扩散张量成像对腕管综合征的诊断及疗效评估

Diffusion Tensor Imaging in Diagnosing Carpal Tunnel Syndrome and Monitoring Treatment

目的评估扩散张量成像(diffusion tensor imaging,DTI)对腕管综合征(carpal tunnel syndrome,CTS)的诊断价值,在CTS分级及评价小剂量激素(强的松,10 mg/d)治疗CTS疗效的作用。方法对11名志愿者(对照组)22个腕关节;28例CTS患者52个腕关节及5例进行小剂量激素治疗的CTS患者10个腕关节进行DTI扫描及神经电生理检查;根据电生理检查结果,将CTS患者分为轻(n=16)、中(n=20)、重度(n=16)3组;并记录小剂量激素治疗前后患者电生理结果的严重程度。测量腕管内正中神经的平均各向异性分数值(fractional anisotropy,FA)及表观扩散系数(apparent diffusion coefficient,ADC)。分别对对照组和CTS患者的DTI数据及其与电生理结果进行统计学分析。结果CTS患者正中神经平均FA值与电生理严重程度呈负相关(r=-0.614,P<0.01),ADC与电生理严重程度呈正相关(r=0.413,P<0.01);对照组与不同严重程度CTS组平均FA值和ADC差异具有统计学意义(P<0.01)。5例口服小剂量强的松的CTS患者,经治疗1个月后,FA值较治疗前增高,ADC较治疗前减低,治疗前后比较差异均具有统计学意义(P<0.01)。结论平均FA值和ADC在对CTS的诊断及分级(轻、中、重度)判断上具有一定指导意义。FA值与ADC可作为观察激素治疗CTS疗效的量化监测指标。

Objective To assess the diagnostic value of diffusion tensor imaging（DTI）in carpal tunnel syndrome（CTS）,its role in the classification of CTS,and the efficacy of low-dose hormone in the therapy of CTS.Methods Twenty-two wrists of 11 volunteers（control group）,52 wrists of 28 patients and 10 wrists of 5 patients treating with low-dose hormone were performed DTI scanning and electrophysiological examination.According to the electrophysiological results,the CTS patients were divided into three groups：mild（n=16）,moderate（n=20）and severe（n=16）.The severity of the 10 wrists were recorded before and after low-dose hormone therapy.The average fractional anisotropy（FA）and apparent diffusion coefficient（ADC）of median nerve in carpal canal was measured.DTI data and electrophysiological results were statistical analyzed in control group and CTS groups,respectively.Results A significant negative correlation was between mean FA of median nerve and electrophysiological severitys（r=-0.614,P〈0.01）,while a significant positive correlation was between mean ADC and electrophysiological severitys（r=0.413,P〈0.01）.The mean FA and ADC were significantly differences between control group and CTS groups with different severity（P〈0.01）.The FA of 5 low-dose oral prednisone（10 mg/d）CTS patients with one-month therapy were increased and ADC was decreased（P〈0.01）.Conclusion The average values of FA and ADC have a certain guiding significance in the diagnosis and classification of CTS（mild,moderate,severe）.The values of FA values and ADC can be used as indicators for monitoring the efficacy of hormone in treating CTS.