磁共振扩散张量成像在评价脊神经根病变中的作用
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摘要
目的探讨磁共振扩散张量成像(DTI)在评价脊神经根病变中的作用。方法选取2014年1月到2015年12月收治的62例腰椎间盘突出、膨出导致脊神经根病变患者,对其进行核磁共振矢状位T1WI、T2WI,轴位T2WI和DTI检查。结果共有27例患者病变侧神经根发生移位,17例病变侧神经纤维局部变细,9例纤维束局部有缺失,4例无法追踪到腰骶神经根的在椎管内穿行的上行段,2例无受压的神经根。相对于健康侧神经根,病侧神经根排列不规则且稀疏,细小神经纤维穿插增多。腰间盘突出症患者病侧神经根表观弥散系数(ADC)均值为(1.769±0.489)×10~(-3)mm~2·s~(-1),高于健侧同一椎间盘水平的神经根[(1.466±0.451)×10~(-3)mm~2·s~(-1),t=3.587,P<0.01];各向异性指数(FA)的均值为(0.251±0.032)×10~(-3),低于健侧同一椎间盘水平的神经根[(10.329±0.026)×10~(-3),t=14.896,3.587,P<0.01]。结论磁共振扩散张量成像可作为常规磁共振很好的补充,它能够对神经根进行功能成像从而定量评价神经根病变,并且有望可以利用DTI根据神经纤维束的面积以及形态的改变,从而诊断神经根病变。
Objective To investigate the application of magnetic resonance diffusion tensor imaging( MR DTI) in the evaluation of spinal nerve root lesions. Methods Sixty-two patients with spinal nerve root lesions( due to lumbar disc herniation) and 62 healthy volunteers from January 2014 to December 2015 were selected. All of them were received MR T1-weighted and T2-weighted imaging at sagittal position and T2-weighted imaging and DTI at axial position. Results There were 22 cases displaced on the lateral nerve root of the lesion,17 cases localized in the lateral nerve fibers,9 cases localized in the fibrous tract,4 cases unable to track the upper segment of the lumbosacral nerve root in the spinal canal,and 2 cases without compressed nerve root. Compared to the lateral nerve root of healthy side,the nerve root of the lesioned side was irregular and sparsely arranged,and there were fine nerve fibers interspersed. The mean apparent diffusion coefficient( ADC) value of the lateral nerve root of the lumbar disc herniation was higher than that of the same level disc in the healthy side [( 1. 769 ± 0. 489) × 10~(-3) mm~2/s vs( 1. 466 ± 0. 451) × 10~(-3) mm~2/s,t = 3. 587,P < 0. 01]. And the mean fractional anisotropy( FA) value of the lateral nerve root of the lumbar disc herniation was lower than that of the same level disc in the healthy side [( 0. 251 ± 0. 032) × 10~(-3) vs( 0. 329 ± 0. 026) × 10~(-3),t = 14. 896,P < 0. 01]. Conclusions MRI DTI could be a good supplement to conventional MRI,which could perform functional imaging of nerve roots and quantitatively evaluate nerve root lesions. It is hopeful that DTI can be used to diagnose nerve root lesions based on the area and morphological changes of nerve fiber bundles.
Objective To investigate the application of magnetic resonance diffusion tensor imaging( MR DTI) in the evaluation of spinal nerve root lesions. Methods Sixty-two patients with spinal nerve root lesions( due to lumbar disc herniation) and 62 healthy volunteers from January 2014 to December 2015 were selected. All of them were received MR T1-weighted and T2-weighted imaging at sagittal position and T2-weighted imaging and DTI at axial position. Results There were 22 cases displaced on the lateral nerve root of the lesion,17 cases localized in the lateral nerve fibers,9 cases localized in the fibrous tract,4 cases unable to track the upper segment of the lumbosacral nerve root in the spinal canal,and 2 cases without compressed nerve root. Compared to the lateral nerve root of healthy side,the nerve root of the lesioned side was irregular and sparsely arranged,and there were fine nerve fibers interspersed. The mean apparent diffusion coefficient( ADC) value of the lateral nerve root of the lumbar disc herniation was higher than that of the same level disc in the healthy side [( 1. 769 ± 0. 489) × 10~(-3) mm~2/s vs( 1. 466 ± 0. 451) × 10~(-3) mm~2/s,t = 3. 587,P < 0. 01]. And the mean fractional anisotropy( FA) value of the lateral nerve root of the lumbar disc herniation was lower than that of the same level disc in the healthy side [( 0. 251 ± 0. 032) × 10~(-3) vs( 0. 329 ± 0. 026) × 10~(-3),t = 14. 896,P < 0. 01]. Conclusions MRI DTI could be a good supplement to conventional MRI,which could perform functional imaging of nerve roots and quantitatively evaluate nerve root lesions. It is hopeful that DTI can be used to diagnose nerve root lesions based on the area and morphological changes of nerve fiber bundles.
引文
[1]肖文丰,黄莹,许蕾,等.3D SPACE STIR结合DTI显示腰骶神经根病变的研究[J].医学影像学杂志,2015(9):1537-1540.
[2]Hou ZJ,Huang Y,Fan ZW,et al.Changes in lumbosacral spinal nerve roots on diffusion tensor imaging in spinal stenosis[J].Neural Regen Res,2015,10(11):1860-1864.
[3]田欣,朱芳华,耿左军,等.磁共振扩散张量成像对腰部脊神经根病变的诊断价值[J].河北医药,2014,36(20):3086-3088.
