应用功能性磁共振及其他无创影像技术评价脊髓损伤后的结构与功能

自20世纪90年代以来,在传统磁共振成像（magnetic resonance imaging,MRI）技术的基础上发展的功能磁共振成像（functional magnetic resonance imaging,fMRI）技术已广泛应用于脑功能的临床和基础研究。fMRI结合功能、解剖和影像3方面的因素,为临床磁共振诊断从单一形态学研究到与功能相结合的系统研究提供强有力的技术支持。该技术具有无创性、无放射性、可重复性、较高的时间和空间分辨率、     

应用功能性磁共振及其他无创影像技术评价脊髓损伤后的结构与功能

自20世纪90年代以来,在传统磁共振成像(magnetic resonance imaging, MRI)技术的基础上发展的功能磁共振成像(functional magnetic resonance imaging, fMRI)技术已广泛应用于脑功能的临床和基础研究.     

磁共振成像在急性脊髓损伤中应用价值

磁共振成像在急性脊髓损伤中应用价值茹选良，赵大正，葛焕祥磁共振成像技术已经应用于急性脊柱损伤的临床检查［１］，它能清晰地显示整个脊髓的轮廓、脊髓损伤的程度。本文对我院１９９２年以来收治的３２例急性脊髓损伤病例进行了ＭＲＩ检查分析。１资料和方法１．１一...     

磁共振波谱成像及其在脊髓疾患诊断中的应用进展

磁共振成像(magnetic resonance imaging,MRI)技术是脊柱脊髓疾病的重要检查方法,特别是椎管内病变和脊髓病变,MRI应作为首选检查方法。但是MRI只能提供形态学的信息,不能反映脊柱脊髓的生化信息和功能状态[1]。     

脊髓损伤的病理变化及其与磁共振成像演变

脊髓损伤的病理变化及其与磁共振成像演变贾宁阳综述肖湘生审校本文就脊髓损伤后的病理变化及其与ＭＲＩ图像之间信号变化演变特点和预后作一文献复习，综述如下：１脊髓损伤的主要病理变化特点１．１脊髓损伤急性期的病理变化脊髓急性损伤后数秒钟，即于灰质及蛛网膜发生...     

脊髓型颈椎病患者颈脊髓磁共振扩散张量成像的特点及临床意义

目的 :观察脊髓型颈椎病(cervical spondylotic myelopathy,CSM)患者磁共振扩散张量成像(diffusion tensor imaging,DTI)的特点,探讨DTI在评价颈脊髓慢性损伤的价值。方法:纳入2011年2月~2015年2月间收治的20例CSM患者(CSM组),并选择年龄匹配的42例健康志愿者作为对照组,均行颈椎磁共振DTI,测量CSM组病变节段以及对照组C2/3~C6/7节段颈脊髓的表观弥散系数(apparent diffusion coefficient,ADC)、各向异性分数(fractional aniostropy,FA)。比较对照组不同节段颈脊髓的ADC值和FA值,将CSM组和对照组颈脊髓的ADC值和FA值分别进行比较,并对CSM患者颈脊髓ADC、FA评分和颈椎改良JOA(m JOA)评分分别进行相关性分析。结果:对照组颈脊髓的ADC值自C2/3~C6/7节段呈上升趋势,而FA值呈下降趋势,C2/3节段颈脊髓的ADC值较C5/6和C6/7节段明显低,而FA值明显高(ADC:F=3.546,P=0.008;FA:F=13.82,P0.001)。CSM组颈脊髓的FA值与对照组比较显著性减小(P0.001),而ADC值则显著性增加(P0.001)。CSM组颈脊髓的ADC值与m JOA评分无显著相关性(r=-0.287,P=0.220),而颈脊髓的FA值与m JOA评分存在显著性正相关(r=0.359,P=0.005)。结论:CSM患者颈脊髓DTI与正常人群存在差异,其ADC值较正常人群升高,而FA值则明显降低;m JOA评分与FA值呈正相关。     

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。     

磁共振成像在骨小梁结构研究中的应用

近来的各项研究都表明,骨小梁的强度和易骨折性不仅由骨密度决定,更与骨微结构有关.磁共振成像(MRI)作为一项新兴的非侵人性技术,也证实骨结构决定骨强度.由于MRI图像中骨小梁为低信号而骨髓为高信号,因此对显示骨结构尤为适合.MRI可以深入反映骨小梁内部的三维结构.MRI图像中的各项参数也与骨的生物力学特性和脆性有关.此外,MRI还可在动物或人体研究为疗效的评估提供帮助.本文对MRI的主要特点、技术方法、操作步骤、图像分析及其不足和应用前景作了回顾.     

