脊髓腰骶膨大扩散张量成像参数评估脊髓型颈椎病患者损伤程度和术后神经功能恢复的研究

Diffusion tensor imaging of the lumbosacral enlargement helps to estimate the neurologic recovery after decompression surgery in patients with cervical spondylotic myelpoathy

目的探讨应用脊髓腰骶膨大扩散张量成像(diffusion tensor imaging,DTI)参数评估脊髓型颈椎病(cervical spondylotic myelopathy,CSM)患者颈脊髓损伤程度和颈椎术后神经功能恢复。材料与方法对9例CSM患者颈椎术前和术后1年行脊髓腰骶膨大DTI扫描,测量各向异性分数(fractional anisotropy,FA)值和表观扩散系数(apparent diffusion coefficient,ADC)值,并分析术前术后的腰骶膨大DTI参数与改良日本骨科协会(modified Japanese Orthopedic Association,mJOA)评分的相关性。结果与术前对比,CSM患者颈椎术后脊髓腰骶膨大FA值明显上升(t=-3.024,P=0.004),ADC值明显下降(t=3.741,P=0.001)。术前脊髓腰骶膨大FA值与mJOA评分有相关性(r=0.832,P<0.05),而术前脊髓腰骶膨大ADC值与mJOA评分无相关性(r=0.281,P=0.465)。术后脊髓腰骶膨大FA值与mJOA评分有相关性(r=0.710,P<0.05),而术后脊髓腰骶膨大ADC值与mJOA评分无相关性(r=0.195,P=0.616)。结论CSM患者脊髓腰骶膨大DTI参数FA值在术前术后与神经功能相关,可为颈脊髓损伤术后功能恢复情况的临床评估提供新的途径。

Objective:To evaluate changes in injury severity and assess postoperative neurologic recovery by conducting diffusion tensor imaging(DTI)of the lumbosacral enlargement and measuring modified Japanese Orthopedic Association(mJOA)score in patients with cervical spondylotic myelopathy(CSM).Materials and Methods:Lumbosacral DTI was performed in 9 CSM patients before surgery and at approximately 1 year after surgery.Apparent diffusion coefficient(ADC)and fractional anisotropy(FA)values were measured as two primary metrics of DTI.The correlation between both metrics and mJOA score was further examined.Results:The postoperative ADC value of the lumbosacral enlargement was significantly decreased(t=-3.024,P=0.004),but FA value was significantly increased(t=3.741,P=0.001)from preoperative levels in CSM patients after surgery.There was significant correlation between FA and mJOA score at both preoperative(r=0.832,P<0.05)and postoperative conditions(r=0.710,P<0.05).There was no significant correlation between ADC and mJOA score at both preoperative(r=0.281,P=0.465)and postoperative conditions(r=0.195,P=0.616).Conclusions:The DTI parameter FA value of spinal lumbosacral enlargement in CSM patients is related to neurological function before and after surgery,which can provide a new way for clinical evaluation of functional recovery after cervical spinal cord injury.