脊髓圆锥弥散张量成像扫描在下尿路功能障碍中的应用  

Application of diffusion tensor imaging scanning of conus medullaris in lower urinary tract dysfunction

作　　者：孙浩瑜 高轶[1,2] 吴娟[1,2] 廖利民[1,2,3,4] 靖华芳 张思雨 李东[1,2] 韩春生 SUN Haoyu;GAO Yi;WU Juan;LIAO Limin;JING Huafang;ZHANG Siyu;LI Dong;HAN Chunsheng(Capital Medical University School of Rehabilitation Medicine,Beijing 100068,China;Beijing Bo'ai Hospital,China Rehabilitation Research Center,Beijing 100068,China;China Rehabilitation Science Institute,Beijing 100068,China;Beijing Key Laboratory of Neural Injury and Rehabilitation,Beijing 100068,China)

机构地区：[1]首都医科大学康复医学院,北京市100068 [2]中国康复研究中心北京博爱医院,北京市100068 [3]中国康复科学所,北京市100068 [4]北京市神经损伤与康复重点实验室,北京市100068

出　　处：《中国康复理论与实践》2024年第3期333-338,共6页Chinese Journal of Rehabilitation Theory and Practice

基　　金：北京市自然科学基金项目重点项目(No.7202236);中国康复研究中心科研基金项目(No.2020-12);中央级公益性科研院所基本科研业务费专项资金项目(No.2023CZ-1)。

摘　　要：目的 利用MRI弥散张量成像(DTI)技术寻找膀胱过度活动症(OAB)和膀胱活动低下(UAB)患者脊髓圆锥信号的异常。方法 2021年5月至2023年4月,从北京博爱医院招募下尿路功能障碍患者23例(病例组)。所有患者行盆底电生理检查和影像尿动力检查,根据患者尿动力灌注期膀胱收缩情况,将病例组分为UAB组和OAB组。同时招募健康受试者8例(对照组)。所有受试者行T_(10)~L_(5)脊髓MRI平扫+DTI序列扫描。通过DTI序列对比MRI平扫节段确定脊髓圆锥位置,提取圆锥中段的各向异性分数(FA)、表观弥散系数(ADC)和相对各项异性(RA)。结果 UAB组12例,OAB组11例。病例组盆底电生理检查均存在异常。盆底电生理检查结果显示,UAB组与OAB组间骶反射弧神经传导有显著性差异(P=0.036)。DTI扫描结果显示,与对照组比较,病例组ADC升高(t=2.185, P=0.037);UAB组FA降低(t=3.439, P=0.005),ADC显著升高(t=4.582, P <0.001)。结论 对于下尿路功能障碍患者,DTI有助于寻找脊髓是否存在潜在的病变。FA和ADC是很有价值的脊髓圆锥损伤的诊断指标。Objective To investigate the signal abnormality of conus medullaris in patients with overactive bladder(OAB)and underactive bladder(UAB)by MRI diffusion tensor imaging(DTI).Methods From May,2021 to April,2023,23 patients with lower urinary tract dysfunction without trauma and supraspinal lesions were enrolled(case group).All patients underwent imaging urodynamics and pelvic floor electromyography.Based on the bladder contraction during the filling phase of urodynamics,the patients were divided into UAB group and OAB group.Eight healthy subjects were included as the control group.All participants underwent T_(10) to L_(5) spinal segment MRI scans and DTI scans.The position of conus medullaris was determined by comparing the DTI sequences with the MRI scans.The fractional anisotropy(FA),apparent diffusion coefficient(ADC),and relative anisotropy(RA)of the conus medullaris intermediate segment were compared.Results Twelve cases were in UAB group,and eleven in OAB goup.Abnormalities were found in the pelvic floor electromyography in the case group.There was significant difference in sacral reflex arc nerve conduction testing between UAB and OAB groups(P=0.036).Compared with the control group,ADC increased(t=2.185,P=0.037)in the case group;FA decreased(t=3.439,P=0.005)and ADC increased(t=4.582,P<0.001)in UAB group.Conclusion DTI is helpful to find the potential lesion of spinal cord in patients with lower urinary tract dysfunction.FA and ADC are valuable indicators for the diagnosis of conus medullaris injury.

关 键 词：膀胱过度活动症 膀胱活动低下 脊髓圆锥 弥散张量成像 

分 类 号：R695[医药卫生—泌尿科学]