弥散张量成像对脊髓型颈椎病的早期诊断价值

发布时间：2018-05-17 10:32

本文选题：弥散张量成像 + 脊髓型颈椎病　；参考：《皖南医学院》2017年硕士论文

【摘要】：第一部分弥散张量成像在正常人颈髓中的初步研究目的:应用磁共振扫描仪进行正常颈髓的弥散张量成像(diffusion tensor imaging,DTI)研究,探讨正常颈髓白质各部位的表观弥散系数(apparent diffusion coefficient,ADC)及各向异性分数(fractional anisotropy,FA)的特征。材料与方法:选取37例健康人群作为志愿者。男21例,女16例,年龄20~70岁,平均年龄(41.4±1.3)岁。按年龄划分为三组:青年组(20~30岁,12例),中年组(31~60岁,10例),老年组(61~70岁,15例)。所有志愿者均无颈髓受压、外伤、肿瘤及其他神经系统疾病。选用GE Signa HDxt 3.0T超导型磁共振扫描仪,头颈联合线圈。对37例志愿者行颈髓矢状位FSE-T1WI、FSE-T2WI扫描及轴位FSE-T2WI扫描。横断位DTI扫描:范围为C1上缘至C7下缘,弥散敏感梯度方向设置为15,弥散敏感系数(b值)设定600s/mm2,扫描时间4min23s。将DTI原始图像传输至GE ADW4.4工作站,应用自带functool软件中的Correct程序对原始图像校对,减少相关伪影影响,阈值设定为下限600,上限最高值。由2名放射科医师进行数据测量,共测量C2/3~C6/7五个椎间盘节段水平;在b0图像上手动划取感兴趣区(region of interest,ROI),白质的前索、后索各划1个ROI,左右侧索前后对称性各划1个ROI及整个白质区划1个ROI(其中前索、后索及侧索共六个ROI设定为4mm2,整个白质ROI设定为35mm2),测量相应ROI的ADC和FA值;ROI尽可能置于颈髓白质区,避免脑脊液及相关伪影等影响。采用SPSS21.0软件包对所测数据进行统计学分析,首先对所测数值进行正态性检验和方差齐性检验。颈髓白质各部位ADC及FA值符合正态分布,用(`X±S)表示。采用单因素方差分析正常成人椎间盘同一节段颈髓白质各部位间ADC、FA值的差异,椎间盘不同节段间及不同年龄组间颈髓白质各部位ADC、FA值的差异,组间多重比较采用LSD-t检验;采用两独立样本t检验分析正常成人男女间颈髓白质各部位ADC、FA值的差异。P0.05,认为差异有统计学意义。结果:37例志愿者颈髓常规矢状位T1WI、T2WI、轴位T2WI图及轴位ADC、FA伪彩图图像均显示良好。1、椎间盘同一节段水平颈髓白质各部位间的ADC、FA值的差异均有统计学意义(P0.05)。进一步多重比较示,C2/3椎间盘节段水平颈髓左前侧索与整个白质ADC值差异有统计学意义(P=0.033),左前侧索与后索、整个白质FA值差异有统计学意义(分别为P=0.02、P=0.029);C3/4椎间盘节段水平颈髓前索与左前侧索ADC值差异有统计学意义(分别为P=0.026);C5/6椎间盘节段水平颈髓前索与左前侧索FA值差异有统计学意义(P=0.014);C6/7椎间盘节段水平颈髓前索与后索ADC值差异有统计学意义(P=0.002),后索与整个白质ADC值差异有统计学意义(P=0.027),后索与前索FA值差异有统计学意义(P0.001)。2、椎间盘不同节段间颈髓前索、左前侧索及整个白质的ADC、FA值差异有统计学意义(P0.05),余颈髓白质所选部位ADC、FA值的差异均无统计学意义(P0.05)。进一步多重比较示:与C3/4及C4/5相比,C6/7椎间盘节段水平颈髓前索、左前侧索及整个白质的ADC值上升(分别为P0.001、P0.001、P=0.036),FA值下降(P分别为0.001、0.001、0.006)。3、不同年龄组间颈髓白质各部位ADC、FA值差异均无统计学意义(P0.05)。4、正常成人男女间颈髓白质各部位ADC、FA值差异均无统计学意义(P0.05)。结论:1、正常成人椎间盘同一节段颈髓白质各部位间ADC、FA值有统计学差异,进一步比较示前索、后索、左前侧索三者之间的弥散或各向异性有差异;左前侧索、后索、整个白质三者之间的弥散或各向异性有差异。2、正常成人椎间盘不同节段间颈髓白质前索、左前侧索及整个白质ADC、FA值有统计学差异。进一步比较示,较C3/4与C4/5,C6/7椎间盘节段水平颈髓前索、左前侧索及整个白质的弥散及各向异性有差异。3、年龄、性别因素对正常成人颈髓白质各部位ADC、FA值影响不明显。第二部分弥散张量成像在脊髓型颈椎病的早期诊断应用目的:探讨弥散张量成像在脊髓型颈椎病(cervical spondylotic myelopathy,CSM)早期诊断中的应用研究。材料与方法:选取CSM患者60例作为研究组。男39例,女21例,年龄25~70岁,平均年龄(45.1±2.6)岁。依据日本骨科学会17分法,对颈髓损害程度进行评分并分为四组:轻度组,JOA=13-16分,22例;中度组,JOA=9-12分,19例;重度组,JOA=5-8分,13例;严重组,JOA=0-4分,6例。对照组为本研究第一部分的37例志愿者。对60例CSM患者行颈椎常规MRI及DTI检查(扫描参数及方法同第一部分)。将DTI原始图像传输至GE ADW 4.4工作站,应用自带functool软件中的Correct程序对原始图像校对,减少相关伪影影响,阈值设定为下限600,上限最高值。由2名影像科医师对DTI图像进行数据ADC和FA值测量,测量受压程度最重平面(ROI选取同第一部分)。采用SPSS 21.0软件包对所测数据进行统计学分析,首先对所测数值进行正态性检验和方差齐性检验。颈髓白质各部位ADC及FA值符合正态分布,用(`X±S)表示。采用单因素方差分析JOA评分组与对照组、JOA评分各组间颈髓白质各部位ADC、FA值的差异,组间多重比较采用LSD-t检验。P0.05,认为差异有统计学意义。结果:60例CSM患者颈髓的常规矢状位T1WI、T2WI、轴位T2WI及轴位ADC、FA伪彩图图像均显示良好。1、对照组与轻度组、中度组、重度组及严重组比较,颈髓白质各部位平均ADC及FA值的差异均有统计学意义(P0.05)。进一步比较示:与对照组相比,轻度组颈髓白质前索ADC值上升(P=0.025),右后侧索FA值下降(P=0.038)。与对照组及轻度组相比,中度组颈髓白质后索及右前侧索ADC值上升(P分别为0.008、0.017),左前侧索及整个白质FA值下降(P分别为0.033、0.026);与对照组、轻度组及中度组相比,重度组间颈髓白质右前侧索及整个白质ADC值上升(P分别为0.011、0.006),前索FA值下降(P=0.004);与其余四组相比,严重组间颈髓白质右后侧索ADC值上升(P=0.001),前索、后索及左前侧索FA值下降(P分别为0.01、0.002、0.023)。2、从轻度组至重度组,随着临床症状的加重,颈髓白质各部位平均ADC值呈现上升趋势,FA值呈现下降趋势。结论:1、对照组与轻度组、中度组、重度组及严重组比较,颈髓白质各部位平均ADC及FA值的差异均有统计学意义。从轻度组至重度组,随着临床症状的加重,颈髓白质各部位平均ADC值呈现上升趋势,FA值呈现下降趋势,表明ADC及FA值是反映CSM患者微细结构变化的敏感指标。2、与对照组相比,轻度组颈髓白质前索ADC值上升(P=0.025),右后侧索FA值下降(P=0.038),表明DTI较常规T2WI能早期、准确评估脊髓损伤程度,更好的服务于临床制定相应的治疗方案及评估预后。
[Abstract]:The primary study of the first part of diffusion tensor imaging in normal human cervical spinal cord: the diffusion tensor imaging (DTI) study of normal cervical spinal cord was performed by magnetic resonance scanner (MRI), and the apparent diffusion coefficient (apparent diffusion coefficient, ADC) and the anisotropic fraction (fractional ANI) in the parts of normal cervical marrow were investigated. Sotropy, FA) characteristics. Materials and methods: 37 healthy people were selected as volunteers. 