磁共振DTI技术在周围神经系统疾病诊断中的进展
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摘要
DTI技术对于中枢神经系统疾病的诊断已被广泛应用,但是对周围神经的研究方兴未艾。研究表明,DTI可以识别早期周围神经的微观病变,可以对疾病进行早期诊治。相较于神经电生理检查、脊髓椎管造影等检查,DTI具有无创、定量评价的优势,有望成为新一代诊断周围神经系统疾病的辅助工具。本文从周围神经DTI值常用参数、感兴趣区域勾画方法、DTI值的测定方法、DTI值相关影响因素以及对周围神经显示的应用现状及其局限性等6个方面进行阐述。
Diffusion tensor imaging(DTI) are applied to the diagnosis of the central nervous system diseases, while the study of DTI in clinical application of peripheral nervous system is in the ascendant. Former studies have shown that DTI can identify the early microscopic lesions of the peripheral nerves, therefore it is possible to diagnose and treat peripheral nerves diseases early. Compared with neurophysiological examination and spinal canal angiography, DTI has the advantages of noninvasive and quantitative evaluation. So it is expected to become a new generation of auxiliary tools for the diagnosis of peripheral nervous system diseases. In this paper, the common parameters of DTI value of peripheral nerve, delineation method of region of interest(ROI), calculation method of DTI value, influencing factors related to DTI value, application situation and limitations of DTI in peripheral nerve are discussed.
Diffusion tensor imaging(DTI) are applied to the diagnosis of the central nervous system diseases, while the study of DTI in clinical application of peripheral nervous system is in the ascendant. Former studies have shown that DTI can identify the early microscopic lesions of the peripheral nerves, therefore it is possible to diagnose and treat peripheral nerves diseases early. Compared with neurophysiological examination and spinal canal angiography, DTI has the advantages of noninvasive and quantitative evaluation. So it is expected to become a new generation of auxiliary tools for the diagnosis of peripheral nervous system diseases. In this paper, the common parameters of DTI value of peripheral nerve, delineation method of region of interest(ROI), calculation method of DTI value, influencing factors related to DTI value, application situation and limitations of DTI in peripheral nerve are discussed.
引文
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[2]Sun YQ, Xiao Q, Hu FX,et al.Diffusion kurtosis imaging in the characterisation of rectal cancer:utilizing the most repeatable region-of-interest strategy for diffusion parameters on a 3T scanner[J].Eur Radiol,2018,28(12):5211-20.
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[11]Wu WF,Liang J,Chen Y,et al.Microstructural changes in compressed nerve roots treated by percutaneous transforaminal endoscopic discectomy in patients with lumbar disc herniation[J].Medicine(Baltimore),2016,95(40):e5106-18.
[12]Li J,Wang Y,Wang Y, et al.Study on lumbosacral nerve root compression using DTI[J].Biomed Reports,2016,5(3):353-6.
[13]Brandstack N, Kurki T, Laalo J,et al.Reproducibility of tractbased and region-of-interest DTI analysis of long association tracts[J].Clin Neuroradiol,2016, 26(2):199-208.
[14]Nogueira L,Brandao S,Matos E,et al.Region of interest demarcation for quantification of the apparent diffusion coefficient in breast lesions and its interobserver variability[J].Diagn Interv Radiol,2015,21(2):123-7.
[15]Liang KN,Feng PY,Feng XR,et al.Diffusion tensor imaging andfiber tractography reveal significant microstructural changes of cervical nerve roots in patients with cervical spondylotic radiculopathy[J].World Neurosurg,2019,126(1):E57-64.
[16]Chen YY,Lin XF,Zhang F,et al.Diffusion tensor imaging of symptomatic nerve roots in patients with cervical disc herniation[J].Acad Radiol,2014,21(3):338-44.
[17]Gasparotti R,Lodoli G,Meoded A,et al.Feasibility of diffusion tensor tractography of brachial plexus injuries at 1.5 T[J].Invest Radiol,2013,48(2):104-12.
[18]Kronlage M,Schwehr V,Schwarz D,et al.Peripheral nerve diffusion tensor imaging(DTI):normal values and demographic determinants in a cohort of 60 healthy individuals[J].Eur Radiol,2018,28(5):1801-8.
[19]Wako Y,Nakamura J,Eguchi Y,et al.Diffusion tensor imaging and tractography of the sciatic and femoral nerves in healthy volunteers at 3T[J].J Orthop Sprg Res,2017,12(1):184-95.
