磁共振SWI技术在急性脊髓损伤中的应用及对神经功能的评价

Application of magnetic resonance SWI in acute spinal cord injury and evaluation of neurological function

目的探讨磁共振磁敏感加权成像(SWI)技术在急性脊髓损伤(ASCI)中的应用及对神经功能的评价。方法选取2017年9月—2020年9月山西省运城市中心医院脊柱外科诊治脊髓损伤患者80例,根据磁共振检查分为研究组51例(急性脊髓损伤),对照组29例(通过CT检查判断为非急性脊髓损伤)。比较2组磁共振SWI技术扫描参数,ASCI不同程度患者神经功能缺损程度评分及相关指标[神经丝轻链(NFL)、胱抑素C(CysC)、美国脊柱损伤协会(ASIA)感觉、运动评分]水平,应用ROC曲线分析磁共振SWI技术对ASCI的预测价值。结果研究组FA参数低于对照组,ADC、λ1、λ2参数高于对照组(t/P=10.650/0.001、9.890/0.001、5.097/0.001、5.157/0.001)。重度ASCI患者FA参数低于轻中度ASCI患者,ADC、λ1、λ2参数高于轻中度ASCI患者(t/P=7.846/0.001、3.579/0.001、3.726/0.001、8.959/0.001)。重度ASCI患者第7、15、30、90 d神经功能缺损程度评分均高于轻中度ASCI患者(t/P=21.630/0.001、15.270/0.001、12.660/0.001、12.010/0.001)。重度ASCI患者血清NFL、CysC水平高于轻中度ASCI患者,ASIA感觉评分、运动评分低于轻中度ASCI患者(t/P=15.100/0.001、13.030/0.001、6.890/0.001、9.846/0.001)。ROC曲线分析显示,FA、ADC、λ1、λ2及4项联合诊断ASCI的AUC分别为0.923、0.662、0.763、0.653、0.967,4项联合诊断ASCI的价值高于单一指标(Z/P=2.353/0.001、2.465/0.031、2.386/<0.001、2.597/0.041)。结论磁共振SWI技术可用于急性脊髓损伤的诊断,与患者神经功能相关,可用于评价患者神经功能。

Objective To explore the application of magnetic resonance susceptibility-weighted imaging(SWI)technology in acute spinal cord injury(ASCI)and the evaluation of neurological function.Methods A total of 80 patients with spinal cord injury from September 2017 to September 2020 were selected for the diagnosis and treatment of Spinal Cord Surgery in Yuncheng Central Hospital of Shanxi Province.According to the magnetic resonance examination,they were divided into the study group of 51 cases(acute spinal cord injury)and the control group of 29 cases(judged by CT examination as non-acute spinal cord injury).Comparison of scanning parameters of magnetic resonance SWI technology,neurological deficit scores and related indicators in patients with different degrees of ASCI neurofilament light chain(NFL),cystatin C(CysC),American Spinal Injury Association(ASIA)sensory and motor scores)between the two groups]level,the ROC curve was used to analyze the predictive value of magnetic resonance SWI technology for ASCI.Results The FA parameters in the study group were lower than those in the control group,and the ADC,λ1 andλ2 parameters were higher than those in the control group(t/P=10.650/0.001,9.890/0.001,5.097/0.001,5.157/0.001).The FA parameters of patients with severe ASCI were lower than those of patients with mild to moderate ASCI,and the parameters of ADC,λ1 andλ2 were higher than those of patients with mild to moderate ASCI(t/P=7.846/0.001,3.579/0.001,3.726/0.001,8.959/0.001).The scores of neurological deficits on the 7th,15th,30th,and 90th days in patients with severe ASCI were higher than those in patients with mild and moderate ASCI(t/P=21.630/0.001,15.270/0.001,12.660/0.001,12.010/0.001).Serum NFL and CysC levels in patients with severe ASCI were higher than those in patients with mild to moderate ASCI,and ASIA sensory scores and motor scores were lower than those in patients with mild and moderate ASCI(t/P=15.100/0.001,13.030/0.001,6.890/0.001,9.846/0.001).The ROC curve analysis showed that the AUCs of FA,ADC,λ1,λ2 and 4 items in the diagnosis of ASCI were 0.923,0.662,0.763,0.653,and 0.967 respectively,and the value of the 4 items in the diagnosis of ASCI was higher than that of a single index(Z/P=2.353/0.001,2.465/0.031,2.386/<0.001,2.597/0.041).Conclusion Magnetic resonance SWI technology can be used for the diagnosis of acute spinal cord injury,which is related to the patient's neurological function and can be used to evaluate the patient's neurological function.