CT number를 이용한 퇴행성 척추원반 질환 진단의 유용성
Diagnostic Usefulness of Degenerative Disc Disease Using the CT Number
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초록
본 연구에서는 퇴행성 척추원반의 등급별 빈도를 조사하고, 해당 부위 척추원반의 높이 및 CT number를 계측하여 한국인의 생체 연구에 대한 기초 자료를 제공하고자 하였다. 허리통증으로 자기공명영상을 촬영한 환자 412명(남자 221명, 여자 191명)을 대상으로, 허리엉치부위 세 곳의 영상을 이용하여 퇴행성 척추원반의 등급 분류 및 높이를 계측하였으며, 또한 컴퓨터단층촬영장치로 퇴행성 척추원반에 대한 CT number를 계측하였다. 평균 연령은 49.47세였다. 성별에 따른 퇴행성 등급은 셋째허리뼈-넷째허리뼈 사이의 경우 연관성은 나타내지 않았지만, 넷째허리뼈-다섯째허리뼈 사이는 남자가 3등급이 21.47%, 여자는 4등급이 24.3%였고(p<0.001), 다섯째허리뼈-첫째엉치뼈 사이는 4등급이 남자 23.8%, 여자 27.4%로 가장 빈도가 높았으며, 성별에 따라 퇴행성 등급의 유의한 차이를 나타냈다(p<0.05). 그리고 척추원반의 높이 계측 결과, 1등급은 10.71 ± 1.47 mm, 2등급은 9.95 ± 1.35 mm, 3등급은 9.65 ± 1.62 mm, 4등급은 8.70 ± 1.74 mm, 마지막으로 5등급은 6.52 ± 1.89 mm로 나타났으며, 등급이 높아짐에 따라 척추원반의 높이가 낮아지는 특징을 보였다(p<0.001). 또한, 퇴행성 등급에 따른 CT number는 1등급에서 5등급까지 각각, 57.34 ± 4.66 HU, 67.64 ± 3.97 HU, 75.75 ± 3.90 HU, 86.51 ± 6.14 HU, 112.48 ± 10.89 HU로 나타나, 등급이 높아짐에 따라 CT number도 증가하는 유의한 차이를 나타냈다(p<0.001). 따라서 본 연구의 결과는 한국인에서 척추원반의 높이 및 CT number가 척추원반의 퇴행 정도를 판단하는 하나의 지표로 작용하여 임상적으로 유용하게 활용될 수 있을 것으로 생각된다.
Abstract
This study aimed to determine the prevalence of each grade of degenerative disc disease (DDD) and to measure the height and computed tomography (CT) numbers of intervertebral discs in affected regions. A total of 412 patients (221 males and 191 females) who underwent magnetic resonance imaging (MRI) for back pain were included in the study. DDD grades were classified, and disc heights were measured using three images from the lumbosacral region. The CT number, measured in Hounsfield unit (HU), for DDD was obtained using CT scans. The average age of the subjects was 49.47 years. In the disc between the 3rd and 4th lumbar vertebrae, no significant difference in degenerative grades was found between genders. However, in the disc between the 4th and 5th vertebrae, grade 3 was observed in 21.47% of male subjects, while grade 4 was found in 24.3% of female subjects (p<0.001). Additionally, in the disc between the 5th lumbar vertebra and the 1st sacral vertebra, grade 4 was the most common degenerative grade in both males (98 cases, 23.8%) and females (113 cases, 27.4%), with a significant difference between genders (p<0.05). Regarding intervertebral disc height, discs in grade 1 measured 10.71 ± 1.47 mm, those in grade 2 measured 9.95 ± 1.35 mm, in grade 3 measured 9.65 ± 1.62 mm, in grade 4 measured 8.70 ± 1.74 mm, and in grade 5 measured 6.52 ± 1.89 mm. This shows a trend of decreasing disc height as the degeneration grade increased (p<0.001). Furthermore, the CT numbers according to the degenerative grade were 57.34 ± 4.66 HU in grade 1, 67.64 ± 3.97 HU in grade 2, 75.75 ± 3.90 HU in grade 3, 86.51 ± 6.14 HU in grade 4, and 112.48 ± 10.89 HU in grade 5, all showing significant differences (p<0.001). Based on the results of this study, disc height and CT numbers (HU) could be clinically useful indicators for assessing the degree of DDD in Koreans.