[20]Ding WQ,Zhou XJ,Tang JB,et al.Three-dimensional display of peripheral nerves in the wrist region based on Mr diffusion tensor imaging and maximum intensity proj ection post-processing[J].Eur J Radiol,2015,84(6):1116-27.
[21]Hiltunen J,Suortti T,Arvela S,et al.Diffusion tensor imaging and tractography of distal peripheral nerves at 3 T[J].Clin Neurophysiol,2005,116(10):2315-23.
[22]Kanamoto H,Eguchi Y,Suzuki M,et al.The diagnosis of doublecrush lesion in the L5 lumbar nerve using diffusion tensor imaging[J].Spine J,2016,16(3):315-21.
[23]Wada K,Goto T,Takasago T,et al.Piriformis muscle syndrome with assessment of sciatic nerve using diffusion tensor imaging and tractography:a case report[J].Skeletal Radiol,2017,46(10):1399-404.
[24]Simon NG,Lagopoulos J,Paling S,et al.Peripheral nerve diffusion tensor imaging as a measure of disease progression in ALS[J].J Neurol,2017,264(5):882-90.
[25]Jambawalikar S,Baum J,Button T,et al.Diffusion tensor imaging of peripheral nerves[J].Skeletal Radiol,2010,39(11):1073-9.
[26]Wang JY,Abdi N,Bakhadirov K,et al.A comprehensive reliability assessment of quantitative diffusion tensor tractography[J].Neuroimage,2012,60(2):1127-38.
[27]Dorrius MD,Dijkstra H,Oudkerk M,et al.Effect of b value and pre-admission of contrast on diagnostic accuracy of 1.5-T breast DWI:a systematic review and meta-analysis[J].Eur Radiol,2014,24(11):2835-47.
[28]Eguchi Y,Ohtori S,Suzuki M, et al.Discrimination between lumbar intraspinal stenosis and foraminal stenosis using diffusion tensor imaging parameters:preliminary results[J].Asian Spine J,2016,10(2):327-34.
[29]Oikawa Y,Eguchi Y,Inoue G,et al.Diffusion tensor imaging of lumbar spinal nerve in subjects with degenerative lumbar disorders[J].Magn Reson Imag,2015,33(8):956-61.
[30]吴杏,胡久益,王小双,等.EA值,ADC值与腰骶丛脊神经根受压程度的相关性研究[J].临床放射学杂志,2017,36(5):710-3.
[2]Sun YQ, Xiao Q, Hu FX,et al.Diffusion kurtosis imaging in the characterisation of rectal cancer:utilizing the most repeatable region-of-interest strategy for diffusion parameters on a 3T scanner[J].Eur Radiol,2018,28(12):5211-20.
[3]Lambregts DJ,Beets GL,Maas M,et al.Tumour ADC measurements in rectal cancer:effect of ROI methods on ADC values and interobserver variability[J].Eur Radiol,2011,21(12):2567-74.
[4]Ma C,Guo XY,Liu L,et al.Effect of region of interest size on ADC measurements in pancreatic adenocarcinoma[J].Cancer Imaging,2017,17(1):13-25.
[5]Hlis R,Poh F,Xi Y,et al.Diffusion tensor imaging of diabetic amyotrophy[J].Skeletal Radiol,2019,38(2):97-108.
[6]Wang XD,Wang HL,Sun C,et al.Analysis of radiological parameters associated with decreased fractional anisotropy values on diffusion tensor imaging in patients with lumbar spinal stenosis[J].Eur Spine J, 2019,28(6):1397-405.
[7]Chiou SY,Hellyer PJ,Sharp DJ,et al.Relationships between the integrity and function of lumbar nerve roots as assessed by diffusion tensor imaging and neurophysiology[J].Neuroradiology,2017,59(9):893-903.
[8]Chen HB,Chen M, Peng HH, et al.Relationship between the benefits of paraspinal mapping and diffusion tensor imaging and the increase of decompression levels determined by conventional magnetic resonance imaging in degenerative lumbar spinal stenosis[J].J Orthop Surg Res,2019,14(1):23-36.
[9]Zhang JL,Zhang F,Xiao FX,et al.Quantitative evaluation of the compressed L5 and S1 nerve roots in unilateral lumbar disc herniation by using diffusion tensor imaging[J].Clin Neuroradiol,2018,28(4):529-37.
[10]Eguchi Y,Ohtori S,Yamashita M,et al.Clinical applications of diffusion magnetic resonance imaging of the lumbar foraminal nerve root entrapment[J].Eur Spine J,2010,19(11):1874-82.
