PDF(Pubmed)
Abstract：
BACKGROUND: The lumbar vertebra and paraspinal muscles play an important role in maintaining the stability of the lumbar spine. Therefore, the aim of this study was to investigate the relationship between paraspinal muscles fat infiltration and vertebral body related changes [vertebral bone quality (VBQ) score and Modic changes (MCs)] in patients with chronic low back pain (CLBP).
METHODS: Patients with CLBP were prospectively collected in four hospitals and all patients underwent 3.0T magnetic resonance scanning. Basic clinical information was collected, including age, sex, course of disease (COD), and body mass index (BMI). MCs were divided into 3 types based on their signal intensity on T1 and T2-weighted imaging. VBQ was obtained by midsagittal T1-weighted imaging (T1WI) and calculated using the formula: SIL1-4/SICSF. The Proton density fat fraction (PDFF) values and cross-sectional area (CSA) of paraspinal muscles were measured on the fat fraction map from the iterative decomposition of water and fat with the echo asymmetry and least-squares estimation quantitation (IDEAL-IQ) sequences and in/out phase images at the central level of the L4/5 and L5/S1 discs.
RESULTS: This study included 476 patients with CLBP, including 189 males and 287 females. 69% had no Modic changes and 31% had Modic changes. There was no difference in CSA and PDFF for multifidus(MF) and erector spinae (ES) at both levels between Modic type I and type II, all P values>0.05. Spearman correlation analysis showed that VBQ was weakly negatively correlated with paraspinal muscles CSA (all r values < 0.3 and all p values < 0.05), moderately positive correlation with PDFF of MF at L4/5 level (r values = 0.304, p values<0.001) and weakly positively correlated with PDFF of other muscles (all r values<0.3 and all p values<0.001). Multivariate linear regression analysis showed that age (β = 0.141, p < 0.001), gender (β = 4.285, p < 0.001) and VBQ (β = 1.310, p = 0.001) were related to the total PDFF of muscles. For MCs, binary logistic regression showed that the odds ratio values of age, BMI and COD were 1.092, 1.082 and 1.004, respectively (all p values ＜ 0.05).
CONCLUSIONS: PDFF of paraspinal muscles was not associated with Modic classification. In addition to age and gender, PDFF of paraspinal muscles is also affected by VBQ. Age and BMI are considered risk factors for the MCs in CLBP patients.
METHODS: Patients with CLBP were prospectively collected in four hospitals and all patients underwent 3.0T magnetic resonance scanning. Basic clinical information was collected, including age, sex, course of disease (COD), and body mass index (BMI). MCs were divided into 3 types based on their signal intensity on T1 and T2-weighted imaging. VBQ was obtained by midsagittal T1-weighted imaging (T1WI) and calculated using the formula: SIL1-4/SICSF. The Proton density fat fraction (PDFF) values and cross-sectional area (CSA) of paraspinal muscles were measured on the fat fraction map from the iterative decomposition of water and fat with the echo asymmetry and least-squares estimation quantitation (IDEAL-IQ) sequences and in/out phase images at the central level of the L4/5 and L5/S1 discs.
RESULTS: This study included 476 patients with CLBP, including 189 males and 287 females. 69% had no Modic changes and 31% had Modic changes. There was no difference in CSA and PDFF for multifidus(MF) and erector spinae (ES) at both levels between Modic type I and type II, all P values>0.05. Spearman correlation analysis showed that VBQ was weakly negatively correlated with paraspinal muscles CSA (all r values < 0.3 and all p values < 0.05), moderately positive correlation with PDFF of MF at L4/5 level (r values = 0.304, p values<0.001) and weakly positively correlated with PDFF of other muscles (all r values<0.3 and all p values<0.001). Multivariate linear regression analysis showed that age (β = 0.141, p < 0.001), gender (β = 4.285, p < 0.001) and VBQ (β = 1.310, p = 0.001) were related to the total PDFF of muscles. For MCs, binary logistic regression showed that the odds ratio values of age, BMI and COD were 1.092, 1.082 and 1.004, respectively (all p values ＜ 0.05).
