腰骶神经病DTI可行性评估及其DTI与神经电生理学相关性分析

发布时间：2018-01-31 03:39

本文关键词： 磁共振成像扩散张量成像神经电生理学腰骶神经病骶丛神经坐骨神经　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:运用磁共振扩散张量成像(diffusion tensor imaging,DTI)技术评估腰骶神经病变,探究该成像技术诊断腰骶神经病变的可行性,并探究腰骶神经病DTI与其神经电生理学之间的相关性。方法:选取2016年1月-2016年9月经河北医科大学第三医院神经科确诊的腰骶神经病患者18例作为实验组(男11例,女7例,年龄21-84岁,平均年龄56.49岁)。选取20例健康者志愿者作为对照组(男9例,女11例,年龄21-32岁,平均年龄25.59岁)。实验组按神经电生理学检查结果分为实验亚组A(脱髓鞘组,6例,其中腰骶神经炎2例,特发性腰骶神经病4例)和实验亚组B(轴索损伤伴脱髓鞘组,12例,其中格林巴利综合征2例,特发性多发周围神经病7例,特发性腰骶神经炎2例,梅毒性神经炎1例)。实验组与对照组均分别进行骶丛神经和坐骨神经3D STIR SPACE序列及DTI序列扫描。将两个序列所得图像传至Neuro3D工作站,使两组图像融合,以3D STIR SPACE图像作为解剖参考图,采用纤维示踪成像方法对双侧L4、L5、S1、S2和坐骨神经(sciatic nerve,SN)(以下统称“L4-SN”神经)DTI进行量化分析,分别选取双侧L4-S2神经近、中及远三处作为相应神经感兴趣区(region of interesting,ROI),选取双侧SN股骨头中心水平、股骨小转子水平及其两处中点水平作为SN ROI。在每条神经三处预定的ROI处进行“播点”,在纤维示踪成像的同时,依次测量出每条目标神经所“播点”的每个ROI范围内的DTI参数(FA、ADC、λ∥和λ⊥),进而分别对每条神经所检测得的3处ROI DTI参数值取平均值,以此平均值作为相应神经的最终DTI参数。采用独立样本t检验分别对对照组和实验组双侧L4-SN同节段神经进行DTI参数对比分析。采用独立样本t检验对实验组与对照组L4-SN同节段神经DTI参数对比分析。对照组和实验组FA值及λ⊥值进行受试者工作特征曲线(receiver operating characteristic,ROC)分析,确立每条目标神经截断值及其诊断灵敏度和特异度。实验亚组A和实验亚组B FA值与胫神经和腓总神经复合肌肉动作电位(compound muscle action potential,CMAP)和运动神经传导速度(motor nerve conduction velocity,m NCV)行非参数秩相关分析。对照组、实验亚组A及实验亚组B DTI参数行非参数独立样本Kruskal-Wallis H检验,三组两两比较采用Nemenyi检验。结果:1对照组双侧L4-SN同节段神经FA值、ADC值、λ∥值及λ⊥值独立样本t检验不存在显著统计学差异(P0.05)(表1)。2实验组双侧L4-SN同节段神经之间FA值、ADC值、λ∥值及λ⊥值独立样本t检验不存在显著统计学差异(P0.05)(表2)。3实验组与对照组L4-SN同节段神经FA值、ADC值、λ∥值和λ⊥值独立样本t检验(表3)显示,实验组L4-SN同节段神经FA值显著低于对照组L4-SN FA值(P0.05);实验组L4、S1-SN同节段神经ADC值显著高于对照组L4、S1-SN ADC之值;实验组与对照组L4-SN同节段神经λ∥值之间对比分析不存在显著统计学差异(P0.05);实验组L4-SN同节段神经λ⊥值显著高于实验组L4-SNλ⊥值(P0.05)。4实验组与对照组FA值和λ⊥值ROC分析(表4)显示,L4-SN FA值曲线下面积(area under the curve,AUC)分别为0.834,0.745,0.860,0.772和0.811,截断值分别为0.427,0.421,0.418,0.414和0.438,灵敏度分别为66.7%,72.2%,77.8%,83.3%和66.7%,特异度分别为91.7%,69.4%,80.6%,61.1%和88.9%;L4-SNλ⊥值AUC分别为0.796,0.656,0.791,0.701和0.843,截断值分别为1208.31,1248.43,1304.96,1098.82和1072.15,灵敏度分别为55.6%,50.0%,66.7%,97.2%和88.9%,特异度分别为91.7%,77.8%,86.1%,36.1%和66.7%。由此可见FA值和λ⊥值具有中等程度鉴别实验组和对照组能力。5实验亚组A和实验亚组B L4-SN神经FA值与胫神经和腓总神经CMAP和m NCV秩相关分析(表5)显示,实验亚组A L4-S2 FA值与双下肢胫神经和腓总神经CMAP及m NCV均无显著相关性(|rs|0.6,P0.01)。SN FA值与胫神经CMAP(rs=0.301,P=0.341)和m NCV(rs=0.078,P=0.81)均无显著相关性。SN FA值与腓总神经CMAP(rs=-0.16,P=0.618)无显著相关性,与腓总神经m NCV之间存在显著相关性(rs=0.846,P0.01)。