DTI技术与常规MRI在脊髓型颈椎病观察脊髓损伤中的对比研究

目的通过比较常规MRI及DTI,评价脊髓型颈椎病的脊髓损伤,探讨DTI对检测脊髓型颈椎病(CSM)脊髓损伤的价值。材料与方法使用GE Signa Hde 1.5T超导型磁共振仪,对40例健康志愿者和60例脊髓型颈椎病患者进行常规MRI及DTI检查。根据T2WI图像颈髓病变区信号不同,将CSM患者分为颈髓病变区高信号组(C组,13例)和等信号组(B组,47例),正常对照组(A组,40例)。观察常规T2WI图,测量DTI不同参数值,比较不同组别ADC值和FA值的变化。结果常规T2WI等信号患者(B组),虽然常规T2WI没有显示出病变脊髓异常信号改变,但是DTI参数值出现变化,FA值降低,提示病变脊髓各向异性减低;ADC值升高,反映各向同性增高。常规T2WI高信号患者(C组),FA值进一步减低,脊髓出现不均淡黄色信号。ADC值、FA值在A,B,C组中均有统计学意义(表1),ADC值在A组、B组、C组中呈逐渐升高变化,反映脊髓各向同性逐渐升高;RA值在A组、B组、C组中呈逐渐降低变化,反映脊髓各向异性逐渐降低。结论通过脊髓型颈椎病两组的研究,显示DTI能在常规T2WI尚未出现异常信号之前既能检测颈髓的较为早期的损伤,DTI较常规MRI检测脊髓慢性损伤更敏感,DTI能更早、更精确地发现脊髓型颈椎病的脊髓病变,有助于临床医生选择最佳的治疗方法,同时可以为手术治疗赢得时间。DTI量化参数可以定量评估脊髓损伤程度,使脊髓损伤的诊断更为准确。

Comparation Between DTI and Conventional MRI in Spinal Cord Damage in Cervical Spondylotic Myelopathy

Objective The application values of DTI on the injury of the cervical spinal cord in cervical spondylopathy was explored by comparing the cervical myelopathy spinal cord injury of conventional MRI and DTI evaluation. MaterialandMethod A total of 40 healthy controls and 60 patients with cervical spondylotic myelopathy was performed on conventional MRI and DTI by using 1.5T scanner. According to the signal of the damage cord on T2WI, the patients were divided into three groups：hyperintense （group C, 13cases）, isointense （group B, 47cases） and control group （group A,40 cases）. Then study the features of DTI and compare the values of ADC and FA between different groups. Results FA maps showed orange or yellow at the compression site of spinal cord, suggested FA values decreasing. ADC maps exhibited inhomogeneous high intensity at involved spinal cord. DTI was sensitive in detecting spinal cord damage and could assess subtle structural damage and changes of the CSM. Conclusion DTI can detect cervical spinal cord earlier injury before the abnormal signal conventional T2WI has not yet appeared;DTI is more sensitive than conventional MRI to detect chronic spinal cord injury; DTI can be earlier and more accurately discover cervical myelopathy spinal cord lesions, which will help clinicians choose the best treatment, and vin the time for the surgical treatment. DTI quantization parameter can quantitatively assess the degree of spinal cord injury, and it makes the diagnosis of spinal cord injury more accurate.