腰椎终板病损的磁共振影像学表现及相关病理机制研究

A recent study reported that the time-point prevalence of low back pain is as high as 26% in Chinese adults. Common back pain substantially impairs patient's quality of life and influences industrial production in China. The current understanding of etiology and pathomechanism of back pain is somehow limited, while related research typically focused on the intervertebral disc. Our previous work revealed that lumbar endplate lesions (pathologies involving the interface issue endplate) are common and are associated with both disc degeneration and back pain, with an estimated prevalence rate of 45.6%. As a newly identified pathology, much of endplate lesions remains unexplored, such as its MR manifestations, pathologic entities, and the cascade pathologic reactions it introduced in the vertebra-endplate-disc complex. The proposed project will collect adult cadavers and hire healthy volunteers from general population to scan the lumbar spine with a high resolution MR scanner. Using quantitative MRI analysis and pathoanatomic techniques, the purposes of our study are to investigate the epidemiologic features of endplate lesions, determine the pathological features and MR findings of endplate lesions, and further to explore the consequent pathological changes in the adjacent trabecular bones and the intervertebral disc. As an extension of authors' research on endplate lesions, to date this is a first comprehensive study to specifically disclose fundamental knowledge of endplate lesions using multiple approaches from epidemiology, pathology and clinical imaging. The study will reveal the pathological characteristics and MR findings of endplate lesions and thus, may add scientific knowledge to the better understanding of the pathogenesis of disc degeneration and clinical significance of endplate lesions and Modic Changes.

我国成人下腰痛患病率高达26%，严重损害人民生活质量，影响经济生产。目前对下腰痛的病因和发病机理认识不足，相关研究多侧重椎间盘。我们的前期研究表明，终板病损(发生于终板的病变)是一个与腰椎间盘退变和下腰痛都相关的常见病理，发病率可达45.6%。终板病损的MR影像学表现、病理学特征及其在邻近松质骨和椎间盘所引发的病理改变目前均尚未明了。本项目将收集腰段脊柱标本，招募一般人群志愿者，行腰椎高分辨率MR扫描，运用量化MR分析技术和解剖病理学技术，进一步探索终板病损的流行病学特点、MR影像学表现、病理学特征及其在松质骨-终板-椎间盘复合体引发的病理反应；并探讨终板病损与腰椎间盘退变和Modic Changes的相关关系。本项目是申请人终板研究的进一步拓展和延伸，将首次揭示终板病损的病理特征和MR表现，为探讨腰椎间盘退变的病理机制、阐明终板病损和Modic Changes的临床意义提供重要的科学依据

我国成人下腰痛患病率高达26%，严重损害人民生活质量，影响经济生产。Modic改变和终板病损是腰椎MRI中常见征象，并可能与腰椎间盘退变和下腰痛相关。目前，Modic改变和终板病损的病理学特征、流行病学特征以及在腰痛中的作用均尚未明了。我国人口占全球人口的1/4，目前尚无基于一般人群的腰痛和病因学一般人群流行病学研究。..课题组打造了我国首个专门研究腰痛的大型流行病学数据库（杭州腰椎研究），目前完成538例一般人群样本的腰痛问卷、腰椎MR、DNA采集及双能X线骨密度检查；在此基础上开展一系列Modic改变和终板缺损研究：1）首次明确国人一般人群中Modic改变的发生率约47.3%，其中84.1%为II型；阐明Modic改变好发于下腰椎，尤其L5/S1，且多同时分布于椎间盘的上下终板；Modic改变与椎间盘退变密切相关，提示Modic改变与椎间盘退变并行的退行性改变；首次阐明II型Modic改变不仅仅是脂肪化，其中可能还存在着包括炎性反应、水肿等其他病理机制；2）创建MRI中终板病损的分类方法，根据形态学特征，将终板病损分为focal defects、corner defects和erosive defects三大类；发现终板缺损与Modic改变和椎间盘退变均密切相关，提示终板缺损可能是引起Modic改变和椎间盘退变的初始病因；并进一步证实终板病损是引起腰痛的一个重要病因；3）终板病损和Modic改变、椎间盘退变三者之间的相互影响，互为因果，是重要的腰椎退变征象；4）确定了椎间盘退变量化测量的最佳方法，实现椎间盘退变的量化测量，开发了一个智能化、专门量化测量腰椎MR的软件Spine Explorer，为进一步开展大规模流行病学研究奠定基础。..以上系列研究，课题组提出腰椎终板病损是一个与Modic改变、椎间盘退变以及腰痛都密切相关的重要的影像学征象，临床可以协助腰痛的诊断。该课题明确了国人腰椎多个流行病学参数，填补了腰痛及其病因学多个空白，具有重要的临床意义。.