实验亚组B L4-SN FA值与双下肢胫神经和腓总神经的CMAP及m NCV均无显著相关性(|rs|0.4,P0.01)。6对照组、实验亚组A及实验亚组B Kruskal-Wallis H检验(表6)示,L4-SN三组之间FA值存在总体分布差异(P0.05);L4、S1-SN三组之间ADC值存在总体分布差异(P0.05),L5 ADC值不存在总体分布差异(P0.05);λ⊥值三组之间存在总体分布差异。Nemenyi检验(表6)两两比较示,对照组与实验亚组B FA值、ADC值和λ⊥值存在总体分布差异(P0.05),L5实验亚组A与实验亚组B及S1对照组与实验亚组A FA值存在总体分布差异(P0.05),余对照组与实验亚组A、实验亚组A与实验亚组B同节段神经FA值、ADC值和λ⊥值均不存在总体分布差异(P0.05)。结论:DTI具有评估腰骶神经病变的能力,能够对健康者与轴索损伤伴脱髓鞘患者进行鉴别,因此有望实现临床无创定量定性诊断腰骶神经病的可能。但本研究未发现腰骶神经DTI与神经电生理学存在显著线性相关性。
[Abstract]:Objective : To evaluate the feasibility of using diffusion tensor imaging ( DTI ) technique to evaluate the feasibility of diagnosis of lumbar sacral neuropathy and to investigate the correlation between the DTI and neurophysiology in the lumbar sacral neuropathy . Methods : 18 cases were selected as experimental group ( 11 males and 7 females , aged 21 - 84 years , mean age 56.49 years ) . 20 healthy volunteers were selected as control group ( male 9 , female 11 , age 21 - 32 years , average age 25.59 years ) . The experimental group was divided into experimental subgroups A ( demyelination group , 6 cases , including 2 cases of neurileitis , 4 cases of idiopathic lumbar sacral neuropathy ) and experimental subgroup B ( axial cord injury with demyelination group , 12 cases , including 2 cases of Guillain ' s syndrome , 7 cases with idiopathic multiple peripheral neuropathy , 2 cases of idiopathic lumbar sacral nerve and 1 case of syphilis ) . In the experimental group and the control group , the 3D STIR SPACE sequence and DTI sequence of the sacral plexus nerve and sciatic nerve were carried out respectively . The two images were transferred to the Neuro3D workstation , and the two groups of images were fused , and the two groups of L4 , L5 , S1 , S2 and sciatic nerves ( SN ) ( hereinafter referred to as " L4 - SN " nerve ) DTI were quantified and analyzed . There was no significant statistical difference between the experimental group and the control group ( P0.05 ) . There was no significant correlation between the values of the two groups ( P = 0.301 , P = 0.618 ) and the difference of the total distribution between the three groups ( P0.05 ) .

【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;R681.5

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