扩散张量成像定量评价脊髓型颈椎病的Meta分析

Meta-analysis on Diffusion Tensor Imaging Diagnosis in Cervical Spondylotic Myelopathy

目的 探讨Meta分析评价扩散张量成像（diffusion tensor imaging,DTI）定量应用于脊髓型颈椎病的价值.方法 联机检索Embase（1974年1月～2011年1月）、The Cochrane library（2011年第1期）、PubMed（1996年1月～2011年1月）、中国生物医学文献数据库（1978年1月～2010年12月）、万方数据库（1982年1月～2011年1月）,并手检拟纳入使用DTI定量分析脊髓型颈椎病的相关研究文献.按Cochrane系统评价方法对纳入文献进行质量评价和资料提取,采用RevMan5.0软件进行Meta分析.结果 符合纳入标准共15篇（555例）文献.Meta分析结果显示：正常组上颈段（C2～3）与中下颈段（C4～7）脊髓ADC（apparent diffusion coefficient）值差异无统计学意义[MD（mean difference）=50.53×10^-6cm^2·s^-1,（95%CI,-56.47×10^-6cm^2·s^-1～157.53×10^-6cm^2·s^-1）,P=0.35];FA值（fractional anisotrophy）差异有统计学意义[MD=61.05,（95%CI,6.73～115.38）,P=0.03].T2高信号脊髓型颈椎病ADC值升高,与正常组比较差异有统计学意义[MD=269.81×10^-6cm^2·s^-1,（95%CI,158.47×10-6cm2.s-1～381.15×10^-6cm^2·s^-1）,P〈0.001];T2高信号脊髓型颈椎病FA值降低,与正常组比较差异有统计学意义[MD=-107.88,（95%CI,-162.14～-53.63）,P〈0.001].T2等信号脊髓型颈椎病升高ADC值与正常组比较差异有统计学意义[MD=180.47×10^-6cm^2·s^-1,（95%CI,79.73×10^-6cm^2·s^-1～281.21×10^-6cm^2·s^-1）,P=0.0004]; FA值亦降低,且与正常组比较差异有统计学意义[MD=-79.23,（95%CI,-125.11～ -33.36）,P=0.0007].结论 Meta分析及其偏倚分析,提示颈髓DTI的ADC值和FA值是定量评估脊髓早期微观结构损伤敏感指标.

Objective To analyze the value of DTI quantificationally in cervical spondylotic myelopathy （CSM） based on Meta - analysis. Materials Retrieved possible databases including Embase （ 1974. 1 - 2011.1 ） , The Co-chrane Database（ Issuel, 2011 ）, PubMed （ 1996. 1 - 2011. 1 ）, Chinese Biomedical Literature Datebase （ 1982. 1 - 2010.12 ） ,Wanfang Datebase（ 1982.1 -2011.1 ）and identified the literatures about cervical spondylotic myelopathy using DTI which were estimated by the Cochrane system evaluation method were analyzed by Meta - analyses using RevMan 5.0 version software. Results Fifteen studies were suitable of the criteria adding up to 555 patients. The re-suits of Meta - analysis showed in normal groups, ADC value had no statistical significance between upper cervical spi-nal cord and middle - lower cervical spinal cord[ MD（ mean difference） = 50.53 × 10^-6cm^2·s^-1, （95% CI, - 56.47-10 ^-6cm^2· s^-1 - 157.53 × 10^-6cm^2·s^-1 ）P =0.35 ]. However,their FA value had statistical significance[ MD =61. 05, （95% CI,6.73 - 115.38） ,P = 0.03 ]. In T2WI hyperintensity of CSM compared with normal group, ADC value increased and had statistical significance[ MD = 269.81 × 10^-6cm^2/s, （95% CI, 158.47 × 10^-6cm^2· s^-l - 381.15 × 10-6cm^2· s^- 1 ）, P 〈 0. 001 ]. FA value decreased and had statistical significance [ MD = - 107.88, （95% CI, （ - 162.14） - （ -53.63 ） ） ,P 〈 0.001 ]. In T2WI isointensity of CSM compared with normal group, ADC statistical sig-nificance [ MD = 180.47 × 10^-6 cm^2· s^ - 1, 79.73 × 10^-6 cm^2· s^-1 - 281.21 × 10^-6 cm^2· s^-1） , P = 0. 0004 ] , FA value also decreased and had statistical significance [ MD = - 79.23, （ 95 % CI, （ - 125.11 ） - （ - 33.36 ） ）, P = 0. 0007 ]. Conclusion Meta - analysis and bias analysis indicate ADC value and the FA value are more sensitive index for tes-ting microscopic structural injury of CSM.