磁共振扩散张量成像对早期脊髓型颈椎病的诊断价值  

Diagnostic value of diffusion tensor imaging in early cervical spondylotic myelopathy

作　　者：信瑞强[1] 宋莉 郭冉 李凤菊 钟佳利[1] 赵爽[1] 彭如臣[1] XIN Ruiqiang;SONG Li;GUO Ran(Department of Radiology,Luhe Hospital Affiliated to Capital Medical University,Beijing 101149,China;不详)

机构地区：[1]首都医科大学附属北京潞河医院放射科,北京市101149 [2]内蒙古自治区赤峰市翁牛特旗医院核磁共振室 [3]武警河北省总队医院放射科

出　　处：《河北医药》2021年第11期1649-1652,共4页Hebei Medical Journal

摘　　要：目的探讨磁共振扩散张量成像(DTI)相关定量参数值对T2WI无高信号脊髓型颈椎病(CSM)患者的诊断价值。方法回顾性分析40例T2WI无高信号CSM患者和38例健康志愿者即对照组的颈髓DTI图像。经后处理得到各向异性分数(FA)、表观扩散系数(ADC)、轴向弥散系数(AD)和径向弥散系数(RD)值。使用独立样本t检验分析2组定量参数值差异;采用受试者工作特征(ROC)曲线分析各定量参数值以及定量参数值两两联合的诊断效能,并采用Delong检验对各定量参数的曲线下面积(AUC)进行两两比较。结果CSM组FA值(0.572±0.063)低于对照组(0.643±0.069),2组差异有统计学意义(P<0.01);CSM组ADC值(1.503±0.464)、AD值(2.365±0.424)及RD值(0.983±0.345)均高于对照组[分别为(1.138±0.130)、(2.037±0.207)、(0.685±0.134)],差异均有统计学意义(均P<0.01);各参数中RD值诊断CSM的AUC最大,为0.822,当诊断临界值为0.782时,敏感性和特异性分别为72.5%和84.2%;FA与ADC、FA与AD联合使用诊断CSM的AUC最大,分别为0.841和0.846;FA与ADC、FA与AD联合使用诊断CSM的AUC分别大于单独使用ADC(0.790)值和AD(0.740)值,差异均有统计学意义(均P<0.05)。结论DTI相关定量参数可能在常规T2WI显示颈髓高信号之前早期客观定量评估颈髓微观结构的变化,FA与ADC、FA与AD联合使用具有较大诊断价值。Objective To investigate the diagnostic value of diffusion tensor imaging(DTI)parameters in diagnosis of cervical spondylotic myelopathy(CSM)without hyperintensity on T2-weighted imaging(T2WI).Methods The DTI image data about 40 CSM patients without hyperintensity on T2WI and 38 healthy volunteers were retrospectively analyzed.The fractional anisotropy(FA),apparent diffusion coefficient(ADC),axial Diffusivity(AD),and radial diffusivity(RD)were obtained by post-processing.Independent sample t-test was used to analyze the differences of quantitative parameters between the two groups,and the receiver operating characteristic(ROC)curve was used to analyze the diagnostic performance of quantitative parameters and the combination of quantitative parameters,moreover,the area under the curve(AUC)of quantitative parameters was compared by Delong test.Results The FA value in CSM group was significantly lower than that in control group(P<0.01).The ADC value,AD value and RD value in CSM group were significantly higher than those in control group(P<0.01).The greatest AUC of RD value in the indexes of diagnosis of CSM was 0.822,when the cut off value was 0.782,the sensitivity and specificity were 72.5%and 84.2%,respectively.The AUC values of FA combined with ADC and FA combined with AD in diagnosis of CSM were the largest,which were 0.841 and 0.846,respectively.The AUC values of FA combined with ADC and FA combined with AD in diagnosis of CSM was significantly higher than that of ADC(0.790)and AD(0.740)only(P<0.05).Conclusion The quantitative parameters of DTI may evaluate objectively and quantitatively the changes of cervical spinal cord microstructure in early stage before the development of T2 hyperintensity on conventional sequences.The combination application of FA and ADC or FA and AD has better diagnostic value.

关 键 词：脊髓型颈椎病 扩散张量成像 诊断效能 受试者工作特征曲线 

分 类 号：R681.53[医药卫生—骨科学]