三维真稳态进动快速成像序列联合扩散张量神经纤维束示踪成像在腰椎间盘突出症中的应用

目的探讨三维真稳态进动快速成像(3D-Ture FISP)序列联合扩散张量神经纤维束示踪成像(DTT)判定腰椎间盘突症(LDH)所致坐骨神经痛责任神经根的价值。方法分别对40例单侧坐骨神经痛LDH患者(病变组)及40名健康志愿者(对照组)行腰骶部MR检查。将3D-Ture FISP序列与DTT图像融合,于L4～S1椎体水平测量双侧神经根FA及ADC值,结合融合图像所示神经根形态、走行及FA、ADC值判定LDH患者坐骨神经痛责任神经根,并进行统计学分析。结果 3D-True FISP序列与DTT融合图像可清晰显示神经根形态及走行。病变组40例(受累神经根51条,未受累神经根189条)中,37例影像学检查判定的责任神经根与临床症状相符,3例不符。对照组(240条神经根)左侧与右侧神经根FA及ADC值差异均无统计学意义(P均0.05),双侧神经根平均FA值为0.346±0.042,ADC值为(1.296±0.080)mm~2/s。病变组患侧神经根FA值为0.253±0.021,ADC值为(1.743±0.089)mm~2/s;对侧神经根FA值为0.339±0.013,ADC值为(1.297±0.075)mm~2/s。病变组患侧神经根FA值明显低于自身同层面对侧神经根(t=0.806,P=0.038)及对照组神经根(t=0.963,P=0.043),ADC值明显高于自身同层面对侧神经根(t=0.866,P=0.040)及对照组神经根(t=0.921,P=0.042)。病变组对侧神经根FA及ADC值与对照组间差异均无统计学意义(P均0.05)。结论 3D-Ture FLSP序列联合DTT技术可清楚显示神经根解剖形态及走行,结合量化分析判定LDH患者坐骨神经痛责任神经根,为临床提供更多诊疗信息。

Application of three-dimensional true fast imaging with steady-state precession sequence combined with diffusion tensor tractography for lumbar disc herniation

Objective To explore the value of three-dimensional true fast imaging with steady-state precession (3D-Ture FISP) sequence combined with diffusion tensor tractography (DTT) in determining the responsible nerve root of sciatica caused by lumbar disc herniation (LDH). Methods MR examinations of lumbosacral region were performed on 40 LDH patients with unilateral sciatica (lesion group) and 40 healthy volunteers (control group). FA and ADC values of bilateral nerve roots were measured at L4-S1 vertebral level based on 3D-Ture FISP sequence and DTT fusing images. The responsible nerve roots of LDH patients with sciatica were detected combining with morphologic findings, course and FA and ADC values of the nerve roots shown on the fusing images. And statistical analysis was carried out. Results All 3D-True FISP sequence and DTT fusing images could clearly show the morphology and course of nerve roots. In lesion group (51 involved nerve roots and 189 uninvolved nerve roots), 37 cases were found to be in accordance with the clinical symptoms whereas 3 cases were not. In control group (240 nerve roots), there was no statistical difference of FA and ADC values between the left and the right nerve roots (both P>0.05). The mean FA value of bilateral nerve roots was 0.346±0.042, and the mean ADC value was (1.296±0.080)mm²/s. The mean FA and ADC values of involved nerve roots in lesion group was 0.253±0.021 and (1.743±0.089)mm²/s, respectively. And the mean FA and ADC values of contralateral uninvolved nerve roots was 0.339±0.013 and (1.297±0.075)mm²/s, respectively. FA value of involved nerve roots in lesion group was significantly lower than that of contralateral uninvolved nerve roots in lesion group (t=0.806, P=0.038) and the mean FA value of control group (t=0.963, P=0.043), respectively,while ADC value significantly increased compared with contralateral uninvolved nerve roots (t=0.866, P=0.040) and control group (t=0.921, P=0.042). There was no statistical difference of the mean FA and ADC values between contralateral nerve roots in lesion group and control group (both P>0.05). Conclusion 3D-Ture FLSP sequence combined with DTT technique can not only clearly show the anatomical morphology and course of nerve root, but also quantitatively detect the responsible nerve roots of sciatica in LDH patients, so as to provide information for clinical diagnosis and treatment.