeneration. J Clin Invest, 1996, 98(4): 996-1003.
- 10. Liebscher T, Haefeli M, Wuertz K, et al. Age-related variation in cell density of human lumbar intervertebral disc. Spine, 2011, 36(2): 153-159.
- 11. Watanabe A, Benneker LM, Boesch C, et al. Classification of intervertebral disk degeneration with axial T2 mapping. AJR Am J Roentgenol, 2007, 189(4): 936-942.
- 12. Andersson GB. Epidemiology of low back pain. Acta Orthop Scand Suppl, 1998, 281: 28-31.
- 13. Peterson CK, Bolton JE, Wood AR. A cross-sectional study correlating lumbar spine degeneration with disability and pain. Spine, 2000, 25(2): 218-223.
- 14. Chiebler ML, Camerino VJ, Fallon MD, et al. In vivo and ex vivo magnetic resonance imaging evaluation of early disc degeneration with histopathologic correlation. Spine (Phila Pa 1976), 1991, 16(6): 635-640.