磁共振水成像技术在泌尿系梗阻中的应用

磁共振水成像是近年来磁共振技术的新技术，它不用放射线与造影剂，利用重Ｔ２效果使含水器官显影，安全性高，操作简便，成像清晰，是一种较好的影像检查手段。它在泌尿系中的应用即磁共振尿路造影（ＭＲＵ），通过临床实践，体现了较好的适用性，尤其对泌尿系梗阻具有良好的诊断价值。本文就其原理、成像技术与方法、成像情况、具体应用等作一综述。     

3.0T磁共振在臂丛神经成像中的应用研究

目的 探讨3.0T磁共振扫描仪3D-STIR序列增强扫描在臂丛神经成像中的可行性,以及临床应用的效果和价值.方法 对26例志愿者及35例臂丛神经病变的患者,采用3.0T磁共振成像(MRI)常规扫描序列、3D-STIR序列平扫及3D-STIR序列增强扫描,观察所得图像,评价显示情况和对比噪声比.结果 3.0T MRI 3D-STIR序列及其增强扫描可清楚明确地显示所有志愿者臂丛神经的构成、走行、连续性、形态及信号,可以清楚地显示外伤或肿瘤累及臂丛神经所致的各种征象.结论 3.0T磁共振扫描仪3D-STIR序列增强扫描对臂丛神经病变的诊断和治疗有非常重要的价值.

Abstract：

Objective To investigate the feasibility of imaging brachial plexus in enhanced scan of 3D-STIR sequence in 3.0T MRI and the practical value of clinical application. Methods Twenty-six healthy volunteers and 35 patients with brachial plexus lesions underwent imaging of the brachial plexus with 3.0T MRI conventional scanning sequence,3D-STIR sequence scanning and 3D-STIR sequence of enhanced scan. The obtained images were observed to evaluate the image quality and signal to noise ratio. Results 3D-STIR sequence and enhanced scan could clearly display the components,course,continuity,shape and signals of the brachial plexus in all the healthy volunteers. The enhanced scan could improve the suppression effects of the background,and therefore could clearly visualize trauma and tumor involving the brachial plexus due to a variety of signs. Conclusion 3.0T MRI enhanced scan of 3D-STIR sequence has potential values in the diagnosis and treatment of brachial plexus diseases.     

脊髓型颈椎病脊髓受压征象的MRI分级及其临床意义

目的:建立脊髓型颈椎病(cervical spondylotic myelopathy,CSM)脊髓受压征象的MRI分级系统,探讨其可靠性及其与年龄、病程和JOA评分的相关性。方法:收集2010年1月～2011年9月就诊的78例多节段CSM患者的颈椎MRI资料,男51例,女27例;年龄42～77岁,平均55.1岁;病程0.25～276个月,平均48.8个月。以颈椎MRI中脊髓形态、脊髓信号、脊髓与硬膜囊关系作为分级依据征象,将每个征象按照其严重程度分为3个等级,相应赋予0～2分,按3个征象总分划分为四级:0级,0分;Ⅰ级,1～2分;Ⅱ级,3～4分;Ⅲ级,5～6分。由3位初、中、高级职称医师对78例患者的颈椎MRI从C2/3～C6/7进行2次独立分级和1次共同分级,Kappa分析评价每位医师前后2次之间及3位医师之间分级结果的一致性。将3位医师对三个征象共同分级的结果进行Spearman相关分析,同时将患者年龄、病程、术前JOA评分与分级结果进行Spearman相关分析。结果:3位医师分别2次对78例患者的390个节段进行分级,0级82～94个(21.03%～24.10%),Ⅰ级112～126个(28.72%～32.31%),Ⅱ级111～137个(28.46%～35.13%),Ⅲ级47～70个(12.05%～17.95%)。同一医师前后2次分级一致的节段占74.6%～78.5%,Kappa值为0.657～0.706;不同级别医师分级一致的节段占71.5%～76.7%,Kappa值为0.614～0.683。三个征象分级的结果之间相关系数分别为0.552、0.603、0.577,呈显著性正相关(P<0.05)。患者年龄、病程与3位医师共同分级结果的相关系数分别为0.372～0.511、0.388～0.498,呈显著性正相关(P<0.05);术前JOA评分与3位医师共同分级结果的相关系数为-0.409～-0.546,呈显著性负相关(P<0.05)。结论:依据脊髓形态、脊髓信号、脊髓与硬膜囊关系建立的脊髓型颈椎病脊髓受压征象的MRI分级系统具有良好的一致性,其与患者年龄、病程呈正性相关,而与术前JOA评分呈负性相关,对脊髓受压后病变的严重程度评估和研究有指导意义。     

