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| 弥散张量成像参数比值对脊髓型颈椎病临床症状及预后的评估价值 |
| 王琨1△,陈士跃2△,陈智1,张帆1,宋庆鑫1,侯藏龙1,唐沂星1,郝强2,沈洪兴1* |
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(1. 第二军医大学长海医院脊柱外科, 上海 200433;
2. 第二军医大学长海医院影像医学科, 上海 200433
△共同第一作者
*通信作者) |
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| 摘要: |
| 目的 探讨磁共振(MR)弥散张量成像(DTI)的表观扩散系数(apparent diffusion coefficient, ADC)比值、各向异性分数(fractional anisotropy, FA)比值对脊髓型颈椎病(CSM)的临床症状及预后的评估价值。方法 对入选的50例CSM患者及36例正常对照人群进行MRI及DTI检查,选择脊髓白质前索、侧索、后索和中央灰质4个部位作为感兴趣区(ROI),CSM组测量和计算脊髓受压最重平面与C1/2平面的ADC比值和FA比值,正常对照人群测量和计算C3/4、C4/5、C5/6、C6/7平面与C1/2平面的ADC比值、FA比值。对比正常对照人群不同节段、不同年龄间DTI参数比值的差异;对比DTI参数(ADC、FA)和参数比值(ADC比值、FA比值)与CSM患者临床症状(JOA评分)及预后(JOA改善率)相关性的差异;CSM患者按术前JOA评分分为轻度损伤组、中度损伤组、重度损伤组,比较各组间DTI参数比值的差异;按术后JOA改善率分为优、中、差3组,比较各组间DTI参数比值的差异。结果 正常对照人群不同年龄组间4个部位ADC比值、FA比值间差异无统计意义;C3/4、C4/5、C5/6、C6/7各平面间脊髓白质前索、侧索、后索ADC比值、FA比值差异均有统计学意义(P<0.05)。相关分析显示:脊髓前索、侧索、后索和中央灰质的ADC比值、FA比值与JOA评分、JOA改善率相关性优于ADC值、FA值(P<0.05或P<0.01),且FA比值优于ADC比值。与正常对照人群相比,轻度损伤组、中度损伤组、重度损伤组患者ADC比值逐渐升高,FA逐渐降低,差异有统计学意义(P<0.05);与正常对照人群相比,改善率为优、中、差3组CSM患者ADC比值逐渐升高,FA比值逐渐降低,差异有统计学意义(P<0.05)。结论 DTI参数比值可消除年龄因素的影响,与CSM患者症状及预后有更优的相关性,可能具有较好的CSM临床症状及预后评估价值。 |
| 关键词: 脊髓型颈椎病 弥散张量成像 表观扩散系数 各向异性分数 |
| DOI：10.3724/SP.J.1008.2015.00268 |
| 投稿时间：2014-07-08修订日期：2014-12-12 |
| 基金项目:第二军医大学长海医院"1255"计划基金 (CH12550900). |
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| Value of magnetic resonance diffusion tensor imaging ratios in evaluating clinical symptoms and prognosis of cervical spondylotic myelopathy |
| WANG Kun1△,CHEN Shi-yue2△,CHEN Zhi1,ZHANG Fan1,SONG Qing-xin1,HOU Cang-long1,TANG Yi-xing1,HAO Qiang2,SHEN Hong-xing1* |
(1. Department of Orthopedics, Changhai Hospital, Second Military Medical University, Shanghai 200433, China;
2. Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
△Co-first authors.
*Corresponding author) |
| Abstract: |
| Objective To explore the value of the apparent diffusion coefficient (ADC) ratio and fractional anisotropy (FA) ratio of magnetic resonance (MR) diffusion tensor imaging (DTI) in evaluating the clinical symptoms, prognosis of cervical spondylotic myelopathy (CSM). Methods Thirty-six healthy subjects and fifty CSM patients were involved and received MRI examination. Regions of interest (ROIs) were selected in the ventral funiculus (VF), lateral funiculi (LF), dorsal funiculus (DF), and central gray matter (GM) for ADC and FA measurements. In the control group, ADC and FA ratios were calculated using the original values at the C3/4, C4/5, C5/6, and C6/7 levels to divide the corresponding values at their C1/2 levels. In the CSM group, ADC and FA ratios were calculated using the ADC and FA values at the most compressed levels to divide the corresponding values at their C1/2 levels. In the control group, the variances of the two ratios were compared between different cervical levels and ages. CSM patients were divided into mild, moderate, and severe group according to the preoperative Japanese Orthopaedic Association (JOA) scoring system, and were divided into well, moderate, and poor group according to the postoperative JOA recovery rates. Correlations between DTI parameters, DTI ratios of the VF, LF, DF, and GM of the CSM patients and the JOA scores, JOA recovery rates were assessed among different clinical symptom subgroups and prognosis subgroups. Results In control group, DTI ratios (ADC ratios and FA ratios) in VF, LF, DF, and GM were significantly different between C3/4, C4/5, C5/6, and C6/7 levels(P<0.05), but not found between different age subgroups. Correlations between DTI ratios of the VF, LF, DF, and GM and JOA scores, JOA recovery rates were significantly superior than the correlations between DTI parameters and JOA scores, JOA recovery rates (P<0.05 or P<0.01), with the FA ratio being superior to the ADC ratio. Compared with normal control group, the ADC ratios increased gradually in order and FA ratios decreased gradually in the mild, moderate, and severe injury subgroups (P<0.05). Compared with normal control group, the ADC ratios increased gradually in order and FA ratios decreased gradually in the well, moderate, and poor recovery subgroups(P<0.05). Conclusion DTI ratios might eliminate the influence of age in evaluating the clinical symptoms and prognosis of CSM. Therefore DTI ratios, compared with DTI parameters, may better evaluate the clinical symptoms, prognosis of CSM. |
| Key words: cervical spondylotic myelopathy diffusion tensor imaging apparent diffusion coefficient fractional anisotropy |
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