脊髓型颈椎病患者3T MR扩散张量成像测量参数值与临床表现的相关性研究  

Correlation study between 3 T MR DTI measurements and clinical symptoms in patients with cervical spondylotic myelopathy

作　　者：袁逍[1] 高思佳[1] 刘秀香[1] 蒋旭远[1] 李燕燕[1] 王永峰[1] 曹际斌[1] 白璐娜[1] 徐克[1] 

机构地区：[1]中国医科大学第一附属医院放射科,沈阳110001

出　　处：《中华放射学杂志》2012年第3期225-229,共5页Chinese Journal of Radiology

摘　　要：目的探讨3TMRDTI各测量值与脊髓型颈椎病临床症状的相关性。方法选取颈椎病患者104例，根据日本骨科学会17分法脊髓损害功能评定标准（JOA评分）将其分为轻（31例、13—16分），中（27例、9～12分），重度（25例、5—8分）及严重（21例、0—4分）4组。按病变部位脊髓信号特征分为3组：A组33例，T1WI、T2WI均未见异常信号；B组30例，T1WI无异常信号，T2WI呈高信号；C组41例，T1WI呈低信号，T2WI呈高信号。所有患者均行DTI，测量受压严重节段脊髓的各向异性分数（FA）、ADC值及本征值（λ1、λ2、λ3），并行颈髓纤维束成像。采用Spearman相关性分析法分析各测量参数值与JOA评分的相关性，采用单因素方差分析比较各组间测量参数。结果所有受检者DTI显示满意。轻、中、重度及严重4组FA值分别为0．69±0．13、0．58±0．03、0．46．±0．08、0．37±0．11，组间比较差异有统计学意义（F=100．59，P〈0．05）。JOA评分与FA值呈正相关（r=0．883，P〈0．05）。JOA评分与ADC及λ1、λ2、λ3值无相关性（r值分别为0．232、0．217、0．113、0．127，P值均〉0．05）。A、B、C3组FA值分别为0．67±0．33、0．51±0．21、0．38±0．03，组问比较差异有统计学意义（F=50．05，P〈0．05）。随着临床症状加重，即JOA评分降低，FA值呈降低趋势；且随着rr2高信号的出现，其FA值也呈降低趋势，FA值越低，其纤维束损害越明显。ADC、入：、k值在轻、中、重度及严重4组问及在A、B、C3组间比较，差异均有统计学意义，入．在各组问比较差异均无统计学意义。结论FA值的改变与临床症状呈正相关，且FA值越低，其纤维束损害越明显。DTI可以反映病变的严重程度及脊髓纤维束受压损伤的范围。Objective To evaluate the correlation between diffusion tensor imaging （DTI） ts, fiber tracking （FT） and the clinical symptoms in patients with cervical spondylotic myelopathy. Methods According to the Japanese orthopaedics association score （JOA）, 104 patients with cervical spondylopathy were divided into 4 groups： mild in 31 patients with 13--16 scores, moderate in 27 with 9--12 scores, severe in 25 with 5--8 scores, and serious in 21 with 0----4 scores. According to the lesion signal characters, all patients were divided into 3 groups： Group A with normal signal in both TI WI and T2WI in 33 patients, Group B with normal signal in TIWI but high signal in T2WI in 30 patients, and Group C with low signal in TIWI and high signal in T2WI in 41 patients. Apparent diffusion coefficient （ADC）, fractional anisotropy（FA）, λ1、λ2、λ3 were measured in the spinal cord at the serious pressed section, and fiber tractography was performed. The Spearman correlation analyses was used to correlate each of the DTI t with JOA score. Group difference was tested with one-way ANOVA method. Results High quality of DTI was acquired in all patients. The FA values in the mild, moderate, severe, and serious Decrease of JOA score and high signal in T2 companied with decrease of FA value.Decrease of FA values was found associated with increase of fiber bundle damage. The ADC, λ2、λ3 but not hi were significantly different among the JOA groups and the group A, B, and C. Conclusions The FA values are positively correlated with clinical symptoms. Decrease of FA values is found associated with increase of fiber bundle damage. DTI can show the severity and extent of damage of spinal cord in patients with cervical spondylotic myelopathy.

关 键 词：磁共振成像 弥散 颈椎病 

分 类 号：R445.2[医药卫生—影像医学与核医学]