脊髓型颈椎病MRI T2信号变化与颈椎活动度的关系

目的探讨脊髓型颈椎病患者MRI T2 WI病理信号变化的危险因素。MRI T2 WI信号变化在脊髓型颈椎病患者经常出现,信号强度的不同反映了脊髓的不同病理改变和颈椎病的发生和发展,但目前没有对引起MRI T2 WI信号变化的危险因素进行探讨,尤其是对颈椎病的发生和发展有着重要影响的颈椎动态特性。方法自2009年5月至2012年5月,符合研究纳入标准的71例脊髓型颈椎病患者纳入本研究。按MRI T2 WI信号强度分为三组：组1,信号无增强;组2,信号轻微增强;组3,信号明显增强。颈椎动态指标采用测量直立位颈椎过屈过伸侧位片Cobb角。结果各组间年龄、症状持续时间、术前JOA评分及性别比例差异无统计学意义（P〉0.05）。各组间颈椎整体过屈、过伸弧度、活动度,颈椎节段过屈差异无统计学意义（P〉0.05）。组1与组2、组3在节段过伸弧度与节段活动度差异有统计学意义（P〈0.05）,组2和组3在节段过伸弧度与节段活动度差异无统计学意义（P〉0.05）。结论颈椎节段过伸弧度和活动度增加是脊髓型颈椎病MRI T2 WI出现高信号变化的危险因素。     

Midsagittal tissue bridges are associated with walking ability in incomplete spinal cord injury: A magnetic resonance imaging case series

Context: Following spinal cord injury (SCI), early prediction of future walking ability is difficult, due to factors such as spinal shock, sedation, impending surgery, and secondary long bone fracture. Accurate, objective biomarkers used in the acute stage of SCI would inform individualized patient management and enhance both patient/family expectations and treatment outcomes. Using magnetic resonance imaging (MRI) and specifically a midsagittal T2-weighted image, the amount of tissue bridging (measured as spared spinal cord tissue) shows potential to serve as such a biomarker. Ten participants with incomplete SCI received MRI of the spinal cord. Using the midsagittal T2-weighted image, anterior and posterior tissue bridges were calculated as the distance from cerebrospinal fluid to the damage. Then, the midsagittal tissue bridge ratio was calculated as the sum of anterior and posterior tissue bridges divided by the spinal cord diameter. Each participant also performed a 6-minute walk test, where the total distance walked was measured within six minutes.

Findings: The midsagittal tissue bridge ratio measure demonstrated a high level of inter-rater reliability (ICC?=?0.90). Midsagittal tissue bridge ratios were significantly related to distance walked in six minutes (R?=?0.68, P?=?0.03).

Conclusion/clinical relevance: We uniquely demonstrated that midsagittal tissue bridge ratios were correlated walking ability. These preliminary findings suggest potential for this measure to be considered a prognostic biomarker of residual walking ability following SCI.     

Prediction of thigh skeletal muscle mass using dual energy x-ray absorptiometry compared to magnetic resonance imaging after spinal cord injury

Objectives: A rapid decline in lean mass (LM), fat-free mass (FFM) and increased intramuscular fat (IMF) predispose persons with spinal cord injury (SCI) to chronic medical conditions including dyslipidemia, insulin resistance, type 2 diabetes mellitus and cardiovascular disease. (1) To determine the relationship between dual energy x ray absorptiometry (DXA) and gold standard magnetic resonance imaging (MRI) LM values; (2) to develop predictive equations based on this relationship for assessing thigh LM in persons with chronic SCI.

Study Design: Cross-sectional predicational design.

Settings: Clinical research medical center.

Participants: Thirty-two men with chronic (>1 y post-injury) motor complete SCI.

Methods: Participants completed total body DXA scans to determine thigh LM and were compared to measurements acquired from trans-axial MRI.

