脑弥散张量成像预测脊髓型颈椎病术后恢复

Brain diffusion tensor imaging for predicting postoperative recovery of cervical spondylotic myelopathy

[目的]探讨脑弥散张量成像(diffusion tensor imaging, DTI)技术预测脊髓型颈椎病(cervical spondylotic myelopathy,CSM)术后运动功能恢复的价值。[方法]选取32例手术治疗的CSM患者及32例正常者,分别于术前与术后行颅脑和颈髓常规磁共振成像及弥散张量成像检查。比较两组术前与术后中央前回(precentral gyrus, PrCG)、中央后回(post-central gyrus,PoCG)的激活体积(volume of activation, VOA)值及各向异性分数(factional anisotrophy, FA)值。分析各DTI指标与日本骨科学会评分系统(Japanese Orthopedic Association, JOA)评分、评分好转率间的相关性。行DTI指标预测CSM术后恢复不良的受试者工作特征曲线(receiver operator characteristic curve, ROC)分析。[结果]术前CSM组PrCG显著大于健康人组,FA显著小于健康人组(P<0.05);DTI各项指标与术前JOA评分、术后评分好转率之间均具有显著相关性(P<0.05),VOA比值及FA值是预测CSM术后恢复不良的主要因素。且VOA比值的ROC曲线下面积最大。[结论] DTI技术中VOA比值及FA值是预测CSM患者术后运动功能恢复的重要指标。

[Objective] To explore the value of brain diffusion tensor imaging(DTI) for predicting the recovery of motor function after anterior cervical decompression and fusion(ACDF) for cervical spondylotic myelopathy(CSM). [Methods] A total of 32 patients who were undergoing ACDF for CSM, and 32 health persons matched with the patients were enrolled in this study. All the subjects underwent routine magnetic resonance imaging(MRI) and diffusion tensor imaging(DTI) for brain before and after surgery. The two groups were compared, additionally, the CSM patients were compared before and after operation in DTI parameters, including the precentral gyrus(PrCG), post-central gyrus(PoCG), volume of activation(VOA), and fractional anisotropy(FA). In addition, the correlations were explored between each DTI parameter and the Japanese Orthopaedic Association(JOA) score preoperatively or improvement rate of the score at the latest followup. A ROC curve analysis was conducted on DTI parameters predicting prognosis of CSM after ACDF. [Results] The CSM group had significantly higher PrCG, while significantly lower FA than the health group before operation(P<0.05). Among the CSM patients, there were significantly correlations between all the DTI parameters and preoperative JOA score, as well as the improvement rate of JOA score at the latest follow-up(P<0.05), of which the VOA ratio and FA proved of the most important factors. In term of ROC curve analysis, the VOA ratio proved of the greatest area under curve. [Conclusion] The VOA ratio and FA value measured by DTI might be the main parameters for predicting the motor function recovery after ACDF for CSM.