无骨折脱位型颈脊髓损伤DTI征象与JOA评分的相关性

The correlation between features of DTI and JOA scores in patients with cervical spinal cord injury without radiographic abnormality

目的探讨无骨折脱位型颈脊髓损伤磁共振弥散张量成像(DTI)征象与日本骨科学会(JOA)评分的相关性。方法对31例无骨折脱位型颈脊髓损伤患者进行JOA评分:Ⅰ级(轻度):16～13分;Ⅱ级(中度):12～9分;Ⅲ级(重度):8～5分;Ⅳ级(严重):≤4分。31例患者均行常规MR及DTI检查,分别测量各向异性分数(FA)值和表观弥散系数(ADC)值,并观察它们与JOA评分的相关性。结果Ⅰ级:FA值略降低,ADC值略升高;Ⅱ级:FA值降低,ADC值升高;Ⅲ级:FA值进一步降低,ADC值混杂;Ⅳ级:FA值更低,ADC值降低。FA值与无骨折脱位型颈脊髓损伤患者JOA评分具有相关性(P=0.000),ADC值与无骨折脱位型颈脊髓损伤患者JOA评分无明显相关性(P=0.802)。结论 DTI可更全面有效地揭示无骨折脱位型颈脊髓损伤的病理生理过程,为颈脊髓损伤程度和预后评估提供理论依据。

Objective To observe the correlation between features of diffusion tension imaging （DTI） and Japanese Or- thopaedic Association （JOA） scores in patients with cervical spinal cord injury without radiographic abnormality （CSCIWORA）. Methods 31 CSCIWORA patients were assessed and divided into 4 stages according to JOA scores. The score of stage Ⅰ / Ⅱ/Ⅲ/Ⅳ was 16-13, 12-9, 8-5 and less than 4 respectively. All the patients accepted conven- tional scan and DTI. The Fractional Anisotropy （FA） and Apparent Diffusion Coefficient （ADC） were measured re- spectively, and the correlation to JOA scores was observed. Results StageⅠ ： FA was slightly lower, ADC was slightly higher; Stage Ⅱ ： FA was lower, ADC was higher; Stage Ⅲ： FA was significantly lower, ADC was confoun- ding; Stage Ⅳ： FA was the lowest, ADC was lower. FA was related to JOA score of patients with CSClWORA（P = 0.000 ）, ADC was not evidently related to JOA scores of patients with CSCIWORA（ P = 0.802 ）. Conclusion DTI could show the pathophysiology process of CSCIWORA more directly and more efficiently. It is suggested that DTI can provide valuable information about injury degree of cervical spinal cord and prognosis evaluation.