Outcome measures: MRI was used to measure whole muscle mass (MM_MRI-WM), absolute muscle mass (MM_MRI-ABS) after excluding IMF, and knee extensor muscle mass (MM_MRI-KE). DXA was used to measure thigh LM (LM_DXA) and (FFM_DXA). To predict MM_MRI-KE, LM_DXA was multiplied by 0.52 and yielded LM_DXA-KE.

Results: LM_DXA predicted MM_MRI-WM [r²_?=?0.90, standard error of the estimate (SEE)?=?0.23?kg, P?<?0.0001] and MM_MRI-ABS (r²?=?0.82, SEE?=?0.28?kg, P?<?0.0001). LM_DXA-KE predicted MM_MRI-KE (r²?=?0.78, SEE?=?0.16?kg, P?<?0.0001).

Conclusion: DXA measurements revealed an acceptable agreement with the gold standard MRI and may be a viable alternative for assessing thigh skeletal muscle mass after SCI.     

脊髓型颈椎病术后MRI脊髓高信号改变与疗效的关系

目的 探讨脊髓型颈椎病术后MR T2WI脊髓高信号改变与疗效的关系.方法 功会26例脊髓型颈椎病患者,男15例,女11例;年龄38~73岁,平均49.8岁.收集患者术前和术后3个月以上脊髓MRI矢状位T2WI照片,用Yukawa法对脊髓信号强度进行评分,对照观察手术前后脊髓高信号变化情况.分别测量轴位T2WI压迫最重节段手术前后的脊髓横截面积.应用JOA17分法评价术前及术后脊髓功能,分析脊髓高信号改变与术后神经功能变化的关系.结果 根据手术后脊髓高信号变化将患者分为3组:脊髓高信号减弱组18例,脊髓高信号不变组7例,脊髓高信号增强组1例.脊髓高信号减弱组与不变组术前脊髓信号评分比较,差异无统计学意义.脊髓高信号减弱组与不变组术前脊髓信号评分与术后JOA评分、神经功能改善率均无相关性.两组相比,脊髓高信号减弱组年龄小[(51.94±11.04):(61.12±10.14),P=0.048]、术前脊髓受压最重节段横截面积大[(60.90±14.77):(42.05±18.05),P=0.010]、术后JOA评分高[(14.44±1.82):(11.00±3.89),P=0.042]、神经功能改善率高[(64%±23%):(38%±30%),P=0.027].脊髓高信号增强组因例数少,未列入对比研究.结论 脊髓型颈椎病术后MR T2WI脊髓高信号改变可作为疗效预测指标.     

Phase contrast magnetic resonance of the spinal cord preliminary results in spinal cord arterio-venous malformations

Summary In spite of the recent advances in neuroradiology including the CT scan and the spin-echo-magnetic resonance (MR), accurate diagnosis of arteriovenous malformations (AVMs) involving the spinal cord is still based on selective angiography. This last procedure is invasive and needs to be repeated during the follow up. Phase contrast angio MR was performed with a 0.5 Tesla unit on 12 patients with an AVM involving the spinal cord (7 intramedullary AVMs, 4 perimedullary fistulas, and 1 dural fistula with perimedullary venous drainage); 4 of these were investigated before and after treatment. Angio MR showed abnormal vascular patterns within the spinal canal in all cases, without distinguishing between arteries and veins; the nidus of the intramedullary AVMs was displayed in all cases. Angio MR provided images of the whole AVMs comparable to the angiographic pictures, in contrast to the spin-echo MR, which provided only discontinued images of the vessels. The efficient range of velocity providing images varied, according to the type of the malformation (slow for dural fistulas, rapid for intra-medullary AVMs). In the 4 patients investigated after treatment, comparison of the images obtained before and after treatment permitted assessment of the degree of occlusion of the malformation. Finally, angio MR as a complement of spin-echo MR can now be used as a reliable tool for detection of spinal cord AVMs, assessing the indication for angiography, and, furthermore, it can probably replace most of the postoperative control angiographies. The value of the efficient imaging velocity is disputable but seems to depend on the haemodynamic characteristics of the malformation and may then serve as a guide to angiography.     

