脊髓型颈椎病患者解压术后大脑皮层结构重塑的MRI研究

发布时间：2018-04-17 01:29

本文选题：脊髓型颈椎病 + 功能磁共振　；参考：《临床放射学杂志》2016年09期

【摘要】：目的应用基于体素形态学测量(VBM),研究脊髓型颈椎病(CSM)患者解压术前、后大脑感觉运动网络(SMN)内的脑区灰质体积的改变,探讨CSM患者大脑感觉运动皮层结构损伤机制及其参与术后结构重塑的神经机制。方法采用3.0 T磁共振对21例CSM患者与21名匹配健康对照者进行容积MRI扫描,并进行随访复查;基于VBM方法,采用独立或配对样本t检验比较CSM患者解压术前、术后大脑感觉运动皮层灰质体积改变情况,及Pearson线性分析异常脑区灰质体积改变情况和临床功能评估之间的相关性。结果与健康对照者比较,CSM患者术前左侧小脑前叶、左侧顶下小叶、右侧额中回、右侧中央前/后回灰质及双侧岛叶灰质体积减小;CSM患者术后3个月复查,左侧小脑后叶、右侧颞中回及颞上回、右侧丘脑、双侧辅助运动区灰质体积较术前减小,左侧顶下小叶、右侧顶上小叶、右侧中央前回/中央后回灰质体积增加;较健康对照者双侧岛叶灰质体积减小及双侧小脑前叶灰质体积增加(GRF校正)。术前及术后3个月复查时CSM患者组异常区域灰质体积与日本骨科协会评估治疗(JOA)评分、颈椎功能障碍指数(NDI)评分及病程并无明显相关性(P0.05)。结论 CSM患者解压术前、术后存在感觉运动皮层灰质体积异常,提示脊髓病变可导致大脑结构损伤;解压术后局部灰质趋于正常提示皮质重塑参与CSM术后恢复;CSM患者术前术后感觉运动皮层存在结构性损伤与重塑。
[Abstract]:Objective to study the changes of gray matter volume in the brain area of CSM patients with cervical Spondylotic myelopathy (CSM) before and after decompression based on morphometric measurement of VBMN.Objective: to investigate the mechanism of sensory motor cortex structure injury in CSM patients and the neural mechanism involved in structural remodeling after operation.Methods 21 patients with CSM and 21 matched healthy controls were examined by volume MRI with 3.0T magnetic resonance imaging, and were followed up. Based on the VBM method, independent or matched sample t-test was used to compare the preoperative decompression of CSM patients.The changes of gray matter volume in the sensorimotor cortex after operation and the correlation between the changes of gray matter volume in abnormal brain regions and the evaluation of clinical function were analyzed linearly by Pearson.Results compared with the healthy controls, the patients with CSM had the following changes: left anterior cerebellar lobe, left inferior parietal lobule, right middle frontal gyrus, right precentral / posterior gyrus gray matter and bilateral insular lobe gray matter volume decreased 3 months after operation, left posterior cerebellar lobe, left posterior cerebellar lobe.The volume of gray matter in right middle temporal gyrus and superior temporal gyrus, right thalamus and bilateral auxiliary motor area was smaller than that before operation. The volume of gray matter in left inferior parietal lobule, right superior parietal lobe, right precentral gyrus / postcentral gyrus was increased.Compared with the healthy controls, the bilateral islet gray matter volume decreased and the bilateral cerebellar anterior lobe gray matter volume increased.Before and 3 months after operation, there was no significant correlation between the gray matter volume of abnormal areas in CSM group and the JOAA score, the cervical spine dysfunction index (NDI) score and the course of disease (P 0.05).Conclusion before and after decompression of CSM patients, there is abnormal volume of sensory motor cortex gray matter, which suggests that spinal cord lesions may lead to brain structure damage.The tendency of local gray matter to normal after decompression suggests that cortical remodeling is involved in the structural damage and remodeling of sensorimotor cortex in patients with CSM.
【作者单位】：南昌大学第一附属医院影像科;南昌大学第一附属医院脊柱外科;
【基金】：中国博士后科学基金(编号:2013M541877) 国家自然基金(编号:81460329) 江西省卫生计生委科技计划项目(编号:20155111)
【分类号】：R445.2;R687.3

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