참고문헌 (32)
- Urits I, "Low back pain, a comprehensive review : pathophysiology, diagnosis, and treatment", Curr Pain Headache Rep, 23, pp.1~10 (2019)
- Boden SD, "Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation", J Bone Joint Surg Am, 72, pp.403~408 (1990)
- Dutmer AL, "Personal and societal impact of low back pain : the groningen spine cohort", Spine(Phila Pa 1976), 44, pp.E1443~E1451 (2019)
- GBD 2021 Low Back Pain Collaborators, "Global, regional, and national burden of low back pain, 1990-2020, its attributable risk factors, and projections to 2050 : a systematic analysis of the global burden of disease study 2021", Lancet Rheumatol, 5, pp.e316~e329 (2023)
- Carpes FP, "Effects of a program for trunk strength and stability on pain, low back and pelvis kinematics, and body balance : a pilot study", J Bodyw Mov Ther, 12, pp.22~30 (2008)
- Basler HD, "Good postural habits : a pilot investigation using EMG scanning of the paraspinals", Appl Psychophys Biof, 22, pp.171~182 (1997)
- Yaltirik CK, "The evaluation of proteoglycan levels and the possible role of ACAN gene(c. 6423T>C)variant in patients with lumbar disc degeneration disease", In Vivo, 33, pp.413~417 (2019)
- Iatridis JC, "Measurements of proteoglycan and water content distribution in human lumbar intervertebral discs", Spine(Phila Pa 1976), 32, pp.1493~1497 (2007)
- Lv B, "Relationship between endplate defects, modic change, disc degeneration, and facet joint degeneration in patients with low back pain", Biomed Res Int, 2019, pp.9369853~ (2019)
- Belykh E, "Apparent diffusion coefficient maps in the assessment of surgical patients with lumbar spine degeneration", PLoS One, 12, pp.e0183697~ (2017)[DOI]
- Ji Y, "Intervertebral disc degeneration associated with vertebral marrow fat, asses-sed using quantitative magnetic resonance imaging", Skeletal Radiol, 49, pp.1753~1763 (2020)
- Murto N, "Reliability of T2-weighted signal intensity-based quantitative measurements and visual grading of lumbar disc degeneration on MRI", Acta Radiol, 64, pp.2145~2151 (2023)
- Thompson JP, "Preliminary evaluation of a scheme for grading the gross morphology of the human intervertebral disc", Spine, 15, pp.411~415 (1990)
- Hong CH, "Measurement of the normal lumbar intervertebral disc space using magnetic resonance imaging", Asian Spine J, 4, pp.1~6 (2010)
- Becker SH, "Cost benefits of picture archiving and communication system", J Am Med Inform Assoc, 1, pp.361~371 (1994)
- Mohd Isa IL, "Discogenic low back pain : anatomy, pathophysiology and treatments of intervertebral disc degeneration", Int J Mol Sci, 24, pp.208~ (2022)
- Näther P, "Distribution patterns of degeneration of the lumbar spine in a cohort of 200 patients with an indication for lumbar MRI", Int J Environ Res Public Health, 19, pp.3721~ (2022)
- Oh CH, "Whole spine disc degeneration survey according to the ages and sex using pfirrmann disc degeneration grades", Korean J Spine, 14, pp.148~154 (2017)
- Wang YXJ, "Lumbar degenerative spondylolisthesis epidemiology : a systematic review with a focus on gender-specific and age-specific prevalence", J Orthop Translat, 11, pp.39~52 (2016)
- Mosley GE, "Males and females exhibit distinct relationships between intervertebral disc degeneration and pain in a rat model", Sci Rep, 10, pp.15120~ (2020)
- Saleem S, "Lumbar disc degenerative disease : disc degeneration symptoms and magnetic resonance image findings", Asian Spine J, 7, pp.322~334 (2013)
- So TY, "Lower prevalence and severity of degenerative changes in the lumbar spine in elderly Hong Kong Chinese compared with age-matched Italian Caucasian women", Spine(Phila Pa 1976), 47, pp.1710~1718 (2022)
- Brinjikji W, "Systematic literature review of imaging features of spinal degeneration in asymptomatic populations", AJNR Am J Neuroradiol, 4, pp.811~816 (2015)
- Zafar K, "Frequency of lumber disc degenerative diseases in patients with and without radiculopathy and low back pain using magnetic resonance imaging", Pak Biomed J, 5, pp.261~265 (2022)
- Chen XL, "Relation of lumbar intervertebral disc height and severity of disc degeneration based on Pfirrmann scores", Heliyon, 9, pp.e20764~ (2023)[DOI]
- Teichtahl AJ, "A dose-response relationship between severity of disc degeneration and intervertebral disc height in the lumbosacral spine", Arthritis Res Ther, 17, pp.297~ (2015)
- Antoniou J, "The human lumbar intervertebral disc : evidence for changes in the biosynthesis and denaturation of the extracellular matrix with growth, maturation, ageing, and degeneration", J Clin Invest, 98, pp.996~1003 (1996)
- Blumenkrantz G, "In vivo 3. 0-tesla magnetic resonance T1ρ and T2 relaxation mapping in subjects with intervertebral disc degeneration and clinical symptoms", Magn Reson Med, 63, pp.1193~1200 (2010)
- Yang B, "Direct quantification of intervertebral disc water content using MRI", J Magn Reson Imaging, 52, pp.1152~1162 (2020)
- Bryant JA, "CT number definition", Radiat Phys Chem, 81, pp.358~361 (2012)
- Lin Y, "Propionibacterium acnes induces intervertebral disc degeneration by promoting nucleus pulposus cell apoptosis via the TLR2", JNK, Emerg Microbes Infect, pp.2018, 7[DOI]
- Zeldin L, "Spatial mapping of collagen content and structure in human intervertebral disk degeneration", JOR Spine, 3, pp.e1129~ (2020)[DOI]