磁共振弥散张量成像在腰椎间盘突出症的应用研究

发布时间：2018-01-20 22:05

本文关键词： 磁共振弥散张量纤维束示踪腰椎间盘突出症腰骶部脊神经　出处：《河北医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:使用DTI成像技术探讨健康志愿者正常神经根和腰椎间盘突出受压神经根各向异性分数(FA)值与表观扩散系数(ADC)值之间的差异;受压神经根微观结构变化与临床症状(ODI指数)及症状持续时间之间的相关性;联合纤维束示踪成像技术(FT)判断神经根的形态及内部微观结构的变化情况,为临床系统全面评价椎间盘突出、及时采取有效治疗提供可靠依据。方法:收集健康志愿者和腰椎间盘突出症患者各32例,应用Philips3.0T MRI设备行L4至S1神经根常规MRI及DTI检查,选择椎间孔内侧脊神经根区域为感兴趣区,定量测量健康对照组和腰椎间盘突出受压神经根组及对侧未受压神经根组的FA值及ADC值,分析组间是否存在统计学差异;分析健康志愿者L4-S1神经根不同节段及不同年龄段是否存在统计学差异;分析受压神经根组FA值和ADC值与临床症状、症状持续时间之间的相关性。同时行L4、L5、S1神经根FT。结果:1健康志愿者L4-S1各节段神经根的平均FA值和ADC值均无统计学差别(P㧐0.05)。健康志愿者年龄㧐35岁组和年龄㩳35岁组平均FA值和ADC值无统计学差别(P㧐0.05);2腰椎间盘突出患者受压神经根组FA值明显低于健康对照组FA值及对侧未受压神经根组FA值(P㩳0.05),差异有统计学意义;受压神经根组ADC值明显低于健康对照组ADC值及对侧未受压神经根组ADC值(P㩳0.05),差异有统计学意义;对侧未受压神经根组FA值及ADC值与健康对照组FA值及ADC值均无统计学差异(P㧐0.05);3受压神经根组FA值与ODI指数(r=-0.984)、症状持续时间(r=-0.940)呈明显的负相关关系(P㩳0.05)。受压神经根组ADC值与ODI指数(r=-0.097)、症状持续时间(r=-0.009)无明显相关性(P㧐0.05);4纤维束示踪成像技术(FT)可清晰显示L4-S1神经根走形特点。正常神经根走行对称、自然,受压神经根稀疏、移位、变细。结论:1 腰骶神经根DTI成像能对腰椎间盘突出症的神经根变化提供量化数值,定量反映神经损伤程度和范围。DTI能早期发现腰骶神经根损伤,为早诊早治提供新的检查手段。2 获得了健康志愿者的FA值,同时发现腰椎间盘突出患者对侧未受压神经根FA值与健康对照组FA值与无统计学差异,可以作为正常对照。3 FA值是神经根损伤的定量参考指标,FA值与临床症状(ODI指数)及持续时间之间呈负向关系,即临床症状越重或病史越长FA值越小,通过FA值能进一步评价椎间盘突出患者神经根的损伤程度和损伤时间,为及早干预和判断预后提供参考依据。4 ADC值的变化目前尚存争议,其是否能够作为评价腰椎间盘突出症神经根损伤的参考指标,仍需进一步探究。5 FT能直观地显示神经根受压形态的改变、确定受压的位置,值得推广应用。
[Abstract]:Objective: to investigate the difference between normal nerve root and lumbar disc herniated nerve root anisotropy fraction (FAA) and apparent diffusion coefficient (DTI) by DTI imaging. The correlation between the microstructural changes of compressed nerve roots and the ODI index of clinical symptoms and the duration of symptoms; Combined with fiber tracer imaging (FTT), the changes of the morphology and internal microstructure of nerve root were judged, and the disc herniation was evaluated comprehensively for clinical system. Methods: 32 healthy volunteers and 32 patients with lumbar disc herniation were collected. The L4 to S1 nerve roots were examined by routine MRI and DTI with Philips3.0T MRI equipment. The medial spinal roots of intervertebral foramen were selected as the region of interest. FA and ADC were measured quantitatively in healthy control group, lumbar disc herniated nerve root group and contralateral uncompressed nerve root group. To analyze whether there were statistical differences in different segments and ages of L4-S1 nerve root in healthy volunteers. To analyze the correlation between FA value, ADC value and clinical symptom and symptom duration in compressed nerve root group. Results there was no significant difference in the mean FA value and ADC value of each segment of L4-S1 nerve root in 1: 1 healthy volunteers. Age of healthy volunteers? Age group and age? There was no significant difference in average FA value and ADC value between 35 years old group. The FA value of the compressed nerve root group in patients with lumbar disc herniation was significantly lower than that in the healthy control group and the contralateral uncompressed nerve root group. The ADC value of the compressed nerve root group was significantly lower than that of the healthy control group and the contralateral uncompressed nerve root group, and the ADC value of the contralateral uncompressed nerve root group was significantly lower than that of the control group. There was no significant difference in FA and ADC between the contralateral uncompressed nerve root group and the healthy control group. There was a significant negative correlation between FA value and ODI index (r = 0.984) and duration of symptoms (r = 0.940) in the group of compressed nerve root (P < 0. 05), but there was a negative correlation between FA value and ODI index (r = 0. 984, P < 0. 940). There was no significant correlation between ADC value and ODI index (r = 0.097) and duration of symptoms (r = 0. 009) in compressed nerve root group (P < 0. 05). 0.05; (4) the fiber tracer imaging technique (FTFT) can clearly show the shape of L4-S1 nerve root. The normal nerve root is symmetrical, natural, compressed and sparse and transposition. Conclusion DTI imaging of lumbosacral nerve root can provide quantitative value for the changes of nerve root in lumbar intervertebral disc herniation, and quantitatively reflect the extent and extent of nerve injury. The FA value of healthy volunteers was obtained for early diagnosis and early treatment. At the same time, the FA value of contralateral uncompressed nerve root in patients with lumbar disc herniation was not significantly different from that of healthy control group. As a normal control, the FA value is a quantitative reference index for nerve root injury. There is a negative relationship between FA value and the clinical symptom / ODI index and duration. That is, the more serious the clinical symptoms or the longer the history of the FA value is smaller, the FA value can further evaluate the degree and duration of nerve root injury in patients with disc herniation. In order to provide reference basis for early intervention and prognosis, the change of ADC value is still in dispute. Whether it can be used as a reference index for evaluating nerve root injury of lumbar disc herniation. It is necessary to further explore that the shape change of nerve root compression can be visualized and the position of compression can be determined by 5.5FT, which is worth popularizing and applying.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.2;R681.53

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