弥散张量成像参数及参数比值在脊髓型颈椎病诊断中的应用  

The value of parameters and parameter ratios of diffusion tensor imaging in diagnosing cervical spondylotic myelopathy

作　　者：陈文静[1] 张傲 汪青山[1] 陈对梅[1] 叶振中[1] Chen Wenjing;Zhang Ao;Wang Qingshan;Chen Duimei;Ye Zhenzhong(Department of Radiology,Guangdong Second Traditional Chinese Medicine Hospital,Guangdong Research Institute of Traditional Chinese Medicine Manuracturing Technology,Guangzhou 510095,China)

机构地区：[1]广东省第二中医院放射科广东省中医药工程技术研究院,广州510095

出　　处：《中华生物医学工程杂志》2021年第6期649-655,共7页Chinese Journal of Biomedical Engineering

摘　　要：目的探讨脊髓型颈椎病(CSM)患者颈髓弥散张量成像(DTI)的参数特征及其用于判断脊髓损伤程度的价值。方法纳入2018年4月至2020年11月本院收治的CSM患者44例为CSM组,以同期本院因体检或其他原因行颈椎MRI检查且结果显示正常者35例为对照组,均接受颈脊髓MRI常规检查和DTI检查。CSM组进行脊髓损伤程度评价,按日本矫外科协会(JOA)评分分为轻、中、重度组,测量颈脊髓最大受压节段和C_(1,2)节段的表观扩散系数(ADC)和各向异性分数(FA),计算最大受压节段与C_(1,2)节段的ADC比值和FA比值。对照组测量C_(1,2)、C_(3,4)、C_(4,5)、C_(5,6)、C_(6,7)节段ADC值、FA值,计算相应部位与C_(1,2)节段的ADC比值和FA比值。探讨DTI相关参数FA值、FA比值、ADC值及ADC比值对CSM患者脊髓损伤程度的诊断价值。结果对照组颈髓FA值在C_(1,2)节段较低,C_(3,4)节段最高,C_(3,4)~C_(6,7)节段FA值及FA比值呈下降趋势(F=9.850,P<0.05);颈髓ADC值在C_(1,2)节段较高,C_(3,4)节段最低,而C_(3,4)~C_(6,7)节段ADC值及ADC比值呈上升趋势(F=19.590,P<0.05)。对照组及不同脊髓损伤程度CSM组颈髓FA值、FA比值、ADC值、ADC比值组间比较,差异均有统计学意义(均P<0.05);且随着病变程度增加FA值及FA比值均逐渐降低,ADC值及ADC比值均逐渐升高。对照组及不同脊髓损伤程度CSM组FA值、FA比值组间两两比较,差异均有统计学意义(均P<0.05)。CSM患者中,轻度组与中度组ADC值比较差异无统计学意义(P>0.05);其他组间ADC值两两比较,差异均有统计学意义(均P<0.05)。轻度、中度、重度组ADC比值组间两两比较,差异均有统计学意义(均P<0.05)。结论DTI相关参数及参数比值可以量化CSM患者脊髓功能受损程度,反应病情严重程度。FA比值及ADC比值对于诊断CSM和判断脊髓损伤严重程度具有一定的价值。Objective To investigate the parametric characteristics of cervical spinal cord diffusion tensor imaging(DTI)in patients with cervical spondylotic myelopathy(CSM)and its value in determining the severity of spinal cord injury.Methods Forty-four CSM patients admitted to our hospital between April 2018 and November 2020 were included as the CSM group.A contemporary cohort of 35 patients who underwent cervical MRI for physical examination or other reasons during the same period and showed normal results were included as the control group.All patients were subjected to conventional MRI and DTI.The CSM patients were evaluated for severity of spinal cord injury according to Japanese Orthopedic Association(JOA)classification,and were assigned to the mild,moderate and severe injury groups.The apparent diffusion coefficient(ADC)and anisotropy fraction(FA)of the maximum cervical spinal cord compression segment and the C_(1,2)segments were measured,and the ADC ratio and FA ratio of the maximum cervical spinal cord compression segment to C_(1,2)segments were calculated.In the control group,ADC values and FA values of C_(1,2),C_(3,4),C_(4,5),C_(5,6),and C_(6,7)segments were measured,and ADC ratios and FA ratios of these segments to C_(1,2)segments,respectively,were calculated.Thereby we investigated the diagnostic value of DTI related parameters including the FA and FA ratios,ADC and ADC ratios in assessing the spinal cord injury in patients with CSM.Results In the control group,the FA value was low at the C_(1,2)segments and was the highest at the C_(3,4)segments.There was a descending tendency in the values and ratios of FA from C_(3,4)through C_(6,7)segments(F=9.850,P<0.05).The ADC values was relatively high at the C_(1,2)segments and was the lowest at the C_(3,4)segments.There was an ascending tendency in the values and ratios of ADC from C_(3,4)through C_(6,7)segments(F=19.590,P<0.05).Pairwise comparisons on the FA and ADC values and ratios among the control group and CSM patients with varied severity of cervical spinal

关 键 词：弥散张量成像 表观扩散系数 各向异性分数 脊髓型脊椎病 

分 类 号：R681.55[医药卫生—骨科学]