MRI T2加权像伴有髓内高信号的轻度脊髓型颈椎病的治疗

目的分析比较MRI T2加权像伴有髓内高信号的轻度脊髓型颈椎病患者行手术治疗和非手术治疗的临床效果,初步探讨可能影响预后的相关因素。方法 2008年7月年-2011年6月,收治轻度脊髓型颈椎病患者91例符合纳入标准,进行回顾性研究,以日本骨科学会（Japanese Orthapaedic Association,JOA）评分改善率作为治疗后临床效果的评估指标,比较手术治疗和非手术治疗的情况。进一步将JOA评分改善率与治疗方式、性别、年龄、病程、节段性前凸角、C2-7活动度、脊髓受压程度进行相关及多元线性回归分析,筛选影响疗效的相关因素,并进一步明确其与治疗后临床效果的关系。结果根据治疗方法不同将本组病例分为2组,A组53例,采用颈前路减压植骨融合钢板内固定手术进行治疗,平均随访30.68个月。B组38例采用非手术治疗,平均随访34.68个月。对于MRI T2加权像伴有髓内高信号的轻度脊髓型颈椎病患者,手术治疗与非手术治疗相比,两者临床疗效差异无统计学意义。病程（P〈0.01）、节段性前凸角（P〈0.01）2个因素与JOA评分改善率之间存在显著相关性。多元线性回归结果表明,病程较短、节段性前凸角较大的患者治疗后效果较好。结论对于MRI T2加权像伴有髓内高信号的轻度脊髓型颈椎病患者,其手术治疗和非手术治疗并无显著差异,然而病程较短、节段性前凸角较大的患者治疗的效果优于病程较长、节段后凸的患者。     

Prognostic value of changes in spinal cord signal intensity on magnetic resonance imaging in patients with cervical compressive myelopathy

Background contextSignal intensity on preoperative cervical magnetic resonance imaging (MRI) of the spinal cord has been shown to be a potential predictor of outcome of surgery for cervical compressive myelopathy. However, the prognostic value of such signal remains controversial. One reason for the controversy is the lack of proper quantitative methods to assess MRI signal intensity.PurposeTo quantify signal intensity and to correlate intramedullary signal changes on MRI T1- and T2-weighted images (WIs) with clinical outcome and prognosis.Study designRetrospective case study.Patient samplePatients (n=148; cervical spondylotic myelopathy, n=102 and ossified posterior longitudinal ligament, n=46) who underwent surgery for cervical compressive myelopathy and had high signal intensity change on sagittal T2-WI MRI before surgery between 2006 and 2010.Outcome measureNeurologic assessment was conducted with the Japanese Orthopedic Association (JOA) scoring system for cervical myelopathy. The rate of neurologic improvement was calculated with the use of preoperative and postoperative JOA scores.MethodsQuantitative analysis of MRI signal on both T1- and T2-WIs via use of the signal intensity ratio (SIR; signal intensity of lesion relative to that at C7-T1 disc level) was performed. Correlations between SIR on T1- and T2-WIs and preoperative JOA score, JOA improvement rate, disease duration, and MRI morphologic classification (cystic or diffuse type) were analyzed. Multivariate regression analysis for JOA improvement rate was also analyzed. In a substudy, 25 patients underwent follow-up MRI starting from 6 months after surgery to analyze the relationship between changes in SIR on follow-up MRI and clinical outcome.ResultsSIR on T1-WIs, but not SIR on T2-WIs, correlated with postoperative neurologic improvement. The disease duration correlated negatively with SIR on T1-WIs and JOA improvement rate but not with SIR on T2-WIs. SIR on T2-WIs of “cystic type” was significantly greater than of “diffuse type,” but SIR on T1-WI and JOA improvement rate were not different in the two types. Stepwise multivariate regression analysis indicated that SIR on T1-WIs and long disease duration were significant predictors of postoperative neurologic outcome. SIR on follow-up T1-WI and changes in SIR on T1-WI after surgery correlated positively with postoperative improvement rate. SIR on follow-up T2-WI and changes on T2-WI correlated negatively with postoperative neurologic improvement.ConclusionsOur results suggest that low intensity signal on preoperative T1-WIs but not T2-WIs correlated with poor postoperative neurologic outcome. Furthermore, decreased signal intensity on postoperative T1-WIs and increased signal intensity on postoperative T2-WIs are predictors of poor neurologic outcome.     

组织移植治疗与脊髓功能重建的研究进展

脊髓损伤后功能重建有赖于脊髓结构的恢复,组织移植替代疗法是目前医学界研究的热点,其种类多,包括周围神经、胚胎脊髓组织、细胞移植以及基因组织工程等,报道结果也不一,本文对近20年来脊髓损伤移植治疗的现状做一综述,旨在提高和加强对脊髓损伤治疗的认识.