腰椎间盘突出症微创术前后的DTI研究

目的探讨扩散张量成像(diffusion tensor imaging,DTI)技术对腰椎间盘突出症患者受压神经根的术前、术后微观结构变化及与临床症状相关性的应用价值.材料与方法选取50例经临床诊断和手术证实的腰椎间盘突出症单侧神经根受压患者纳入本研究.术前、术后3个月均接受磁共振常规序列、DTI扫描和功能障碍指数(oswestry disability index,ODI)评分、视觉模拟评分(visual analogue score,VAS).比较DTI参数的ADC、各向异性分数(fractional anisotropy,FA)值、ODI、VAS评分的差异,分析DTI参数与ODI、VAS评分的相关性.结果术前患侧神经根ADC值与健侧比较,差异无统计学意义(P>0.05);术前患侧神经根FA值低于健侧,差异有统计学意义(P<0.05);术后患侧神经根FA值增加,与健侧比较,差异无统计学意义(P>0.05);术前患侧神经根FA值与术前ODI、VAS评分均呈负相关(r=-0.494、-0.560,P<0.05);术前患侧神经根FA值与ODI、VAS评分改善值均呈正相关(r=0.492、0.435,P<0.05).结论DTI可以定量评估受压神经根的微观结构变化,为患者治疗方案的选择、术后疗效的准确评估提供一定的参考价值.

Study on diffusion tensor imaging before and after minimally invasive surgery for lumbar disc herniation

Objective:To estimate the application value of diffusion tensor imaging(DTI)technology on detecting the preoperative and postoperative microstructural changes of compressed nerve roots in patients with lumbar disc herniation.And to investigate the DTI obtained data correlation with clinical symptoms.Materials and Methods:50 patients with unilateral nerve root compression of lumbar disc herniation confirmed by clinical diagnosis and surgery were selected for this study.All patients underwent conventional magnetic resonance imaging sequence,diffusion tensor imaging(DTI)scan,oswestry disability index(ODI)score judgement,and visual analogue scale(VAS)score judgement before surgery and 3 months after surgery.The differences in apparent diffusion coefficient(ADC),fractional anisotropy(FA),ODI score and VAS score were compared.The correlation of DTI parameters with ODI score and with VAS score was analyzed.Results:There was no significant difference in ADC values between the affected nerve roots and the healthy side before surgery(P>0.05).The FA values of the affected nerve roots before surgery were significantly lower than that of the healthy side(P<0.05).The FA values of the affected nerve roots were increased after operation,yet there was no significant difference when it was compared with the healthy side(P>0.05).The preoperative FA value of the affected nerve root was negatively correlated with the preoperative ODI score(r=-0.494,P<0.05)and VAS score(r=-0.560,P<0.05).The FA value of the affected nerve root before surgery was positively correlated with the improvement of ODI score(r=0.492,P<0.05)and VAS score(r=0.435,P<0.05).Conclusions:DTI could be quantitatively used to evaluate the microstructural changes of the compressed nerve roots,and it also provides reference values for the selection of patients'treatments and accurate assessment of postoperative curative effect.