目的 探索磁共振T2 mapping和T1 mapping成像诊断兔进展期腰椎间盘退变的应用价值。方法 7只新西兰兔行椎间盘退变造模。造模前以及造模后1个月、3个月，行矢状位T1WI、T2WI、T2 mapping和T1 mapping扫描，基于T2WI，对L1~S1的6个椎间盘行Pfirrmann分级，基于T2 mapping和T1 mapping测量椎间盘T2值和T1值。观察相应椎间盘病理改变，以病理结果非进展期和进展期退变为标准，使用接受者操作特征(ROC)曲线判断各成像指标的诊断效能。结果 造模前、造模后1个月和造模后3个月，椎间盘T2值显著降低(F = 24.224, P < 0.001)，椎间盘T1值无显著性差异(F = 2.191, P = 0.116)。诊断进展期椎间盘退变的效能从高到低依次为：T2 mapping+T1 mapping = T2 mapping > T1 mapping > Pfirrmann评分。结论 T2 mapping可以较准确地区分非进展期和进展期椎间盘退变。
Objective To apply magnetic resonance T2 mapping and T1 mapping in diagnosing progressive intervertebral disc degeneration. Methods Seven New Zealand rabbits modeled with intervertebral disc degeneration underwent sagittal T1WI, T2WI, T2 mapping and T1 mapping before, and one and three months after modeling. Pfirrmann grade of six intervertebral discs (L1-S1) in each rabbit was obtained based on T2WI and values of T2 and T1 based on T2 mapping and T1 mapping. They were observed pathologically as progressive or non-progressive intervertebral disc degeneration. The diagnostic efficacy of these imaging markers was compared with receiver operating characteristic (ROC) curve according to pathological results. Results T2 values of intervertebral discs decreased after degeneration (F = 24.224, P < 0.001), while T1 values varied little (F = 2.191, P = 0.116). The diagnostic efficacy from more to less ranked as T2 mapping+T1 mapping = T2 mapping > T1 mapping > Pfirrmann grade. Conclusion T2 mapping may differentiate progressive intervertebral disc degeneration from non-progressive for clinic.
[1] van Uden S, Silva-Correia J, Oliveira J M, et al. Current strategies for treatment of intervertebral disc degeneration: substitution and regeneration possibilities [J]. Biomater Res, 2017,21: 22.
[2] 崔凤珍,王世雷,张哲,等. 磁共振T2-mapping检查对颈椎间盘退行性变的诊断价值[J]. 解放军医药杂志, 2018, 30(1): 56-59.
[3] 谢光友,杨海涛,吕富荣,等. T2 mapping动态定量监测兔腰椎间盘退变模型[J]. 磁共振成像, 2016, 7(3): 213-217.
[4] 侯昌龙,杨建勇,庄文权,等. 经皮穿刺兔腰椎椎体内注射平阳霉素对腰椎软骨终板及椎间盘的影响[J]. 中山大学学报(医学科学版), 2010, 31(2): 221-224, 237.
[5] Togao O, Hiwatashi A, Wada T, et al. A qualitative and quantitative correlation study of lumbar intervertebral disc degeneration using glycosaminoglycan chemical exchange saturation transfer, Pfirrmann grade, and T1-rho [J]. AJNR, 2018, 39(7): 1369-1375.
[6] Siepe C J, Heider F, Haas E, et al. Influence of lumbar intervertebral disc degeneration on the outcome of total lumbar disc replacement: a prospective clinical, histological, X-ray and MRI investigation [J]. Eur Spine J, 2012, 21(11): 2287-2299.
[7] Jarman J P, Arpinar V E, Baruah D, et al. Intervertebral disc height loss demonstrates the threshold of major pathological changes during degeneration [J]. Eur Spine J, 2015, 24(9): 1944-1950.
[8] 胡君,李霞. MRI T2 mapping成像技术对腰椎间盘退行性变的诊断价值[J]. 中国继续医学教育, 2018, 10(9): 45-47.
[9] 温群,孟凡华,钱亭,等. 1.5 T磁共振T2 mapping成像在腰椎间盘退行性变中的诊断价值[J]. 中国医学影像学杂志, 2017, 25(7): 531-535.
[10] 蒙仲猛,潘希敏,陈应明,等. 缺血性腰椎间盘退变模型兔的磁共振T1ρ和T2 mapping成像评价[J]. 中国组织工程研究, 2017, 21(31): 5032-5036.
[11] 陈江波,潘希敏,陈应明,等. 磁共振T2 mapping和T1ρ成像研究群养成年恒河猴腰椎间盘的退变过程[J]. 中国组织工程研究, 2017, 21(3): 418-422.
[12] Sasho T, Katsuragi J, Yamaguchi S, et al. Associations of three-dimensional T1 rho MR mapping and three-dimensional T2 mapping with macroscopic and histologic grading as a biomarker for early articular degeneration of knee cartilage [J]. Clin Rheumatol, 2017, 36(9): 2109-2119.
[13] Cao Y, Zeng W, Cui Y, et al. Increased myocardial extracellular volume assessed by cardiovascular magnetic resonance T1 mapping and its determinants in type 2 diabetes mellitus patients with normal myocardial systolic strain [J]. Cardiovasc Diabetol, 2018, 17(1): 7.
[14] Karur G R, Robison S, Iwanochko R M, et al. Use of myocardial T1 mapping at 3.0 T to differentiate Anderson-Fabry disease from hypertrophic cardiomyopathy [J]. Radiology, 2018, 288(2): 398-406.
[15] Huber A T, Bravetti M, Lamy J, et al. Non-invasive differentiation of idiopathic inflammatory myopathy with cardiac involvement from acute viral myocarditis using cardiovascular magnetic resonance imaging T1 and T2 mapping [J]. J Cardiovasc Magn Reson, 2018, 20(1): 11.