21 men and 16 women, age 20~70, average age (41.4 + 1.3) years. The age group was divided into three groups: young group (20~30 years, 12 cases), middle age group (31~60 years, 10 cases), aged group (61~70 years, 15 cases). All volunteers had no cervical compression, trauma, tumor and other gods. The GE Signa HDxt 3.0T superconducting magnetic resonance scanner and the head and neck coils were selected for the systemic disease. The cervical spinal cord sagittal FSE-T1WI, FSE-T2WI scan and axial FSE-T2WI scan were performed on 37 volunteers. The transverse DTI scan: the range from the upper margin to the C7 lower margin, the dispersion sensitive gradient direction was set to 15, the dispersion sensitivity coefficient (b value) set 600s/mm2, scanning. Time 4min23s. transfers the original DTI image to the GE ADW4.4 workstation, and uses the Correct program in the functool software to proofread the original image to reduce the correlation artifact. The threshold is set to the lower limit of 600, the upper limit is maximum. The data is measured by 2 radiologists, and the level of the five intervertebral segments of the C2 /3~C6/7 is measured, and the hands are on the B0 image. Region of interest (ROI), the anterior cable of white matter, 1 ROI of the posterior cable, 1 ROI for the left and right lateral cord, and 1 ROI for the whole white matter division (among which six ROI are set as 4mm2, and the whole white matter ROI is set as 35mm2). To avoid the influence of cerebrospinal fluid and related artifacts. The SPSS21.0 software package was used to analyze the measured data. First, the measured values were tested by normality test and variance homogeneity test. The ADC and FA values of the different parts of the white matter in the cervical marrow were in the normal distribution and were expressed with (`X + S). The same segment cervical pulp of normal adult intervertebral discs was analyzed by the single factor variance. The difference of ADC and FA values between different parts of the white matter, the difference of ADC and FA value between the different segments of the intervertebral disc and the different age groups of the white matter in the cervical marrow, and the LSD-t test for multiple comparison between the groups, and the t test of two independent samples were used to analyze the difference of ADC and FA in the different parts of the cervical pulp white matter between men and women in normal adults. The difference was statistically significant. The result was that 37 The normal sagittal T1WI, T2WI, axial T2WI map and axial ADC, FA pseudo color images showed good.1. The difference of ADC and FA values between the different parts of the cervical disc of the same segment of the intervertebral disc was statistically significant (P0.05). Further multiple comparison showed that the C2/3 vertebral disc segment level left anterior cervical cord and the whole white matter ADC value was poor. The difference was statistically significant (P=0.033). The difference in the FA value of the whole white matter was statistically significant (P=0.02, P=0.029), and the difference between the level of the cervical spinal cord anterior cord and the ADC of the left anterior lateral cord was statistically significant (P=0.026, respectively), and the difference between the level of the anterior cervical cord and the left anterior lateral cord in C5/6 intervertebral disc level was statistically significant. The difference between the ADC value of the anterior cord and the posterior cord of the C6/7 disc segment was statistically significant (P=0.002), and the difference between the posterior cord and the whole white matter ADC value was statistically significant (P=0.027), the difference between the posterior cord and the anterior cable FA value was statistically significant (P0.001).2, the cervical spinal cord anterior cord between the different segments of the intervertebral disc, the ADC of the left anterior lateral cord and the whole white matter, and FA difference. There was no statistical significance (P0.05). There was no significant difference in the value of ADC and FA in the selected parts of the white matter of the residual