摘要
背景：腰椎后路椎间融合术具有良好的临床效果，但邻近节段疾病（ASD）会影响其长期疗效。在接受 L4-5 椎间融合术并随访 10 年以上的患者中，ASD 的发生率为 33.3%。磁共振成像（MRI）是ASD诊断的关键，但内固定产生的金属伪影限制了其应用；因此，去除伪影对ASD的诊断和治疗至关重要：在我院，通过腰椎 MRI 对 ASD 患者的腰椎进行评估，包括常规序列和伪影序列。使用 PACS 工作站进行图像测量、分析和评估，主要包括测量内固定植入物的伪影面积、评估植入物周围解剖结构的可见度以及切片中 ASD 的诊断评估。常规 MRI 数据序列和伪影，对 MRI 数据进行序列对比分析：研究共纳入了 30 例腰椎融合术和内固定术后 ASD 患者，其中男性 13 例，女性 17 例，年龄（66.03±5.83）岁。WARP T2-tirm 序列的金属伪影面积明显小于传统 STIR 序列[（20.85 ± 6.27）cm² vs (50.56 ± 8.55) cm²，P < 0.01]。WARP T2-tirm 序列可在植入物、椎弓根、椎间孔和椎体周围观察到，而传统 STIR 序列可清晰显示椎间孔内的神经根。在所有 30 位患者中，WARP T2-tirm 序列的所有相邻节段均可清晰观察到（4 级以上），而在传统 STIR 序列中，由于存在较严重的金属伪影，很难观察到这些节段：结论：WARP序列可显著减少钛合金脊柱固定矢状面和横截面图像中的伪影面积，为ASD的诊断提供良好的成像参考。Background: Posterior lumbar interbody fusion has good clinical results, but adjacent segment disease (ASD) affects its long-term efficacy. In patients with L4-5 fusion who were followed up for more than 10 years, the ASD incidence was 33.3%. Magnetic resonance imaging (MRI) is key for ASD diagnosis, but metal artifacts from internal fixation limit its use; therefore, removing the artifacts is crucial for ASD diagnosis and treatment.
Aim: To evaluate the value of WARP MRI for patients with lumbar ASD.
Methods: In our hospital, the lumbar spines of patients with ASD were assessed via lumbar MRI, including conventional sequences and sequences for artifacts. A PACS workstation was used for image measurement, analysis, and assessment, which mainly included measurement of the internal fixation implant artifact area, evaluation of the visibility of the anatomical structures surrounding the implant, and diagnostic assessment of ASD in the section. Conventional MRI data sequences and artifacts to sequence the contrast analysis of the MRI data.
Results: A total of 30 patients with ASD after lumbar fusion and internal fixation were included in the study; the patients included 13 male and 17 female patients and were aged 66.03 ± 5.83 years. The metal artifact area of the WARP T2-tirm sequence was significantly smaller than that of the conventional STIR sequence [(20.85 ± 6.27) cm² vs (50.56 ± 8.55) cm², P < 0.01]. The WARP T2-tirm sequence was observed around the implants, pedicles, intervertebral foramen, and vertebral bodies, and the conventional STIR sequence clearly displayed nerve roots within the intervertebral foramen. In all 30 patients, all adjacent segments of the WARP T2-tirm sequence could be clearly observed (above Grade 4), whereas it was difficult to observe these segments in the conventional STIR sequence due to the presence of more severe metal artifacts.
Conclusion: WARP sequences can significantly reduce the artifact area in the sagittal and cross-sectional images of titanium alloy spinal fixation, providing a good imaging reference for the diagnosis of ASD.
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