摘要
目的探讨弥散张量成像(DTI)技术在脊髓型颈椎病手术疗效评价中的应用价值。方法对2010年1月~2016年12月在我院诊断为脊髓型颈椎病并行手术治疗的94例患者进行回顾性分析,所有患者术前、术后(6个月)进行3.0T磁共振DTI序列扫描,并采集DTI量化数据[表观张量系数(ADC)、各向异性分数(FA)、轴向弥散率(AD)及垂直弥散率(VD)]。采用改良日本骨科学会(JOA)脊髓损害功能评定标准进行术前、术后脊髓功能评分并采用Hirabayashi方法计算脊髓神经功能改善率,将改善率≥50%纳入恢复良好组,共58例;将改善率<50%纳入恢复欠佳组,共36例。比较两组术前、术后的JOA评分、ADC、FA、AD及VD。结果恢复良好组术后的JOA评分高于术前,差异有统计学意义(P<0.05);恢复欠佳组术前、术后的JOA评分比较,差异无统计学意义(P>0.05);恢复良好组术前、术后的JOA评分均高于恢复欠佳组,差异有统计学意义(P<0.05)。在DTI序列方面,恢复良好组术后的ADC、VD值低于本组术前,FA、AD值高于本组术前,差异均有统计学意义(P<0.05)。恢复欠佳组术前与术后的ADC、FA、AD、VD值比较,差异均无统计学意义(P>0.05)。两组术前的ADC值比较,差异无统计学意义(P>0.05);恢复良好组术前的FA、AD值高于恢复欠佳组,VD值低于恢复欠佳组,差异均有统计学意义(P<0.05);恢复良好组术后的FA、AD高于恢复欠佳组,ADC、VD低于恢复欠佳组,差异均有统计学意义(P<0.05)。结论DTI能量化分析脊髓型颈椎病的颈髓微结构改变,FA、AD、VD量化有助于脊髓型颈椎病的疗效评估。
Objective To explore the application value of diffusion tensor imaging(DTI)in surgical curative effect evaluation of cervical spondylotic myelopathy.Methods Retrospective analysis was performed on 94 patients diagnosed with cervical spondylotic myelopathy and treated by operation in our hospital from January 2010 to December 2016.All patients underwent 3.0 T magnetic resonance DTI sequence scanning before and 6 months after operation,and the quantitative data of DTI(apparent diffusion coefficient[ADC],fractional anisotropy[FA],axial diffusivity[AD],vertical diffusivity[VD])were collected.The preoperative and postoperative spinal cord function score were evaluated by the spinal cord injury function evaluation standard of modified Japanese Orthopaedic Association(JOA).The recovery rate of spinal cord nerve function were calculated using Hirabayashi method.A total of 58 patients with no less than 50%recovery rate were included in the good recovery group,and 36 patients with less than 50%recovery rate were included in the poor recovery group.The JOA score,the value of ADC,FA,AD and VD were compared between the two groups before and after operation.Results In the good recovery group,the JOA score after operation was higher than that before operation,the difference was statistically significant(P<0.05),whereas in the poor recovery group,there was no significant difference between the preoperative and the postoperative JOA score(P>0.05).Both preoperative and postoperative JOA score in the good recovery group were significantly higher than those of the poor recovery group,the difference was statistically significant(P<0.05).In terms of DTI sequences,the value of ADC and VD in the good recovery group after operation were significantly lower than those before operation,the value of FA and AD in the good recovery group after operation were higher than those before operation,and all the differences were statistically significant(P<0.05).As regards to the poor recovery group,there were no significant difference between before and after operation in the value of ADC,FA,AD and VD(P>0.05).There was no significant difference in preoperative ADC value between the two groups(P>0.05).The preoperative FA and AD value of the good recovery group were significantly higher than those of the poor recovery group,and the preoperative VD value of the good recovery group was lower than that of the poor recovery group,the difference was statistically significant(P<0.05).The postoperative FA and AD value of the good recovery group were significantly higher that those of the poor recovery group,and the postoperative ADC and VD of the good recovery group was lower than that of the poor recovery group,the difference was statistically significant(P<0.05).Conclusion DTI can quantitatively analyze the changes of cervical spinal cord microstructure of cervical spondylotic myelopathy.Besides,the quantified FA,AD,VD are conducive to evaluating the curative effect of cervical spondylotic myelopathy.
作者
祝捷
梁英杰
ZHU Jie;LIANG Ying-jie(Department of Orthopedics,Guangzhou First People's Hospital,Guangdong Province,Guangzhou 510180,China)
出处
《中国当代医药》
2019年第21期40-44,共5页
China Modern Medicine
基金
广东省科技计划项目(2014A020212571)
关键词
颈髓型颈椎病
磁共振成像
弥散张量成像
表观张量系数
各向异性分数
轴向扩散率
垂直扩散率
Cervical spondylotic myelopathy
Magnetic resonance imaging
Diffusion tensor imaging
Apparent diffusion coefficient
Fractional anisotropy
Axial diffusivity
Vertical diffusivity
