DOI QR코드

DOI QR Code

Diffusion-Weighted Imaging for Pretreatment Evaluation and Prediction of Treatment Effect in Patients Undergoing CT-Guided Injection for Lumbar Disc Herniation

  • Niu, Xiang-Ke (Department of Radiology, Affiliated Hospital of Chengdu University) ;
  • Bhetuwal, Anup (Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College) ;
  • Yang, Han-Feng (Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College)
  • 투고 : 2014.05.08
  • 심사 : 2015.03.12
  • 발행 : 2015.08.01

초록

Objective: To determine whether a change in apparent diffusion coefficient (ADC) value could predict early response to CTguided Oxygen-Ozone ($O_2-O_3$) injection therapy in patients with unilateral mono-radiculopathy due to lumbar disc herniation. Materials and Methods: A total of 52 patients with unilateral mono-radiculopathy received a single intradiscal (3 mL) and periganglionic (5 mL) injection of an $O_2-O_3$ mixture. An ADC index of the involved side to the intact side was calculated using the following formula: pre-treatment ADC index = ([ADC involved side - ADC intact side] / ADC intact side) $\times$ 100. We analyzed the relationship between the pre-treatment Oswestry Disability Index (ODI) and the ADC index. In addition, the correlation between ODI recovery ratio and ADC index was investigated. The sensitivity and specificity of the ADC index for predicting response in $O_2-O_3$ therapy was determined. Results: Oswestry Disability Index and the ADC index was not significantly correlated (r = -0.125, p = 0.093). The ADC index and ODI recovery ratio was significantly correlated (r = 0.819, p < 0.001). When using 7.10 as the cut-off value, the ADC index obtained a sensitivity of 86.3% and a specificity of 82.9% for predicting successful response to therapy around the first month of follow-up. Conclusion: This preliminary study demonstrates that the patients with decreased ADC index tend to show poor improvement of clinical symptoms. The ADC index may be a useful indicator to predict early response to CT-guided $O_2-O_3$ injection therapy in patients with unilateral mono-radiculopathy due to lumbar disc herniation.

