Progress of quantitative magnetic resonance T2 mapping imaging in disc degeneration
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摘要: 椎间盘退变是引起下腰背痛的主要原因之一，影像学的检查是诊断椎间盘退变的重要手段。传统MRI技术虽可显示椎间盘的信号强度和形态学改变，但很难客观量化椎间盘退变的程度。T2 mapping技术能够检测椎间盘内水含量、蛋白多糖含量及胶原纤维排列顺序等多种生化成分，为椎间盘退变早期临床评估提供新的方法。本文从T2 mapping与其他定量磁共振技术对比，及其与椎间盘退变分级、日本骨科学会评分、视觉模拟评分及年龄、性别等联系论述定量磁共振T2映射成像在椎间盘退变中的研究进展。Abstract: Intervertebral disc degeneration is one of the main causes of low back pain. Imaging examination is an important means of diagnose intervertebral disc degeneration. Although traditional MRI technique can show the signal intensity and and morphological changes of the intervertebral disc, it is difficult to objectively quantify the degree of disc degeneration. T2 mapping technology can detect various biochemical components such as intervertebral disc water content, proteoglycan content and collagen fiber sequence, providing a new method for early clinical evaluation of intervertebral disc degeneration. This article discusses the research progress of quantitative magnetic resonance T2 mapping in disc degeneration is discussed from the comparison of T2 mapping with other quantitative magnetic resonance technologies, and its relationship with disc degeneration grade, Japanese Orthopaedic Association score, visual analog scale score, age and gender.
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图 1 Pfirrmann分级的T2WI影像学表现
A~E分别表示椎间盘退变Ⅰ~Ⅴ级.
Figure 1. T2WI images of Pfirrmann grading.
图 2 矢状位L3~S1的T2WI图和T2映射图
A: 矢状位L3~S1的T2WI图; B: 矢状位腰椎间盘T2映射（L3~S1）[29].
Figure 2. T2WI and T2 mapping images of sagittal L3-S1 images.
表 1 Pfirrmann分级
Table 1. Pfirrmann grading
等级 髓核信号 髓核结构 髓核与纤维环的分界 椎问盘的高度 Ⅰ 高 亮白、均一 清楚 正常 Ⅱ 高 不均、有水平带 清楚 正常 Ⅲ 中等 灰、不均 模糊 正常-轻度减低 Ⅳ 中低 灰-黑、不均 模糊 正常-中度减低 Ⅴ 低 不均、黑 消失 重度减低 
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表 2 改良Pfirrmann分级
Table 2. Improved Pfirrmann grading
分级 髓核及内层纤维信号 后方纤维内外层信号差别 椎间盘高度 1 均匀高信号, 与脑脊液相当 明显 正常 2 高信号(＞骶骨前脂肪, ＜脑脊液)-髓核内低信号裂隙 明显 正常 3 高信号(＜骶骨前脂肪) 不明显 正常 4 中等高信号(略＞外层纤维环) 不明显 正常 5 低信号(=外层纤维环) 不明显 正常 6 低信号 不明显 椎间盘高度减小＜30% 7 低信号 不明显 椎间盘高度减小30%~ 60% 8 低信号 不明显 椎间盘高度减小＞60%
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表 3 椎间盘退变组织学分级量表
Table 3. Histological grading scale for disc degeneration
椎间盘成分 1分 2分 3分 纤维环 纤维环正常, 纤维软骨板(向后呈u形, 向前略凸)纤维环无破裂, 环内任何部位无裂纹 纤维环破裂或呈裂纹样＜30% 纤维环破裂或呈裂纹样＞30% 纤维环与髓核的分界 正常 最小中断 中度、重度中断 髓核细胞结构 正常细胞, 基质凝胶状结构中有大液泡 细胞数量轻微减少, 空泡减少 细胞数量中度/重度减少(＞50%), 无空泡 髓核基质 正常的凝胶状外观 细胞外基质轻度凝结 细胞外基质中度/重度凝结 髓核的细胞外基质 正常 细胞外基质轻度形成 中度/重度细胞外基质形成
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表 4 髓核组织学退变评分量表
Table 4. Nucleus pulposus histological degeneration Scale
髓核成分 1分 2分 3分 髓核细胞 正常细胞形态, 在基质凝胶状结构中有大量的空泡 细胞数量轻度减少, 空泡轻度减少 细胞数量中度/重度减少(＞50%), 无空泡 髓核基质 正常凝胶结构 细胞外基质轻度皱缩 细胞外基质中、重度皱缩
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