CONCLUSIONS: PDFF of paraspinal muscles was not associated with Modic classification. In addition to age and gender, PDFF of paraspinal muscles is also affected by VBQ. Age and BMI are considered risk factors for the MCs in CLBP patients.
摘要：
背景：腰椎和椎旁肌在维持腰椎稳定性方面起着重要作用。因此,这项研究的目的是探讨慢性下腰痛（CLBP）患者椎旁肌肉脂肪浸润与椎体相关变化[椎体骨质量（VBQ）评分和Modic变化（MC）]之间的关系。
方法：前瞻性收集四所医院的CLBP患者，所有患者均接受3.0T磁共振扫描。收集基本临床资料,包括年龄,性别,病程（COD），体重指数（BMI）。根据其在T1和T2加权成像上的信号强度，将MC分为3种类型。VBQ通过正中矢状T1加权成像（T1WI）获得，并使用公式：SIL1-4/SICSF计算。在脂肪分数图上测量了椎旁肌肉的质子密度脂肪分数（PDFF）值和横截面积（CSA），该脂肪分数图具有回声不对称性和最小二乘估计定量（IDEAL-IQ）序列和L4/5和L5/S1盘中央水平的进/出相位图像。
结果：本研究包括476例CLBP患者，其中男性189人，女性287人。69%没有Modic变化，31%有Modic变化。在ModicI型和II型之间的两个水平上，多裂（MF）和竖脊（ES）的CSA和PDFF没有差异，所有P值>0.05。Spearman相关分析显示,VBQ与椎旁肌CSA呈弱负相关(r值均<0.3,p值均<0.05),与L4/5水平MF的PDFF呈中度正相关（r值=0.304，p值<0.001），与其他肌肉的PDFF呈微弱正相关（所有r值<0.3，所有p值<0.001）。多元线性回归分析显示,年龄(β=0.141,p<0.001),性别（β=4.285，p<0.001）和VBQ（β=1.310，p=0.001）与肌肉总PDFF相关。对于MC来说，二元逻辑回归显示，年龄的比值比值，BMI和COD分别为1.092、1.082和1.004(p值均＜0.05)。
结论：椎旁肌的PDFF与Modic分类无关。除了年龄和性别,椎旁肌的PDFF也受VBQ的影响。年龄和BMI被认为是CLBP患者MC的危险因素。
方法：前瞻性收集四所医院的CLBP患者，所有患者均接受3.0T磁共振扫描。收集基本临床资料,包括年龄,性别,病程（COD），体重指数（BMI）。根据其在T1和T2加权成像上的信号强度，将MC分为3种类型。VBQ通过正中矢状T1加权成像（T1WI）获得，并使用公式：SIL1-4/SICSF计算。在脂肪分数图上测量了椎旁肌肉的质子密度脂肪分数（PDFF）值和横截面积（CSA），该脂肪分数图具有回声不对称性和最小二乘估计定量（IDEAL-IQ）序列和L4/5和L5/S1盘中央水平的进/出相位图像。
结果：本研究包括476例CLBP患者，其中男性189人，女性287人。69%没有Modic变化，31%有Modic变化。在ModicI型和II型之间的两个水平上，多裂（MF）和竖脊（ES）的CSA和PDFF没有差异，所有P值>0.05。Spearman相关分析显示,VBQ与椎旁肌CSA呈弱负相关(r值均<0.3,p值均<0.05),与L4/5水平MF的PDFF呈中度正相关（r值=0.304，p值<0.001），与其他肌肉的PDFF呈微弱正相关（所有r值<0.3，所有p值<0.001）。多元线性回归分析显示,年龄(β=0.141,p<0.001),性别（β=4.285，p<0.001）和VBQ（β=1.310，p=0.001）与肌肉总PDFF相关。对于MC来说，二元逻辑回归显示，年龄的比值比值，BMI和COD分别为1.092、1.082和1.004(p值均＜0.05)。
结论：椎旁肌的PDFF与Modic分类无关。除了年龄和性别,椎旁肌的PDFF也受VBQ的影响。年龄和BMI被认为是CLBP患者MC的危险因素。
