基于MRS IDEAL序列构建非特异性腰痛患者椎旁多裂肌脂肪浸润程度的预测模型及效能评价

doi:10.3969/j.issn.1006-6233.2023.12.07

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摘要 目的: 利用磁共振波谱成像(MRS)和非对称回波的最小二乘估算法迭代水脂分离技术(IDEAL)定量分析非特异性腰痛患者椎旁多裂肌脂肪相对含量,并构建预测列线图模型。方法: 纳入2021年7月至2023年7月于我院接受治疗的88例非特异性腰痛患者的临床资料,所有患者椎旁多裂肌脂肪浸润程度按照Goutallier分级标准分为少量组与多量组,对比两组临床资料,基于MRS、IDEAL序列检测两组患者脂肪含量和水含量,分析两组脂肪含量与患者椎旁多裂肌浸润程度相关性;绘制受试者工作特征(ROC)曲线分析脂肪含量和水含量对患者椎旁多裂肌浸润程度的预测价值;将基于MRS、IDEAL序列检测的脂肪含量和水含量纳入列线图模型,采用R软件中C指数、ROC曲线及校准曲线评价脂肪含量和水含量与发生椎旁多裂肌脂肪浸润程度的列线图模型效能。结果: 两组性别、年龄、病程等临床资料对比无差异(P>0.05)。基于MRS以及IDEAL序列检测出的Fat(%)和Water(%),多量组的Fat(%)明显高于少量组,少量组的Water(%)明显高于多量组,差异具有统计学意义(P<0.05),且经卡方检验Phi系数、Kendall’s tau-b相关性分析结果显示,Fat(%)的值与椎旁多裂肌脂肪浸润程度呈正相关,其中MRS检测(r=0.420,P<0.05),IDEAL序列检测(r=0.477,P<0.05),Water(%)的值与椎旁多裂肌脂肪浸润程度呈负相关,其中MRS检测(r=-0.469,P<0.05),IDEAL序列检测(r=-0.496,P<0.05),并绘制ROC曲线结果显示,MRS以及IDEAL序列检测Fat(%)评估非特异性腰痛患者椎旁多裂肌脂肪浸润程度的AUC值分别为0.800、0.841,说明其具有较好的评估价值。基于MRS、IDEAL序列检测的Fat(%)和Water(%)构建列线图模型,其所对应的分值即为椎旁多裂肌脂肪浸润程度,验证结果显示,校准曲线的C-index值为为0.978,说明该列线图模型具备较好的区分度。绘制ROC曲线,建模组的AUC为0.978(95%CI:0.948~1.000),验证组的AUC为0.935(95%CI:0.838~1.000),说明该列线图模型有较好的预测能效。结论: 基于MRS、IDEAL序列检测的Fat(%)和Water(%)构建的列线图模型,能直观的预测非特异性腰痛患者椎旁多裂肌脂肪的浸润程度。

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关键词 ：磁共振波谱成像, 非对称回波的最小二乘估算法迭代水脂分离技术, 非特异性腰痛, 椎旁多裂肌脂肪浸润

Abstract：Objective: To assess the relative content of paravertebral multifidus fat in patients with nonspecific low back pain, and construct a predictive nomogram model utilizing magnetic resonance spectroscopy imaging (MRS) and iterative decomposition of water and fat with echo asymmetry and least squares estimation (IDEAL) quantitative analysis. Methods: The clinical data of 88 patients with nonspecific low back pain who were treated in our hospital from July 2021 to July 2023 were included. All patients were divided into small group and large group according to Goutallier grading standard. MRS and IDEAL sequences were used to detect fat and water content in both groups. The correlation between fat content and the degree of paravertebral multifidus muscle infiltration was analyzed. ROC curves were plotted to analyze the predictive value of fat and water content for the degree of paravertebral multifidus fat infiltration.Fat and water content detected by MRS and IDEAL sequences were included in the nomogram model. R software was used to evaluate the efficacy of the nomogram model using the C-index, ROC curves, and calibration curves. Results: There were no significant differences in gender, age, and duration between the two groups (P>0.05). Fat (%) detected by MRS and IDEAL sequences in the many group was significantly higher, while Water (%) in the few group was significantly higher, with statistical significance (P<0.05). Correlation analysis showed a positive correlation between Fat (%) and the degree of paravertebral multifidus fat infiltration, with significant values for MRS (r=0.420, P<0.05) and IDEAL sequences (r=0.477, P<0.05). Water (%) showed a negative correlation, with significant values for MRS (r=-0.469, P<0.05) and IDEAL sequences (r=-0.496, P<0.05). ROC curve results showed that the AUC values for evaluating the degree of paravertebral multifidus fat infiltration in patients with nonspecific low back pain were 0.800 and 0.841 for MRS and IDEAL sequences, respectively.The nomogram model based on Fat (%) and Water (%) detected by MRS and IDEAL sequences had good discrimination, with a C-index of 0.978. ROC curve analysis showed an AUC of 0.978 (95% CI: 0.948-1.000) for the modeling group and 0.935 (95% CI: 0.838-1.000) for the validation group, indicating good predictive efficacy. Conclusion: The nomogram model based on Fat (%) and Water (%) detected by MRS and IDEAL sequences provides an intuitive prediction of the degree of paravertebral multifidus fat infiltration in patients with nonspecific low back pain.

Key words： Magnetic resonance spectroscopy imaging Iterative water-fat separation technology by least square estimation method of asymmetric echo Nonspecific low back pain Fat infiltration of paravertebral multifidus muscle

基金资助:河北省卫健委医学科学研究课题计划,(编号:20210870)

引用本文:

刘云鹏, 曹斌, 左玉强, 田玉良, 陈秋敬, 张耀杰. 基于MRS IDEAL序列构建非特异性腰痛患者椎旁多裂肌脂肪浸润程度的预测模型及效能评价[J]. 河北医学, 2023, 29(12): 1967-1973.
LIU Yunpeng, CAO Bin, et al. Construction of a Predictive Model and Efficacy Evaluation of Paraspinal Multifidus Fat Infiltration in Patients with Non-specific Low Back Pain Based on MRS and IDEAL Sequence. HeBei Med, 2023, 29(12): 1967-1973.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2023.12.07 或 http://www.hbyxzzs.cn/CN/Y2023/V29/I12/1967

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