[11]Wu WF,Liang J,Chen Y,et al.Microstructural changes in compressed nerve roots treated by percutaneous transforaminal endoscopic discectomy in patients with lumbar disc herniation[J].Medicine(Baltimore),2016,95(40):e5106-18.
[12]Li J,Wang Y,Wang Y, et al.Study on lumbosacral nerve root compression using DTI[J].Biomed Reports,2016,5(3):353-6.
[13]Brandstack N, Kurki T, Laalo J,et al.Reproducibility of tractbased and region-of-interest DTI analysis of long association tracts[J].Clin Neuroradiol,2016, 26(2):199-208.
[14]Nogueira L,Brandao S,Matos E,et al.Region of interest demarcation for quantification of the apparent diffusion coefficient in breast lesions and its interobserver variability[J].Diagn Interv Radiol,2015,21(2):123-7.
[15]Liang KN,Feng PY,Feng XR,et al.Diffusion tensor imaging andfiber tractography reveal significant microstructural changes of cervical nerve roots in patients with cervical spondylotic radiculopathy[J].World Neurosurg,2019,126(1):E57-64.
[16]Chen YY,Lin XF,Zhang F,et al.Diffusion tensor imaging of symptomatic nerve roots in patients with cervical disc herniation[J].Acad Radiol,2014,21(3):338-44.
[17]Gasparotti R,Lodoli G,Meoded A,et al.Feasibility of diffusion tensor tractography of brachial plexus injuries at 1.5 T[J].Invest Radiol,2013,48(2):104-12.
[18]Kronlage M,Schwehr V,Schwarz D,et al.Peripheral nerve diffusion tensor imaging(DTI):normal values and demographic determinants in a cohort of 60 healthy individuals[J].Eur Radiol,2018,28(5):1801-8.
[19]Wako Y,Nakamura J,Eguchi Y,et al.Diffusion tensor imaging and tractography of the sciatic and femoral nerves in healthy volunteers at 3T[J].J Orthop Sprg Res,2017,12(1):184-95.
[20]Ding WQ,Zhou XJ,Tang JB,et al.Three-dimensional display of peripheral nerves in the wrist region based on Mr diffusion tensor imaging and maximum intensity proj ection post-processing[J].Eur J Radiol,2015,84(6):1116-27.
[21]Hiltunen J,Suortti T,Arvela S,et al.Diffusion tensor imaging and tractography of distal peripheral nerves at 3 T[J].Clin Neurophysiol,2005,116(10):2315-23.
[22]Kanamoto H,Eguchi Y,Suzuki M,et al.The diagnosis of doublecrush lesion in the L5 lumbar nerve using diffusion tensor imaging[J].Spine J,2016,16(3):315-21.
[23]Wada K,Goto T,Takasago T,et al.Piriformis muscle syndrome with assessment of sciatic nerve using diffusion tensor imaging and tractography:a case report[J].Skeletal Radiol,2017,46(10):1399-404.
[24]Simon NG,Lagopoulos J,Paling S,et al.Peripheral nerve diffusion tensor imaging as a measure of disease progression in ALS[J].J Neurol,2017,264(5):882-90.
[25]Jambawalikar S,Baum J,Button T,et al.Diffusion tensor imaging of peripheral nerves[J].Skeletal Radiol,2010,39(11):1073-9.
[26]Wang JY,Abdi N,Bakhadirov K,et al.A comprehensive reliability assessment of quantitative diffusion tensor tractography[J].Neuroimage,2012,60(2):1127-38.
[27]Dorrius MD,Dijkstra H,Oudkerk M,et al.Effect of b value and pre-admission of contrast on diagnostic accuracy of 1.5-T breast DWI:a systematic review and meta-analysis[J].Eur Radiol,2014,24(11):2835-47.
[28]Eguchi Y,Ohtori S,Suzuki M, et al.Discrimination between lumbar intraspinal stenosis and foraminal stenosis using diffusion tensor imaging parameters:preliminary results[J].Asian Spine J,2016,10(2):327-34.
[29]Oikawa Y,Eguchi Y,Inoue G,et al.Diffusion tensor imaging of lumbar spinal nerve in subjects with degenerative lumbar disorders[J].Magn Reson Imag,2015,33(8):956-61.
[30]吴杏,胡久益,王小双,等.EA值,ADC值与腰骶丛脊神经根受压程度的相关性研究[J].临床放射学杂志,2017,36(5):710-3.