磁共振扩散张量成像对T2WI无异常信号颈髓损伤的诊断价值
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摘要
目的探讨磁共振扩散张量成像(DTI)对T2WI无异常信号颈髓损伤的诊断价值。方法通过测量17例轻微颈髓损伤患者(病例组)和20例正常颈髓患者(对照组)的表观扩散系数值和各向异性值,观察颈髓损伤的表观扩散系数(ADC)图、部分各向异性(FA)图和纤维束的特征表现,分析比较两组颈髓的ADC值、FA值,并绘制受试者工作曲线(ROC)确定诊断颈髓轻微损伤的ADC和FA的阈值。结果对照组不同节段颈髓的ADC值和FA值进行比较,差异均无统计学意义(F分别=0.44、0.85,P均>0.05)。病例组的ADC图呈黄绿信号,FA图呈黄绿信号,颈髓损伤纤维束损伤区表现为局部纤维束略受压改变、颜色略变浅。病例组ADC值高于对照组,FA值低于对照组(t分别=-10.22、7.47,P均<0.05)。绘制ROC曲线得出当ADC=1.12×10-3mm2/s和FA=0.64作为颈髓损伤的诊断阈值时,诊断效能最高。结论 DTI可以定量分析颈髓损伤,反映损伤脊髓的微观改变及直观显示脊髓纤维损伤情况,对早期诊断、治疗具有重要临床价值。
Objective To discuss the diagnostic value of magnetic resonance diffusion tensor imaging(DTI) on the diagnosis of cervical spinal cord injury without abnormal signals in T2 WI. Methods Apparent diffusion coefficient values and anisotropy values of 17 patients with minor cervical spinal cord injury(case group)and 20 normal cervical spinal cord(control group) were measured. The characteristics of the ADC, FA map and fiber bundle in cervical spinal cord injury were observed. The ADC values and FA values of the two groups were compared by statistical analysis, and draw the receiver operating curve(ROC) was used to determine the diagnostic threshold of ADC and FA in minor cervical spinal cord injury. Results In the control group,there was no significant difference in ADC value and FA value between different segments of cervical spinal cord(F=0.44, 0.85, P>0.05).In the case group,the ADC map showed yellow-green signal, the FA map signal showed yellow-green signal, the fiber bundle injury area of cervical cord injury showed local fiber bundle compression slightly and slightly shallow color. In the case group, the ADC value was significantly higher than the control group(t=-10.22, P<0.05),while the FA value was significantly lower than the control group(t= 7.47, P<0.05). The ROC curve showed that when ADC was 1.12×10-3mm2/s and FA was 0.64,the diagnostic efficacy was the highest. Conclusion DTI can quantitatively analyze the cervical spinal cord injury, reflect the microscopic changes of spinal cord injury and visually display spinal cord fiber injury. It has important clinical value for early diagnosis and treatment.
Objective To discuss the diagnostic value of magnetic resonance diffusion tensor imaging(DTI) on the diagnosis of cervical spinal cord injury without abnormal signals in T2 WI. Methods Apparent diffusion coefficient values and anisotropy values of 17 patients with minor cervical spinal cord injury(case group)and 20 normal cervical spinal cord(control group) were measured. The characteristics of the ADC, FA map and fiber bundle in cervical spinal cord injury were observed. The ADC values and FA values of the two groups were compared by statistical analysis, and draw the receiver operating curve(ROC) was used to determine the diagnostic threshold of ADC and FA in minor cervical spinal cord injury. Results In the control group,there was no significant difference in ADC value and FA value between different segments of cervical spinal cord(F=0.44, 0.85, P>0.05).In the case group,the ADC map showed yellow-green signal, the FA map signal showed yellow-green signal, the fiber bundle injury area of cervical cord injury showed local fiber bundle compression slightly and slightly shallow color. In the case group, the ADC value was significantly higher than the control group(t=-10.22, P<0.05),while the FA value was significantly lower than the control group(t= 7.47, P<0.05). The ROC curve showed that when ADC was 1.12×10-3mm2/s and FA was 0.64,the diagnostic efficacy was the highest. Conclusion DTI can quantitatively analyze the cervical spinal cord injury, reflect the microscopic changes of spinal cord injury and visually display spinal cord fiber injury. It has important clinical value for early diagnosis and treatment.
引文
1李旭,秦东京,曹新山.磁共振弥散张量成像在无骨折脱位型颈脊髓损伤的临床应用研究[J].医学影像学,2012,22(11):1829-1832.
2 林锟.104例脊柱外伤患者临床诊治体会[J].医学理论与实践,2012,25(11):1334-1335.
3 Boldin C,Raith J,Fankhauser F,et al.Predicitinng neurologic recovery in cervical spinal cord injury with postoperative MR imaging[J].Spine,2006,3(5):554-559.
4 Rajasekaran S,Kanna RM,Shetty AP,et al.Efficacy of diffusion tensor anisotropy indices and tractography in assessing the extent of severity of spinal cord injury:an in vitro analytical study in calf spinal cords[J].Spine J,2012,12(12):1147-1153.
5 Amdt C,Graessner J,Cramer MC,et al.Functional imaging of submandibular glands:diffusion-eighted echo-planar MRI before and after stimulation[J].Rofo,2006,178(9):893-897.
6 刘艳辉,高阳,朱广明.急性颈髓外伤的DTI临床应用[J].放射学实践,2015,30(8):826-830.
7 Stroman PW,Wheeler-Kingshott C.The current state-ofthe-art of spinal cord imaging[J].Methods Neuroimage,2014,1(84):1070-1081.
8 赵鹏,陈学明,刘亚东.无骨折脱位型脊髓损伤患者颈髓的弥散张量成像[J].中国康复理论与实践,2015,21(7):838-840.
9 陈昕.脊髓损伤的弥散张量成像研究进展[J].中国医学影像技术,2011,27(10):2149-2152.
2 林锟.104例脊柱外伤患者临床诊治体会[J].医学理论与实践,2012,25(11):1334-1335.
3 Boldin C,Raith J,Fankhauser F,et al.Predicitinng neurologic recovery in cervical spinal cord injury with postoperative MR imaging[J].Spine,2006,3(5):554-559.
4 Rajasekaran S,Kanna RM,Shetty AP,et al.Efficacy of diffusion tensor anisotropy indices and tractography in assessing the extent of severity of spinal cord injury:an in vitro analytical study in calf spinal cords[J].Spine J,2012,12(12):1147-1153.
5 Amdt C,Graessner J,Cramer MC,et al.Functional imaging of submandibular glands:diffusion-eighted echo-planar MRI before and after stimulation[J].Rofo,2006,178(9):893-897.
6 刘艳辉,高阳,朱广明.急性颈髓外伤的DTI临床应用[J].放射学实践,2015,30(8):826-830.
7 Stroman PW,Wheeler-Kingshott C.The current state-ofthe-art of spinal cord imaging[J].Methods Neuroimage,2014,1(84):1070-1081.
8 赵鹏,陈学明,刘亚东.无骨折脱位型脊髓损伤患者颈髓的弥散张量成像[J].中国康复理论与实践,2015,21(7):838-840.
9 陈昕.脊髓损伤的弥散张量成像研究进展[J].中国医学影像技术,2011,27(10):2149-2152.