弥散张量成像技术联合白质纤维束成像技术在脊髓型颈椎病中的诊断价值研究

Diagnostic value of diffusion tensor imaging combined with diffusion tensor tractography in cervical spondylotic myelopathy

目的 探讨弥散张量成像(DTI)技术联合白质纤维束成像(DTT)技术各项参数对脊髓型颈椎病(CSM)患者的诊断价值。方法 前瞻性选取20例接受手术的CSM患者(CSM组)和20名健康志愿者(对照组)为研究对象。研究对象接受颈椎常规磁共振成像(MRI)检查及DTI扫描,对图像进行后处理得到DTI和DTT参数值,主要指标包括分数各向异性(FA)、平均弥散系数(DC-avg)及白质纤维束密度(DTT-density)值,并记录每位CSM患者的日本骨科协会(JOA)评分及脊髓受压程度,同时根据JOA评分对CSM患者进行分级,以脊髓受压程度与JOA评分分为影像学典型表现组及影像学非典型表现组。比较CSM组患者与对照组健康志愿者DTI、DTT参数的差异,通过Pearson及Spearman相关性分析影像学典型表现组及非典型表现组CSM患者DTI、DTT参数与JOA评分间的相关性。结果 CSM组患者(除C1/2的FA、DTT-density值及C7/T1的DC-avg、DTT-density值外)FA及DTT-density值较对照组健康志愿者明显降低,DC-avg较对照组健康志愿者明显升高,差异有统计学意义(P<0.05);CSM组患者(除C3/4、C6/7的DTT-density值外)受压迫节段的FA、DC-avg、DTT-density值与对照组比较差异有统计学意义(P<0.05)。影像学典型表现组脊髓受压程度与患者JOA评分相关(P<0.05),而影像学非典型表现组脊髓受压程度与JOA评分不具有相关性(P>0.05)。影像学典型表现组患者及非典型表现组患者的FA、DC-avg、DTT-density值与患者JOA评分相关(P<0.05)。结论 在CSM患者的术前诊断中,FA、DC-avg、DTT-density值与患者的JOA评分密切相关,可有效判断患者的实际神经损伤。

Objective To investigate the diagnostic value of diffusion tensor imaging(DTI)combined with diffusion tensor tractography(DTT)in patients with cervical spondylotic myelopathy(CSM).Methods A prospective study was conducted on 20 CSM patients(the CSM group)who underwent surgery and 20 healthy volunteers(the control group).The subjects underwent routine MRI examination and DTI scan of the cervical spine,then the images were post-processed,and the corresponding parameter values of DTI and DTT were recorded,including fraction anisotropy(FA),average diffusion coefficient(DC-avg)and diffusion tensor tractography density(DTT-density).The score of the Japanese Orthopaedic Association(JOA)and the degree of spinal cord compression of all CSM patients were recorded,and the CSM patients were graded according to the JOA score.According to the degree of compression degree of spinal cord and JOA score,they were divided into the imaging typical performance group and atypical performance group.The DTI and DTT parameters between the patients of the CSM group and the healthy volunteers of the normal control group were compared,and the correlation between DTI and DTT parameters and JOA score of CSM patients in the imaging typical and atypical performance groups was analyzed by Pearson and Spearman correlation analysis.Results The values of FA and DTT-density(except for the values of FA and DTT-density in C 1/2 and DC-avg and DTT-density in C 7/T 1)in the CSM group were significantly lower than those in the control group,and the values of DC-avg were significantly higher than those in the control group,with statistical significance(P<0.05).The values of FA,DC-avg and DTT-density(except for the values of C 3/4 and C 6/7 DTT-density)in the CSM group were significantly different from those in the control group(P<0.05).The degree of spinal cord compression was correlated with the JOA score in the imaging typical performance group(P<0.05),while the JOA score in the imaging atypical performance group was not correlated with the degree of spinal cord compression(P>0.05).The values of FA,DC-avg and DTT-density were correlated with JOA scores of patients in the imaging typical and atypical performance groups(P<0.05).Conclusion In the preoperative diagnosis of CSM patients,the values of FA,DC-avg and DTT-density are closely related to the JOA score of patients,which can effectively judge the actual nerve injury of patients.