动态扩散张量成像对脊髓型颈椎病患者手术预后的预测价值  

Predictive value of dynamic diffusion tensor imaging in surgical prognosis of patients with cervical spondylotic myelopathy

作　　者：王晓云 白瑞 张玉金 田笑楠 张迪[4] 王勇 张力 WANG Xiaoyun;BAI Rui;ZHANG Yujin;TIAN Xiaonan;ZHANG Di;WANG Yong;ZHANG Li(School of Medical Imaging,Hebei Medical University,Shijiazhuang 050000,China;Department of Radiology and Nuclear Medicine,the First Hospital of Hebei Medical University,Shijiazhuang 050000,China;CT Room,the Third Hospital of Hebei Medical University,Shijiazhuang 050039,China;Department of Spinal Surgery,the Third Hospital of Hebei Medical University,Shijiazhuang 050039,China)

机构地区：[1]河北医科大学医学影像学院,河北石家庄050000 [2]河北医科大学第一医院放射与核医学科,河北石家庄050000 [3]河北医科大学第三医院CT室,河北石家庄050039 [4]河北医科大学第三医院脊柱外科,河北石家庄050039

出　　处：《实用放射学杂志》2024年第9期1489-1493,共5页Journal of Practical Radiology

基　　金：国家自然科学基金项目(82072454);河北省政府资助临床医学优秀人才培养项目(ZF2024131)。

摘　　要：目的 探讨动态扩散张量成像(DTI)对脊髓型颈椎病(CSM)术后疗效的预测价值,判断不同体位DTI参数是否可作为神经功能预后不良的预测因子.方法 纳入行颈椎减压手术的CSM患者105例.使用改良日本骨科学会(mJOA)评分进行患者术前及术后1年神经功能评估,根据恢复率分为预后良好组(恢复率≥50%)(44例)和预后不良组(恢复率<50%)(61例).基于患者临床特征、影像学特征和动态DTI参数进行单因素分析,有意义的变量进行二元logistic回归分析以确定CSM患者术后预后不良的危险因素.结果 单因素分析结果显示,2组间糖尿病、压迫节段数、术前mJOA评分、最狭窄位置椎管横截面积[自然体位(Area-N)、伸颈位(Area-E)、屈颈位(Area-F)]以及表观扩散系数(ADC)(ADC-N、ADC-E、ADC-F)和各向异性分数(FA)(FA-N、FA-E、FA-F)的差异有统计学意义(P<0.05).二元logistic回归分析显示,Area-N[比值比(OR)0.226;95%置信区间(CI)0.069~0.732,P=0.013]、FA-N(OR 3.028;95%CI 1.12~8.19,P=0.029)、Area-E(OR 0.248;95%CI 0.076~0.814,P=0.021)、FA-E(OR 4.793;95%CI 1.737~13.228,P=0.002)、Area-F(OR 0.288;95%CI 0.095~0.87,P=0.027)、FA-F(OR 2.964;95%CI 1.126~7.801,P=0.028)是预后不良的独立危险因素.FA-E对CSM患者预后不良有重要的预测价值.结论 动态DTI可以预测CSM术后疗效,FA-E值可以作为神经功能预后不良的优良预测因子.Objective To investigate the predictive value of dynamic diffusion tensor imaging(DTI)in the postoperative efficacy of cervical spondylotic myelopathy(CSM)and to determine whether DTI parameters in different positions can be used as predictors of poor neurological prognosis.Methods A total of 105 CSM patients who underwent cervical spine decompression surgery were included.The modified Japanese Orthopedic Association(mJOA)score was used to assess patients'neurological function before surgery and one year after surgery.Patients were divided into two groups based on the recovery rate:the good prognosis group(recovery rate≥50%)(44 cases)and the poor prognosis group(recovery rate<50%)(61 cases).Univariate analysis was performed based on patients'clinical characteristics,imaging features and dynamic DTI parameters.Significant variables were subjected to binary logistic regres-sion analysis to identify risk factors for poor postoperative prognosis in CSM patients.Results Univariate analysis results showed significant differences between the two groups in terms of diabetes,number of compression segments,pre-mJOA score,cross-sectional area of the spinal canal at the narrowest location[Area-N(natural),Area-E(extension),Area-F(flexion)],apparent diffusion coefficient(ADC)(ADC-N,ADC-E,ADC-F)and fractional anisotropy(FA)(FA-N,FA-E,FA-F)(P<0.05).Binary logistic regression analysisrevealed that Area-N[odds ratio(OR)0.226;95%confidence interval(CI)0.069-0.732,P=0.013],FA-N(OR 3.028;95%CI 1.12-8.19,P=0.029),Area-E(OR 0.248;95%CI0.076-0.814,P=0.021),FA-E(OR 4.793;95%CI1.737-13.228,P=0.002),Area-F(OR 0.288;95%CI 0.095-0.87,P=0.027),FA-F(OR 2.964;95%CI 1.126-7.801,P=0.028)were independent risk factors for poor prognosis.FA-E had significant predictive value for poor prognosis in CSM patients.Conclusion Dynamic DTI can predict the postoperative outcomes in CSM,and FA-E value can serve as an excellent predictor of poor neurological prognosis.

关 键 词：脊髓型颈椎病 扩散张量成像 磁共振成像 预后 危险因素 

分 类 号：R681[医药卫生—骨科学] R445.2[医药卫生—外科学] R818.07[医药卫生—临床医学]