弥散张量成像技术定位腰椎管狭窄责任节段的临床应用价值  

Clinicalapplication value of diffusion tensor imaging in the location of responsible segment in lumbar spinal stenosis

作　　者：陈适 徐鹏[1] 葛鹏[1] 王海宝[1] 申才良[1] 刘畅[1] CHEN Shi;XU Peng;GE Peng;WANG Hai-bao;SHEN Cai-liang;LIU Chang(Department of Orthopedics,the First Affiliated Hospital of Anhui Medical University,Hefei,Anhui 230022,China)

机构地区：[1]安徽医科大学第一附属医院骨科脊柱外科病区,安徽合肥230022

出　　处：《颈腰痛杂志》2020年第5期548-552,共5页The Journal of Cervicodynia and Lumbodynia

基　　金：安徽省高校自然科学研究项目(编号:KJ2018A0661)。

摘　　要：目的研究磁共振弥散张量技术(diffusion tensor technique,DTI)在多节段腰椎管狭窄症责任节段定位方面的可行性,进而探讨其指导后路腰椎椎管减压手术方案制定的临床应用价值。方法选取2019年2月~2019年10月于本院收治的多节段腰椎管狭窄症患者40例,随机分组为试验组和对照组各20例。两组受检者均行DTI及常规MRI检查,对患者神经根各项异性分数(fractional anisotropy,FA)值、表观扩散系数(apparent diffusion coefficient,ADC)值进行测量和统计学比较,验证既往研究结论。试验组患者依据DTI参数及神经根纤维束成像结果认定责任节段,对照组根据常规MRI和临床经验认定责任节段,两种方法认定责任节段数量进行比较,并分组根据不同认定结果进行手术治疗。术前、术后应用腰椎JOA评分以及下腰痛视觉模拟评分(visual analogue scale-Back pain,VAS-BP)、下肢痛视觉模拟评分(visual analogue scale-Leg pain,VAS-LP)评估手术疗效,对比评价DTI在指导手术责任节段定位的临床应用价值。结果在定位多节段腰椎管狭窄症责任节段方面,纳入病例可疑受累神经根的FA值明显低于其他节段神经根,ADC值则明显较高,差异有统计学意义(P<0.05)。试验组认定责任节段数量明显少于对照组,差异有统计学意义(P<0.05)。试验组和对照组依据不同的责任节段认定方案进行手术治疗后,JOA、VAS评分均可见明显改善,差异无统计学意义(P>0.05)。结论DTI相较于常规MRI,可通过量化手段对多节段腰椎管狭窄症中腰骶神经根的受压情况进行更精准的评估,对于指导多节段腰椎管狭窄症手术治疗具有积极的临床应用价值。Objective To investigate the feasibility of location of responsible segments in multi-segment lumbar spinal stenosis by using diffusion tensor imaging(DTI),and to further explore its clinical application value in guiding the formulation of surgical procedures for posterior lumbar spinal decompression.Methods From February 2019 to October 2019,40 patients with multilevel lumbar spinal stenosis in our hospital were randomly divided into the experimental group and the control group,with 20 cases in each group.DTI and conventional MRI were performed in both two groups.The fractional anisotropy(FA)and apparent diffusion coefficient(ADC)values were measured and statistically compared to verify the previous findings.Patients in the experimental group were identified as responsible segments according to DTI parameters and nerve root fiber bundle imaging results,while patients in the control group were identified as responsible segments according to conventional MRI and clinical experience.The number of responsible segments identified by two methods was compared,and surgical treatment was performed according to different identified results.Preoperative and postoperative lumbar JOA score,visual analogue score of low back pain(VAS-BP)and visual analogue score of leg pain(VAS-LP)were used to evaluate the surgical efficacy,and the clinical application value of DTI in guiding the localization of surgical responsibility segment was evaluated.Results In terms of locating the responsible segments of multi-segment lumbar spinal stenosis,FA value of the nerve roots suspected to be involved in the included cases was significantly lower than that of other segments,ADC value was significantly higher,and the difference was statistically significant(P<0.05).The number of responsible segments in the experimental group was significantly lower than that in the control group,and the difference was statistically significant(P<0.05).JOA and VAS scores were significantly improved in the experimental group and the control group according to dif

关 键 词：腰椎管狭窄症 弥散张量成像 表观张量系数 各向异性分数 椎管减压手术 

分 类 号：R445[医药卫生—影像医学与核医学] R681.5[医药卫生—诊断学]