키워드

참고문헌

  1. Andreula CF, Simonetti L, De Santis F, Agati R, Ricci R, Leonardi M. Minimally invasive oxygen-ozone therapy for lumbar disk herniation. AJNR Am J Neuroradiol 2003;24:996-1000
  2. Bocci V. Biological and clinical effects of ozone. Has ozone therapy a future in medicine? Br J Biomed Sci 1999;56:270-279
  3. Lehnert T, Mundackatharappel S, Schwarz W, Bisdas S, Wetter A, Herzog C, et al. [Nucleolysis in the herniated disk]. Radiologe 2006;46:513-519 https://doi.org/10.1007/s00117-006-1379-2
  4. Oder B, Loewe M, Reisegger M, Lang W, Ilias W, Thurnher SA. CT-guided ozone/steroid therapy for the treatment of degenerative spinal disease--effect of age, gender, disc pathology and multi-segmental changes. Neuroradiology 2008;50:777-785 https://doi.org/10.1007/s00234-008-0398-2
  5. Lehnert T, Naguib NN, Wutzler S, Nour-Eldin NE, Bauer RW, Kerl JM, et al. Analysis of disk volume before and after CT-guided intradiscal and periganglionic ozone-oxygen injection for the treatment of lumbar disk herniation. J Vasc Interv Radiol 2012;23:1430-1436 https://doi.org/10.1016/j.jvir.2012.07.029
  6. Komori H, Shinomiya K, Nakai O, Yamaura I, Takeda S, Furuya K. The natural history of herniated nucleus pulposus with radiculopathy. Spine (Phila Pa 1976) 1996;21:225-229 https://doi.org/10.1097/00007632-199601150-00013
  7. Splendiani A, Puglielli E, De Amicis R, Barile A, Masciocchi C, Gallucci M. Spontaneous resolution of lumbar disk herniation: predictive signs for prognostic evaluation. Neuroradiology 2004;46:916-922 https://doi.org/10.1007/s00234-004-1232-0
  8. Splendiani A, Perri M, Conchiglia A, Fasano F, Di Egidio G, Masciocchi C, et al. MR assessment of lumbar disk herniation treated with oxygen-ozone diskolysis: the role of DWI and related ADC versus intervertebral disk volumetric analysis for detecting treatment response. Neuroradiol J 2013;26:347-356 https://doi.org/10.1177/197140091302600316
  9. Basser PJ, Jones DK. Diffusion-tensor MRI: theory, experimental design and data analysis - a technical review. NMR Biomed 2002;15:456-467 https://doi.org/10.1002/nbm.783
  10. Beaulieu C, Does MD, Snyder RE, Allen PS. Changes in water diffusion due to Wallerian degeneration in peripheral nerve. Magn Reson Med 1996;36:627-631 https://doi.org/10.1002/mrm.1910360419
  11. Basser PJ, Pierpaoli C. Microstructural and physiological features of tissues elucidated by quantitative-diffusion-tensor MRI. 1996. J Magn Reson 2011;213:560-570 https://doi.org/10.1016/j.jmr.2011.09.022
  12. Hiltunen J, Suortti T, Arvela S, Seppa M, Joensuu R, Hari R. Diffusion tensor imaging and tractography of distal peripheral nerves at 3 T. Clin Neurophysiol 2005;116:2315-2323 https://doi.org/10.1016/j.clinph.2005.05.014
  13. Khalil C, Hancart C, Le Thuc V, Chantelot C, Chechin D, Cotten A. Diffusion tensor imaging and tractography of the median nerve in carpal tunnel syndrome: preliminary results. Eur Radiol 2008;18:2283-2291 https://doi.org/10.1007/s00330-008-0971-4
  14. Kabakci N, Gurses B, Firat Z, Bayram A, Ulug AM, Kovanlikaya A, et al. Diffusion tensor imaging and tractography of median nerve: normative diffusion values. AJR Am J Roentgenol 2007;189:923-927 https://doi.org/10.2214/AJR.07.2423
  15. Chen YY, Lin XF, Zhang F, Zhang X, Hu HJ, Wang DY, et al. Diffusion tensor imaging of symptomatic nerve roots in patients with cervical disc herniation. Acad Radiol 2014;21:338-344 https://doi.org/10.1016/j.acra.2013.11.005
  16. Fairbank JC, Couper J, Davies JB, O'Brien JP. The Oswestry low back pain disability questionnaire. Physiotherapy 1980;66:271-273
  17. Gallucci M, Limbucci N, Zugaro L, Barile A, Stavroulis E, Ricci A, et al. Sciatica: treatment with intradiscal and intraforaminal injections of steroid and oxygen-ozone versus steroid only. Radiology 2007;242:907-913 https://doi.org/10.1148/radiol.2423051934
  18. Borich MR, Wadden KP, Boyd LA. Establishing the reproducibility of two approaches to quantify white matter tract integrity in stroke. Neuroimage 2012;59:2393-2400 https://doi.org/10.1016/j.neuroimage.2011.09.009
