扩散张量成像对创伤性颈髓损伤的早期诊断及预后演变研究

The Study on Early Diagnosis and Prognosis Evolution in Traumatic Cervical Spinal Cord Injury by Diffusion Tensor Imaging

目的使用3.0 T磁共振扩散张量成像(DTI)技术观察创伤性颈髓损伤(SCI)患者颈髓白质纤维束的改变,探讨DTI对SCI的早期诊断价值及其预后演变规律。方法选取经临床诊断为SCI的患者34例(损伤组)及20名健康对照者(对照组)分别进行常规MRI及DTI检查;损伤组分为A,B组,A组为T_2WI序列显示颈髓内高信号16例,B组为T_2WI序列显示无明显异常信号18例;分别测量A、B组(急性期、亚急性期、伤后5周~3个月)和对照组各向异性分数(FA)值、表观扩散系数(ADC)值,行统计学分析。结果与正常对照组相比,A、B组FA值减低,以后呈逐渐升高趋势,但均低于对照组,差异有统计学意义(P均<0.001);A组ADC值增高,以后呈逐渐减低趋势,但均高于对照组,差异有统计学意义(P均<0.001),B组ADC值在急性期增高(P<0.001),以后逐渐与对照组趋于一致,差异无统计学意义(P均>0.05)。结论DTI及DTT能够显示T_2WI序列上阴性的早期SCI;FA值能够预测SCI的预后情况。

Objective To observe the changes of cervical spinal cord white matter fiber tracts in patients with traumatic spinal cord injury （SCI） by using 3.0T magnetic resonance diffusion tensor imaging （ DTI）, and to explore the value of DTI in early diagnosis of SCI and prognostic evolution in different stages. Methods 34 cases of SCI patients confirmed by clinical examination and 20 cases of healthy control group were investigated by conventional MRI and DTI examination. According to T2WI signal ,injury group were divided into A, B group, i.e. A group of high signal group（ n = 16） and B group of negative group（n = 18）. A,B group and control group were measured by FA value, ADC value at different times （ acute, subacute, injury after 5 weeks to 3 months） and this data was statistically analyzed. Results In A, B group , FA values decreased early and increased gradually, but were always lower than the control group, and the difference was statis- tically significant （ all P 〈 0. 001 ）. In A group, ADC values increased early and decreased gradually, but they were always higher than the control group, and the difference was statistically significant （all P 〈 0.001 ）. In B group, ADC values increased in the acute period （P 〈 0. 001 ）, then gradually tended to values with the control group, and the difference was not statistically significant （ both P 〉 0.05 ）. Conclusion DTI and DTT can show early cervical cord injury examined in T2W negative images. FA values can predict the prognosis of cervical spinal cord injury.