| 李 翔,陆瓞骥,胡 勇.磁共振弥散张量成像对脊髓型颈椎病患者术后神经功能恢复的预测作用[J].中国脊柱脊髓杂志,2019,(5):385-393. |
| 磁共振弥散张量成像对脊髓型颈椎病患者术后神经功能恢复的预测作用 |
| 中文关键词: 脊髓型颈椎病 弥散张量成像 手术预后 |
| 中文摘要: |
| 【摘要】 目的：探讨磁共振弥散张量成像（diffusion tensor imaging，DTI）在预测脊髓型颈椎病（cervical spondylotic myelopathy，CSM）患者术后神经功能恢复中的作用。方法：前瞻性分析50例行手术治疗的CSM患者的临床资料，患者年龄43~86岁（64.3±11.2岁）。以19例年龄50~62岁（54.6±4.2岁）的健康志愿者作为对照组。应用3.0T磁共振DTI成像序列，观察患者术前各神经纤维束感兴趣区（包括整个颈髓、颈髓前束、侧束及后束）中的各向异性分数（fractional anisotropy，FA）、平均弥散率（mean diffusivity，MD）、轴向弥散系数（axial diffusivity，AD）及径向弥散系数（radial diffusivity，RD），将患者按术后神经功能日本骨科协会（Japanese Orthopedic Association，JOA）评分改善率（recovery rate，RR）分为3组：优良疗效组（RR>0.7）、中等疗效组（RR 0.4~0.7）和一般疗效组（RR<0.4）。比较对照组和3个患者组之间DTI参数值的差异，分析CSM患者脊髓神经束感兴趣区中的FA、MD、AD和RD值与神经功能改善率的相关性，并比较年龄、术前JOA评分、发病时间、MRI T2加权像脊髓高信号及DTI参数在预测CSM患者手术预后中的效果。结果：3个患者组的年龄、发病时间及术前JOA评分均无显著性差异（P>0.05）。除优良疗效组整个颈髓的FA值外，3个患者组的FA、MD和RD值与对照组比较均存在显著性差异（P<0.01）。3个患者组之间仅优良疗效组的整个颈髓、脊髓侧束和后束的FA值与一般疗效组有显著性差异（P<0.05）。除后束MD值外，CSM患者所有脊髓神经束感兴趣区中的FA、MD和RD值均与神经功能改善率有显著相关性（P<0.05）；FA值在所有脊髓神经束感兴趣区中与神经功能改善率呈正相关，MD和RD值与神经功能改善率呈负相关（P<0.05），后束FA值有最好的相关性（r2=0.253，P<0.001）。ROC分析显示FA值的曲线下面积显著大于年龄、术前JOA评分、发病时间及T2加权像中脊髓高信号（P<0.05）。脊髓侧束的FA值在预测CSM患者优良手术效果中最为准确。结论：CSM患者术前DTI参数值，尤其是脊髓后束及侧束FA值，在预测患者术后神经功能康复程度中表现出优于临床及传统影像学指标的特性，具有潜在的临床应用前景。 |
The predictive effect of diffusion tensor imaging in the postoperative neurological recovery of cervical spondylotic myelopathy |
| 英文关键词:Cervical spondylotic myelopathy Diffusion tensor imaging Prognosis |
| 英文摘要: |
| 【Abstract】 Objectives: To investigate the usage of diffusion tensor imaging(DTI) in predicting postoperative neurologic recovery of cervical spondylotic myelopathy(CSM). Methods: The clinical data of fifty patients with CSM who underwent surgical treatment(43 to 86 years old, with mean age of 64.3±11.2 years old) were analyzed in this prospective study. Nineteen healthy volunteers(50 to 62 years old, with mean age of 54.6±4.2 years old) were recruited as control group. DTI parameters including fractional anisotropy(FA), mean diffusivity(MD), axial diffusivity(AD) and radial diffusivity(RD) in several regions of interest(ROIs) of cervical spinal cord(including the whole cord, ventral columns, lateral columns and dorsal columns) were derived from the images of a 3.0T magnetic resonance DTI sequence. The patients were divided into three groups according to postoperative neurologic recovery rate(RR) based on Japanese Orthopedic Association(JOA) scores, including patients with RR<0.4, patients with 0.40.7 respectively. The differences of DTI parameters between the control group and the three patient groups were compared. The correlations among FA, MD, AD and RD values in different regions of interest(ROI) and neurologic recovery rate were analyzed. The ability of predicting surgical outcome in CSM patients was compared among age, preoperative JOA scores, duration of symptoms, increased signal intensity on T2-weighted images and DTI parameters. Results: None of age, duration of symptoms and preoperative JOA scores showed significant difference among the three patient groups(P>0.05). Except for the FA value in the whole cord of RR>0.7 group, the FA, MD and RD values in the three patient groups showed significant differences from those in the control group respectively(P<0.01). In the three patient groups, only the FA values in the whole cord, lateral column and dorsal column of RR>0.7 group showed significant differences from those of RR<0.4 group. The FA, MD and RD values in all the investigated ROIs were significantly correlated with neurologic recovery rate(P<0.05), except for MD value in the dorsal column. A positive correlation existed between the FA value and the recovery rate in all the investigated ROIs(P<0.05), while MD and RD values showed negative associations with the recovery rate(P<0.05), in which FA value in the dorsal column showed the strongest correlation(r2=0.253, P<0.001). In the receiver operating characteristic curve(ROC) analysis, the areas under the curve(AUC) of the FA value in all the ROIs were significantly larger than those of age, preoperative JOA scores, duration of symptoms and increased signal intensity within cervical cord on the T2-weighted images. Among them, FA value of lateral column presented the best ability of predicting surgical outcome for CSM patients. Conclusions: Preoperative DTI parameters, especially the FA values in the dorsal and lateral columns, has superior capacity in predicting surgical outcome for patients with CSM compared to clinical and traditional MRI features. DTI may be a promising tool in the clinical practice of CSM. |
| 投稿时间：2018-12-17 修订日期：2019-04-14 |
| DOI： |
| 基金项目:深圳市科技研发基金（编号：JCYJ20170413162540673） |
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