[4]Yamada H,Yamamoto A,Okada T,et al.Diffusion tensor imaging of the optic chiasm in patients with intra-or parasellar tumor using readout-segmented echo-planar[J].Magn Reson Imaging,2016,34(5):654-661.
[5]Landi A,Palmarini V,D'Elia A,et al.Magnetic resonance diffusion tensor imaging and fiber-tracking diffusion tensor tractography in the management of spinal astrocytomas[J].World J Clin Cases,2016,4(1):1-4.
[6]宋泽进,谭永明,何来昌,等.磁共振弥散张量成像在腰椎间盘突出症神经根受压中的临床应用[J].南昌大学学报(医学版),2014,54(12):74-76.
[7]Zhang XY,Fan FM,Chen DC,et al.Extensive white matter abnormalities and clinical symptoms in drug-naive patients with first-episode schizophrenia:a voxel-based diffusion tensor imaging study[J].J Clin Psychiatry,2016,77(2):205-211.
[8]时寅,王德杭,宗敏,等.磁共振扩散张量成像定位及定量评价腰骶神经根压迫症[J].临床放射学杂志,2014,33(8):1229-1232.
[9]汪博,范国光.DTI在腰椎间盘突出引起腰骶神经根压迫症中的应用价值[J].放射学实践,2016,31(7):658-661.
[10]Edlow BL,Copen WA,Izzy S,et al.Diffusion tensor imaging in acute-to-subacute traumatic brain injury:a longitudinal analysis[J].BMC Neurol,2016,16:2.
[11]刘长彬,李建军,杨德刚,等.弥散张量成像在脊髓损伤临床和基础研究中的应用[J].中国康复理论与实践,2015,21(9):1031-1036.
[12]Mekkaoui C,Metellus P,Kostis WJ,et al.Diffusion tensor imaging in patients with glioblastoma multiforme using the supertoroidal model[J].Plos one,2016,11(1):e0146693.
[13]时寅,王传兵,刘伟,等.采用扩散张量成像定量研究及纤维束示踪成像观察正常腰骶丛神经[J].中华放射学杂志,2014,48(2):135-138.
[14]Assis ZA,Saini J,Ranjan M,et al.Diffusion tensor imaging in evaluation of posterior fossa tumors in children on a 3T MRI scanner[J].Indian J Radiol Imaging,2015,25(4):445-452.
[15]肖胜,郭涛.磁共振扩散张量成像在评价以及神经根病变中的作用[J].中国CT和MRI杂志,2016,14(3):51-54.
[2]Hou ZJ,Huang Y,Fan ZW,et al.Changes in lumbosacral spinal nerve roots on diffusion tensor imaging in spinal stenosis[J].Neural Regen Res,2015,10(11):1860-1864.
[3]田欣,朱芳华,耿左军,等.磁共振扩散张量成像对腰部脊神经根病变的诊断价值[J].河北医药,2014,36(20):3086-3088.
[4]Yamada H,Yamamoto A,Okada T,et al.Diffusion tensor imaging of the optic chiasm in patients with intra-or parasellar tumor using readout-segmented echo-planar[J].Magn Reson Imaging,2016,34(5):654-661.
[5]Landi A,Palmarini V,D'Elia A,et al.Magnetic resonance diffusion tensor imaging and fiber-tracking diffusion tensor tractography in the management of spinal astrocytomas[J].World J Clin Cases,2016,4(1):1-4.
[6]宋泽进,谭永明,何来昌,等.磁共振弥散张量成像在腰椎间盘突出症神经根受压中的临床应用[J].南昌大学学报(医学版),2014,54(12):74-76.
[7]Zhang XY,Fan FM,Chen DC,et al.Extensive white matter abnormalities and clinical symptoms in drug-naive patients with first-episode schizophrenia:a voxel-based diffusion tensor imaging study[J].J Clin Psychiatry,2016,77(2):205-211.
[8]时寅,王德杭,宗敏,等.磁共振扩散张量成像定位及定量评价腰骶神经根压迫症[J].临床放射学杂志,2014,33(8):1229-1232.
[9]汪博,范国光.DTI在腰椎间盘突出引起腰骶神经根压迫症中的应用价值[J].放射学实践,2016,31(7):658-661.
[10]Edlow BL,Copen WA,Izzy S,et al.Diffusion tensor imaging in acute-to-subacute traumatic brain injury:a longitudinal analysis[J].BMC Neurol,2016,16:2.
[11]刘长彬,李建军,杨德刚,等.弥散张量成像在脊髓损伤临床和基础研究中的应用[J].中国康复理论与实践,2015,21(9):1031-1036.
[12]Mekkaoui C,Metellus P,Kostis WJ,et al.Diffusion tensor imaging in patients with glioblastoma multiforme using the supertoroidal model[J].Plos one,2016,11(1):e0146693.
[13]时寅,王传兵,刘伟,等.采用扩散张量成像定量研究及纤维束示踪成像观察正常腰骶丛神经[J].中华放射学杂志,2014,48(2):135-138.
[14]Assis ZA,Saini J,Ranjan M,et al.Diffusion tensor imaging in evaluation of posterior fossa tumors in children on a 3T MRI scanner[J].Indian J Radiol Imaging,2015,25(4):445-452.
[15]肖胜,郭涛.磁共振扩散张量成像在评价以及神经根病变中的作用[J].中国CT和MRI杂志,2016,14(3):51-54.