任务态fMRI对脊髓型颈椎病严重程度及手术预后的评价  

Application of task-state fMRI in evaluating disease severity and prognosis of cervical spondylotic myelopathy

作　　者：宋彦澄 康立清[2] 申沧海[3] 刘凤海[2] 冯永健[3] Song Yancheng;Kang Liqing;Shen Canghai;Liu Fenghai;Feng Yongjian(Teaching Hospital of Cangzhou Central Hospital,Tianjin Medical University,Cangzhou 061000,Hebei Province,China;Department of MRI,Cangzhou Central Hospital,Cangzhou 061000,Hebei Province,China;Four Department of Orthopedic Surgery,Cangzhou Central Hospital,Cangzhou 061000,Hebei Province,China)

机构地区：[1]天津医科大学沧州市中心医院教学医院,河北省沧州市061000 [2]沧州市中心医院磁共振成像科,河北省沧州市061000 [3]沧州市中心医院骨四科,河北省沧州市061000

出　　处：《中国组织工程研究》2020年第21期3341-3346,共6页Chinese Journal of Tissue Engineering Research

基　　金：沧州市重点研发计划指导项目(172302149)，项目负责人：申沧海~~

摘　　要：背景:血氧水平依赖功能磁共振(BOLD-fMRI)通过检测大脑功能区活动时血流变化而获得脑功能改变的客观信息。以往关于脊髓型颈椎病的任务态fMRI研究能够观察到患者感觉和运动皮质功能的重构。目的:运用任务态fMRI分析脊髓型颈椎病患者皮质激活的变化程度与临床症状严重程度及手术预后之间的关系。方法:2018年1月至2019年1月收集行颈椎后路减压手术治疗的脊髓型颈椎病患者82例(脊髓型颈椎病组)及健康志愿者45名(正常组)。所有对象均行颅脑fMRI扫描,动作任务均为右手对指任务。采用日本骨科学会(JOA)评分评估患者脊髓功能,术后6个月随访时将JOA评分改善率<50%定义为手术预后不良。结果与结论:①脊髓型颈椎病组术后JOA评分较术前显著改善(P<0.05);②脊髓型颈椎病组术前左侧中央前回的激活体积值较正常组显著升高(P<0.05),左侧中央后回的激活体积值与正常组差异无显著性意义(P>0.05);脊髓型颈椎病组术前左侧激活体积比值(中央前回/中央后回)较正常组显著升高(P<0.05);③术后6个月随访时,脊髓型颈椎病组左侧中央前回的激活体积值较术前显著减低(P<0.05),左侧中央后回的激活体积值与术前差异无显著性意义(P>0.05),左侧激活体积比值较术前显著降低(P<0.05);④相关性分析显示左侧中央前回、中央后回的激活体积值、激活体积比值与术前JOA评分、术后JOA评分改善率间均具有显著相关性(P<0.05)。激活体积比值与术前JOA评分、术后改善率的相关系数绝对值最大;⑤受试者工作特征曲线分析发现术前激活体积比值预测预后不良的曲线下面积为0.803,界值为3.621;术前JOA评分预测预后不良的曲线下面积为0.751,界值为8;激活体积比值的预测效能高于JOA评分;⑥结果表明,脊髓型颈椎病患者任务态fMRI皮质左侧中央前回与中央后回的激活体积比值与临床症状严重程度(JOA评BACKGROUND:Blood oxygenation level dependent functional MRI(BOLD-fMRI)has proven to be a powerful tool for studying the functional change of the brain.In task-state fMRI study,the functional reorganization of sensory and motor cortex has been observed in patients with cervical spondylotic myelopathy.OBJECTIVE:To discuss the correlations between task-state fMRI measurements with clinical symptoms and surgical outcomes of cervical spondylotic myelopathy.METHODS:Eighty-two patients with cervical spondylotic myelopathy undergoing posterior cervical decompression(cervical spondylotic myelopathy group)and forty-five healthy volunteers(normal group)were recruited from January 2018 to January 2019.All subjects underwent fMRI and performed a finger-tapping paradigm with the right hand.The Japanese Orthopaedic Association score was used to evaluate the function of the spinal cord.Japanese Orthopaedic Association score recovery rate less than 50%was defined as a poor result.RESULTS AND CONCLUSION:(1)Japanese Orthopaedic Association score was significantly improved after surgery in the cervical spondylotic myelopathy group compared with that before surgery(P<0.05).(2)The volume of activation(VOA)in the left precentral gyrus was significantly higher in the cervical spondylotic myelopathy group than in the normal group preoperatively(P<0.05).There were no significant differences in the VOA in the left postcentral gyrus between cervical spondylotic myelopathy and normal groups(P>0.05).Before surgery,VOA ratio(left precentral gyrus/left postcentral gyrus)was significantly higher in the cervical spondylotic myelopathy group than in normal group(P<0.05).(3)In 6-month follow-up,the VOA in the left precentral gyrus was significantly reduced compared with that preoperatively in the cervical spondylotic myelopathy group(P<0.05).There were no significant differences in the VOA in the left postcentral gyrus compared with that preoperatively(P>0.05).VOA ratio was significantly decreased compared with that preoperatively(P<0.05).(4)Correl

关 键 词：脊髓型颈椎病 减压术 外科 功能磁共振 皮质重构 JOA评分 

分 类 号：R445.2[医药卫生—影像医学与核医学] R318[医药卫生—诊断学]