  19. Kunogi J, Hasue M. Diagnosis and operative treatment of intraforaminal and extraforaminal nerve root compression. Spine (Phila Pa 1976) 1991;16:1312-1320 https://doi.org/10.1097/00007632-199111000-00012
  20. Hasegawa T, Mikawa Y, Watanabe R, An HS. Morphometric analysis of the lumbosacral nerve roots and dorsal root ganglia by magnetic resonance imaging. Spine (Phila Pa 1976) 1996;21:1005-1009 https://doi.org/10.1097/00007632-199605010-00001
  21. Jenis LG, An HS. Spine update. Lumbar foraminal stenosis. Spine (Phila Pa 1976) 2000;25:389-394 https://doi.org/10.1097/00007632-200002010-00022
  22. Muto M, Andreula C, Leonardi M. Treatment of herniated lumbar disc by intradiscal and intraforaminal oxygen-ozone (O2-O3) injection. J Neuroradiol 2004;31:183-189 https://doi.org/10.1016/S0150-9861(04)96989-1
  23. Muto M, Avella F. Percutaneous treatment of herniated lumbar disc by intradiscal oxygen-ozone injection. Interv Neuroradiol 1998;4:279-286 https://doi.org/10.1177/159101999800400403
  24. Zhang Y, Ma Y, Jiang J, Ding T, Wang J. Treatment of the lumbar disc herniation with intradiscal and intraforaminal injection of oxygen-ozone. J Back Musculoskelet Rehabil 2013;26:317-322 https://doi.org/10.3233/BMR-130386
  25. Lutze M, Stendel R, Vesper J, Brock M. Periradicular therapy in lumbar radicular syndromes: methodology and results. Acta Neurochir (Wien) 1997;139:719-724 https://doi.org/10.1007/BF01420044
  26. Takashima H, Takebayashi T, Yoshimoto M, Terashima Y, Ida K, Yamashita T. Efficacy of diffusion-weighted magnetic resonance imaging in diagnosing spinal root disorders in lumbar disc herniation. Spine (Phila Pa 1976) 2013;38:E998-E1002 https://doi.org/10.1097/BRS.0b013e31829862d3
  27. Mac Donald CL, Dikranian K, Bayly P, Holtzman D, Brody D. Diffusion tensor imaging reliably detects experimental traumatic axonal injury and indicates approximate time of injury. J Neurosci 2007;27:11869-11876 https://doi.org/10.1523/JNEUROSCI.3647-07.2007
  28. Morisaki S, Kawai Y, Umeda M, Nishi M, Oda R, Fujiwara H, et al. In vivo assessment of peripheral nerve regeneration by diffusion tensor imaging. J Magn Reson Imaging 2011;33:535-542 https://doi.org/10.1002/jmri.22442
  29. Ford JC, Hackney DB, Alsop DC, Jara H, Joseph PM, Hand CM, et al. MRI characterization of diffusion coefficients in a rat spinal cord injury model. Magn Reson Med 1994;31:488-494 https://doi.org/10.1002/mrm.1910310504
  30. Sakai K, Yamada K, Oouchi H, Nishimura T. Numerical simulation model of hyperacute/acute stage white matter infarction. Magn Reson Med Sci 2008;7:187-194 https://doi.org/10.2463/mrms.7.187
  31. Chang KJ, Kamel IR, Macura KJ, Bluemke DA. 3.0-T MR imaging of the abdomen: comparison with 1.5 T. Radiographics 2008;28:1983-1998 https://doi.org/10.1148/rg.287075154
  32. Olsrud J, Latt J, Brockstedt S, Romner B, Bjorkman-Burtscher IM. Magnetic resonance imaging artifacts caused by aneurysm clips and shunt valves: dependence on field strength (1.5 and 3 T) and imaging parameters. J Magn Reson Imaging 2005;22:433-437 https://doi.org/10.1002/jmri.20391
  33. Wiesinger F, Van de Moortele PF, Adriany G, De Zanche N, Ugurbil K, Pruessmann KP. Potential and feasibility of parallel MRI at high field. NMR Biomed 2006;19:368-378 https://doi.org/10.1002/nbm.1050
  34. Miyoshi S, Sekiguchi M, Konno S, Kikuchi S, Kanaya F. Increased expression of vascular endothelial growth factor protein in dorsal root ganglion exposed to nucleus pulposus on the nerve root in rats. Spine (Phila Pa 1976) 2011;36:E1-E6 https://doi.org/10.1097/BRS.0b013e3181d345fa
  35. Kobayashi S, Uchida K, Kokubo Y, Takeno K, Yayama T, Miyazaki T, et al. Synapse involvement of the dorsal horn in experimental lumbar nerve root compression: a light and electron microscopic study. Spine (Phila Pa 1976) 2008;33:716-723 https://doi.org/10.1097/BRS.0b013e318169500e

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