磁共振扩散张量成像与纤维束成像在脊髓型颈椎病中的应用研究

目的 :评价磁共振扩散张量成像技术(diffusion tensor imaging,DTI)对脊髓型颈椎病的诊断价值。方法 :对收集的2014年1月至2015年4月20例健康志愿者和50例脊髓型颈椎病(CSM)患者行颈髓DTI。以健康志愿者作为对照组。依据颈髓MRI平扫结果将CSM患者分A、B、C组,A组17例(单纯硬膜囊受压),B组23例(颈髓受压,信号正常),C组10例(颈髓受压,T2高信号)。分析4组颈髓的平均表观扩散系数(ADC)、平均分数各向异性值(FA)之间的差异,对所有受检者行颈髓纤维束成像。结果:对照组C_2/C_3、C_3/C_4、C_4/C_5、C_5/C_6、C_6/C_7之间ADC值及FA值差异无统计学意义(P0.05),平均ADC值为(0.875±0.096)×10~(-3)mm~2/s,平均FA值为0.720±0.051;对照组与A组比较,平均ADC值、FA值差异无统计学意义,对照组与B、C组及A、B、C组间比较,平均ADC值、FA值差异均有统计学意义。结论:颈髓DTI较常规MRI能够早期、准确地量化脊髓型颈椎病的颈髓微结构改变,颈髓纤维束成像可以反映脊髓纤维束受压损伤的范围。

The value of diffusion tensor imaging and fiber tractography in cervical spondylotic myelopathy

Objective:To study the diagnostic value of diffusion tensor imaging (DTI) in cervical spondylotic myelopathy. Methods:Twenty healthy volunteers and fifty patients with cervical spondylotic myelopathy underwent DTI in the Affiliated Hospital of Medical College of Ningbo University from January 2014 to April 2015. Healthy volunteers served as controls. Fifty patients were divided into three groups (group A, B, C) according to cervical MRI scan standard. Group A (17 cases) had only the dura mater spinalis compressed;Group B(23 cases) showed the cervical spinal cord compressed, but no high signal in it;Group C (10 cases) had the cervical spinal cord compressed with high signal in the same level. The average apparent diffusion coefficients(ADC) and fractional anisotropy(FA)values in these examinee were analyzed and all subjects were performed fiber tracking. Results:There was no statistically significant differences in ADC and FA values in C₂/C₃, C₃/C₄, C₄/C₅, C₅/C₆, C₆/C₇ of control group(P>0.05). The average ADC and FA values in control group were(0.875±0.096)×10^-3 mm²/s and 0.720±0.051, respectively; compared with group A, there was no statistically significant difference;compared with group B and C, there was significant difference;comparison among group A, B, C, there was significant differences. Conclusion:DTI can early and accurately quantify the changes of microstructure in cervical spondylotic myelopathy. Fiber tracking can show the damage range of spinal cord lesions.