Department of Radiology,the First Affiliated Hospital of Nanjing Medical University
目的：研究超短回波序列(UTE)评估软骨终板(CEP)损伤的可行性。方法：对36位患有下腰痛患者进行UTE序列及常规腰椎MR序列扫描,选取了其中85个软骨终板。将所得到的UTE图像处理成UTE软骨终板图像,并通过计算图像的信噪比(SNR)及对比信噪比(CNR)来评价图像质量。在UTE软骨终板图像的基础上,参考Rajasekaran分级并根据CEP及骨性终板的形态将终板分为6级。两名肌骨放射方向医师独立评估终板损伤,评估结果应用Cohen"s kappa分析检验一致性。最后评估85个终板Modic改变的分布情况。结果：UTE软骨终板图像的高图像信噪比及对比信噪比(平均SNR：33.06±2.92；平均CNR：9.4±2.08)证明图像具有较高的成像质量。两名肌骨放射医师独立评估6级终板形态的Cohen"s kappa系数为0.922。85个终板中34个存在Modic改变,Kendall’s tau-b分析示相关系数为0.737。结论：UTE成像可能会成为临床上评价软骨终板损伤较为有效的方式。通过评估Modic改变的分布情况发现损伤越严重的终板越容易出现Modic改变。
Objective: To investigate the feasibility of ultra-short echo time (UTE) imaging for assessing the cartilage endplate (CEP) damage. Methods: MR imaging of 85 CEPs from 36 patients with low back pain were performed at 3T MR using UTE imaging and routine lumbar MR sequences. UTE image of CEP was dealt with subtracted UTE image by a simple subtraction of UTE image from short to long TEs. Signal to Noise Ratio (SNR) and contrast-to-noise ratio (CNR) were calculated for the resultant subtracted UTE images to evaluate the image quality. Based on the subtracted UTE images and Rajasekaran grading, the endplates were classified into six grades according to the morphology of CEP and bony endplate. Two musculoskeletal radiologists assessed the grade of endplate damage based on the subtracted UTE images. Agreement between two radiologists was determined using Cohen"s kappa analysis. The distribution of Modic change in 85 endplates were evaluated. Results: The resultant subtracted UTE image quality was confirmed by high SNR and CNR (mean SNR: 33.06±2.92; mean CNR: 9.4±2.08). Six grades endplates were evaluated by two radiologists in substantial agreement with Cohen"s kappa of 0.922. Modic changes were found in 34 of 85 endplates. High coefficient of 0.737 with Kendall"s TAU-B analysis was obtained in evaluating the relationship between the degree of endplate damage and Modic change. Conclusion: UTE imaging might be considered an effective tool to assess the CEP damage in clinic. The distribution of Modic changes shows that the more serious the damage of endplate, the more prone to Modic changes.