MRI对颈椎横孔韧带与神经根型颈椎病神经卡压的相关性研究

发布时间：2018-01-04 10:47

本文关键词：MRI对颈椎横孔韧带与神经根型颈椎病神经卡压的相关性研究　出处：《南方医科大学》2017年博士论文　论文类型：学位论文

【摘要】：目的:通过尸体解剖确认颈椎横孔韧带为金标准,评估3D-FIESTA序列对颈椎横孔韧带的显示能力。通过3D-FIESTA序列显示活体颈椎横孔韧带,评价横孔韧带卡压臂丛神经与神经根型颈椎病的相关性。结合IDEAL像显示臂丛神经,评估DTI参数对神经受到卡压的应用价值。方法:取5具正常成人颈椎防腐标本,行MR 3D-FIESTA序列扫描;放射学家在MR图像上辨认C4-T1横孔韧带,解剖学家解剖确认C4-T1存在的横孔韧带;以尸体解剖确认颈椎横孔韧带的结果作为金标准,计算3D-FIESTA图像辨别横孔韧带的相关能力。选取10例神经根型颈椎病患者(除外间盘病变、小关节突增生硬化及外伤)和10例健康受试者,行3D-FIESTA序列扫描C4-T1椎间孔区,计算横孔韧带的显示率及其与神经根型颈椎病的相关性。然后将确定的8例横孔韧带引起卡压的神经根型颈椎病患者,分别行IDEAL和DTI扫描,并行DTT后处理,确定臂丛神经受到卡压的位置,在该位置分别测量受到横孔韧带卡压的神经及同一水平对侧未受到卡压的神经的FA值、ADC值。结果:MR 3D-FIESTA序列图像能够显示颈椎横孔韧带;放射学家通过3D-FIESTA序列辨别横孔韧带的相关能力如下:特异性96.2%;敏感性76.5%;阳性预测值92.9%;阴性预测值86.2%;准确率88.4%。20例研究对象C4-T1包括160个椎间孔,横孔韧带显示率约18.8%;10例神经根型颈椎病患者包括80个椎间孔,17个存在横孔韧带,其中10个显示横孔韧带增生肥厚造成神经卡压,与神经根型颈椎病症状一致者有8条横孔韧带;横孔韧带卡压神经根与神经根型颈椎病的相关性:特异性为96.8%,敏感性为80.0%,阳性预测值为80.0%,阴性预测值为96.8%;10例健康受试者C4-T1包括80个椎间孔,13个椎间孔外存在横孔韧带,其中一条横孔韧带增生肥厚卡压神经根。IDEAL能够清晰显示臂丛神经;DTT可以显示神经解剖结构,亦能够显示横孔韧带卡压造成神经扭曲及部分中断;受到横孔韧带卡压的神经根的平均FA值为0.232±0.046,平均ADC值为1.958±0.327mm2/s,同一水平未受到卡压的神经的平均FA值为0.284 ± 0.045,平均 ADC 值为1.950 ± 0.308mm2/s。结论:MR 3D-FIESTA序列确认颈椎横孔韧带具有较高的临床应用价值;放射学家认为颈椎椎间孔外存在横孔韧带时,确实存在横孔韧带的可能性约93%;同理,如果认为不存在时,也有约14%的可能性存在横孔韧带。3D-FIESTA序列可以在活体颈椎清晰显示横孔韧带及其与神经根的关系;如果3D-FIESTA序列显示神经受到横孔韧带卡压,那么这条横孔韧带造成神经根型颈椎病的可能性约80.0%;同理,如果未显示神经受到卡压,仍有3.2%的可能存在神经根型颈椎病。IDEAL显示的臂丛神经可以提示神经受到卡压的位置,DTI能定量评估受到卡压的神经根,DTT能够显示神经走行的解剖结构和神经可能受到卡压的位置;DTI评估神经根型颈椎病患者神经受到卡压具有潜在性临床应用能力。
[Abstract]:Objective: to confirm the gold standard of cervical transverse foramen ligament by autopsy. To evaluate the ability of 3D-FIESTA sequence to display the transverse foramina ligament of cervical vertebrae. 3D-FIESTA sequence was used to display the transverse foramina ligament of the cervical vertebra in vivo. To evaluate the correlation between the compression of the transverse foramen ligament and the nerve root type cervical spondylopathy, and to display the brachial plexus nerve with IDEAL image. To evaluate the value of DTI parameters in nerve compression. Methods: Mr 3D-FIESTA sequences were performed in 5 normal adult cervical spine specimens. Radiologists identified the transverse foramen ligaments of C4-T1 on Mr images, and anatomical anatomy confirmed the existence of transverse foramen ligaments in C4-T1. Based on the results of cervical vertebra transverse foramen ligament confirmed by autopsy as gold standard, the correlation ability of 3D-FIESTA image to distinguish transverse foramen ligament was calculated. Ten patients with cervical spondylopathy of nerve root type (except external disc lesion) were selected. The intervertebral foramen area of C4-T1 was scanned by 3D-FIESTA sequence in 10 healthy subjects and 10 healthy subjects. The display rate of transverse foramen ligament and its correlation with cervical spondylopathy of nerve root type were calculated. Then IDEAL and DTI scans were performed in 8 patients with cervical spondylopathy whose transverse foramen ligament was compressed by transverse foramen ligament. DTT postprocessing was performed to determine the position where the brachial plexus nerve was compressed, and the FA values of the nerve compressed by the transverse foramen ligament and the nerve without compression on the contralateral side were measured respectively at this position. ADC value. Results the transverse foramen ligament of cervical vertebra could be shown by the image of the 3D-FIESTA sequence of Mr 3D-Festa. The ability of radiologists to identify the transverse foramen ligament by 3D-FIESTA sequence is as follows: specificity 96.2kb; Sensitivity 76. 