DTI与DTT在外伤性脊髓半切综合征中的应用

The application of DTI and DTT in Brown-Sequard syndrome caused by trauma

目的:探讨DTI和DTT对急性脊髓损伤导致脊髓半切综合征患者的应用价值。方法:对外伤后导致脊髓损伤并出现脊髓半切综合征症状的患者在1周内行常规MRI及DTI检查,分别测量脊髓损伤水平损伤侧(A区)、相对正常侧(B区)、损伤近端(C区)及远端(D区)的FA值和ADC值,然后绘制DTI参数图及DTT图。比较各区域之间的FA值及ADC值的差别,并对各区域间的差别进行统计学分析。结果:A区FA值为0.296±0.011、ADC值为(1.957±0.41)×10-3mm2/s,B区FA值为0.734±0.059、ADC值为(1.287±0.416)×10-3mm2/s,A区与B区比较,FA值、ADC值均具有统计学意义(P<0.05)。C区FA值为0.799±0.076、ADC值为(0.924±0.113)×10-3mm2/s,D区FA值为0.716±0.078、ADC值为(0.995±0.097)×10-3mm2/s,C区和D区比较,FA值具有统计学意义(P<0.05),ADC值没有明显的统计学差异(P>0.05)。A区与B区、C区、D区比较,FA值明显降低有统计学差异(P<0.05),ADC值明显升高有统计学差异(P<0.05);B区与C区、D区比较,FA值无统计学差异(P>0.05),ADC值升高有统计学差异(P<0.05)。DTT图直观显示脊髓损伤水平纤维束损伤侧向相对正常侧靠拢,且损伤纤维束断裂。结论:脊髓半切损伤水平的损伤侧与相对正常侧和损伤的近端、远端FA值降低,ADC值升高。DTT更形象地显示出神经纤维束的不对称的损伤及程度,与病人表现出的神经功能损伤相符。DTI和DTT能够准确地为外伤导致的脊髓半切综合征病人提供与临床相关的影像信息。

Objective：To investigate the value of diffusion tensor imaging （DTI） and diffusion tensor tractography （DTT） in spinal cord injury with Brown-Sequard syndrome caused by trauma.Method：The routine MRI and DTI examnation were performed for patients with Brown-Sequard syndrome caused by trauma within a week.The FA value and the ADC value were measured in more than one vertebral bodies,including the injury side（called A） and relatively normal side（called B） of spinal cord in the level of injury,and the upper（called C） and lower（called D） level of spinal cord injury,then mapping the DTI parameters and DTT figure.Compare and statistical analysed the differences of FA values and ADC values in different regions.Results：The FA value was 0.296±0.011,0.734±0.059,0.799±0.076 and 0.716±0.078 in the group A,B,C and D respectively.The ADC value was （1.957±0.41）×10-3 mm2/s,（1.287±0.416）×10-3 mm2/s,（0.924±0.113）×10-3 mm2/s and （0.995±0.097）×10-3 mm2/s in the group A,B,C and D respectively.The differences of FA values and ADC values were statistically significant （P＜0.05） between group A and B.The differences of FA values were statistically significant（P＜0.05） between group C and D,while the differences of ADC values were not （P＞0.05）.The reduction of FA values and the rise of ADC values were statistically significant（P＜0.05） in group A,B,C and D,while the reduction of FA values were not in group B,C,and D（P＞0.05）.DTT images showed the fiber bundles of the injured side were fractured and closed to the relatively normal side in the level of spinal cord injury.Conclusion：The FA and ADC values change obviously in the group A,B,C and D.DTI and DTT images can show the damage and degree of asymmetry in the nerve fiber bundles more precisely,and consistent with the nerve function injury of patients.DTI and DTT can provide the image information of patients with Brown-Sequard syndrome caused by trauma accurately.