Pfirrmann 椎间盘退变分级系统在 9.4T MRI 中的新应用：与 3T MRI 相比具有更高的可靠性。
Novel Application of the Pfirrmann Disc Degeneration Grading System to 9.4T MRI: Higher Reliability Compared to 3T MRI.
机构信息
Department of Neurosurgery, Monash Medical Centre, Clayton, Victoria, Australia.
Department of Surgery, Monash University, Clayton, Victoria, Australia.
出版信息
Spine (Phila Pa 1976). 2019 Jul 1;44(13):E766-E773. doi: 10.1097/BRS.0000000000002967.
STUDY DESIGN
Reliability study.
OBJECTIVE
To evaluate the applicability and reliability of 9.4T magnetic resonance imaging (MRI) in the assessment of degenerative disc disease compared with 3T MRI.
SUMMARY OF BACKGROUND DATA
MRI is a reliable indicator of biochemical changes in the intervertebral disc (IVD) including hydration status, proteoglycan content, and disc degeneration compared with anatomical and histological studies. High-field 9.4T MRI has been shown to provide superior resolution and anatomical detail. However, it has not been tested against current standard MRI techniques.
METHODS
Disc degeneration was initiated in 36 skeletally mature ewes 6 months prior to necropsy via validated surgical IVD injury models using either scalpel injury or drill-bit injury techniques at lumbar spine levels L2/3 and L3/4 with L1/2, L4/5, and L5/6 serving as control discs. All ex vivo IVDs were examined with 9.4T MRI and 3T MRI. All scans were analyzed using the Pfirrmann grading system by four independent observers. Intra- and interobserver reliability was assessed using kappa statistics and Spearman correlation.
RESULTS
Inter- and intraobserver agreement for 9.4T MRI was excellent, both at κ 0.91 (P < 0.001). Comparatively, 3T interobserver reliability demonstrated substantial agreement at κ 0.61 (P < 0.001). Complete agreement was obtained in 92.7% to 100% of discs at 9.4T compared with 69.7% to 83.1% at 3T. A difference of one grade or more occurred in 6.7% at 9.4T and 39.3% at 3T. 9.4T MRI scored 97.3% of discs as grade 1 to 2 compared with 71.3% at 3T. 3T MRI tended to over-score the extent of disc degeneration with 28.6% of discs scored as grade 3 or higher compared with 2.7% at 9.4T MRI.
CONCLUSION
9.4T MRI study of IVD degeneration using the Pfirrmann grading system demonstrated excellent inter- and intraobserver reliability. Comparatively, 3T MRI demonstrated a tendency to over score the extent of disc degeneration. This improved reliability of 9.4T MRI holds great potential for its clinical applications.
LEVEL OF EVIDENCE
研究设计
可靠性研究。
目的
评估 9.4T 磁共振成像（MRI）在评估退行性椎间盘疾病方面的适用性和可靠性，与 3T MRI 相比。
背景资料概要
与解剖学和组织学研究相比，MRI 是一种可靠的指标，可用于评估椎间盘（IVD）的生化变化，包括水合状态、蛋白聚糖含量和椎间盘退变。高场 9.4T MRI 已被证明具有更好的分辨率和解剖细节。然而，它尚未经过当前标准 MRI 技术的测试。
方法
在解剖前，通过使用手术刀或钻头技术在腰椎 L2/3 和 L3/4 水平对 36 只骨骼成熟的绵羊进行验证的椎间盘损伤模型，在 6 个月前开始椎间盘退变，L1/2、L4/5 和 L5/6 作为对照椎间盘。所有离体椎间盘均采用 9.4T MRI 和 3T MRI 进行检查。所有扫描均使用 Pfirrmann 分级系统由四位独立观察者进行分析。使用kappa 统计和 Spearman 相关性评估观察者内和观察者间的可靠性。
结果
9.4T MRI 的观察者内和观察者间一致性均极好，kappa 值分别为 0.91（P<0.001）和 0.61（P<0.001）。相比之下，3T 观察者间可靠性为中度一致，kappa 值为 0.61（P<0.001）。在 9.4T 时，92.7%至 100%的椎间盘获得完全一致，而在 3T 时为 69.7%至 83.1%。在 9.4T 时，1 级至 2 级的椎间盘发生一级或更高级别的差异发生率为 6.7%，而在 3T 时为 39.3%。9.4T MRI 将 97.3%的椎间盘评为 1 级至 2 级，而 3T 为 71.3%。3T MRI 倾向于过度评估椎间盘退变的程度，有 28.6%的椎间盘评分为 3 级或更高，而 9.4T MRI 为 2.7%。
结论
使用 Pfirrmann 分级系统对 IVD 退变进行的 9.4T MRI 研究显示出极好的观察者内和观察者间可靠性。相比之下，3T MRI 显示出过度评分椎间盘退变程度的趋势。9.4T MRI 的这种可靠性提高为其临床应用带来了巨大的潜力。
证据水平
3 级。
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