5; The positive predictive value was 92.9%; Negative predictive value was 86.2; The accuracy of C4-T1 included 160 intervertebral foramina, and the display rate of transverse foramen ligament was about 18.8%. Ten patients with cervical spondylopathy of nerve root type included 80 intervertebral foramen and 17 transverse foramen ligaments. Among them 10 cases showed hypertrophy of transverse foramen ligament which resulted in nerve compression. There were 8 transverse foramen ligaments in patients with cervical spondylopathy of nerve root type. The correlation between nerve root compression of transverse foramen ligament and cervical spondylosis of nerve root type: specificity was 96.8, sensitivity was 80.0, positive predictive value was 80.0and negative predictive value was 96.8; In 10 healthy subjects, C4-T1 consisted of 80 intervertebral foramina, and 13 had transverse foramen ligaments outside intervertebral foramen, one of which was hypertrophic and compressed nerve root. Idea could clearly display brachial plexus nerve. DTT could display the anatomical structure of the nerve, and also showed that the compression of the transverse foramen ligament caused the distortion and partial interruption of the nerve. The mean FA value and ADC value of the nerve roots compressed by the transverse foramen ligament were 0.232 卤0.046 and 1.958 卤0.327mm-2 / s respectively. The average FA value of the nerve without compression at the same level was 0.284 卤0.045. The average ADC value was 1.950 卤0.308 mm-2 / s.Conclusion the confirmation of cervical transverse foramen ligament by WMR3D-FIESTA sequence is of high clinical value. Radiologists believe that when the transverse foramen ligament exists outside the intervertebral foramen of the cervical vertebrae, the possibility of the existence of the transverse foramen ligament is about 93. Similarly, if there is no existence of the transverse foramen ligament, there is a possibility that the transverse foramen ligament. 3D-FIESTA sequence can clearly display the transverse foramen ligament and its relationship with the nerve root in the cervical vertebrae in vivo. If the 3D-FIESTA sequence shows that the nerve is compressed by the transverse foramen ligament, the possibility of this transverse foramen ligament causing radicular cervical spondylosis is about 80. 0%. Similarly, if the nerve was not shown to be compressed, 3.2% of the brachial plexus nerves displayed in the presence of radicular cervical spondylosis could indicate the location of the nerve being compressed. DTI can quantitatively evaluate the anatomical structure of the nerve and the position where the nerve may be compressed. DTI evaluation of nerve compression in patients with radicular cervical spondylopathy has potential clinical application.
【学位授予单位】：南方医科大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R681.5;R445.2

【相似文献】