cervical marrow (P0.05). Further multiple comparisons showed that the ADC value of the cervical spinal cord anterior cord, left anterior lateral cord and the whole white matter increased (P0.001, P0.001, P=0.036) compared with C3/4 and C4/5. .3, there was no significant difference in the value of ADC and FA between different parts of the cervical pulp white matter in different age groups (P0.05).4. There was no significant difference between the ADC and FA values of the white matter in the normal adult male and female adults (P0.05). Conclusion: 1, there was a statistical difference between the normal adult intervertebral discs of the same segment of the cervical medullary white matter, and the value of FA was statistically different, and further compared the anterior and posterior cord. The dispersion or anisotropy of the left anterior lateral cord between the three is different. The dispersion or anisotropy of the left anterior lateral cord, the posterior cable and the whole white matter is different.2. The normal adult intervertebral disc between the different segments of the cervical spinal cord, the left anterior lateral cord and the whole white matter ADC, and the FA value are statistically different. Further comparison is compared with C3/4 and C4/5, C6/7 intervertebral discs. The diffusion and anisotropy of the segment level cervical cord anterior cord, the left anterior lateral cord and the whole white matter were different.3, age, sex factors had no significant influence on the ADC and FA values of the normal adult cervical marrow white matter. The second part of diffusion tensor imaging in the early diagnosis of cervical spondylotic myelopathy was to explore the diffusion tensor imaging in the cervical spondylotic myelopathy (cervical Spondylotic myelopathy, CSM) application research in early diagnosis. Materials and methods: 60 cases of CSM patients were selected as study group. 39 men and 21 women, age 25~70 years, average age (45.1 + 2.6) years old. According to the 17 division of the Japanese Department of orthopedics, the degree of cervical spinal cord injury was scored and divided into four groups: mild group, JOA=13-16 score, 22 cases, moderate group, JOA=9-12 Scores, 19 cases, severe group, JOA=5-8, 13 cases, severe group, JOA=0-4, 6. The control group was 37 volunteers in the first part of this study. The cervical vertebra routine MRI and DTI examination (scanning parameters and methods and the first part) were performed on 60 cases of CSM patients. The original DTI images were transferred to the GE ADW 4.4 workstation, and the Correct program in the functool software was applied to the original. The initial image is proofed to reduce the correlation artifact. The threshold is set to the lower limit of 600 and the upper limit. The ADC and FA values of the DTI image are measured by 2 radiologists and the most heavy plane of compression is measured (ROI is selected as the first part). SPSS 21 software package is used to carry out statistical analysis of the measured data, first of all the measured values are normal. The ADC and FA values of all parts of the white matter of the cervical marrow were in accordance with the normal distribution, with the normal distribution and (`X + S). The difference of ADC and FA in the various parts of the white matter of the neck pulp between the JOA score group and the control group was analyzed by the single factor variance analysis JOA score group. The multiple comparison between the groups was compared with the LSD-t test.P0.05, and the difference was statistically significant. The result: CSM 60 cases. The normal sagittal T1WI, T2WI, axial T2WI and axis position ADC of the cervical spinal cord showed good.1. Compared with the mild group, the control group and the mild group, the moderate group, the severe group and the severe group, the difference of the average ADC and FA value of the white matter in the cervical marrow was statistically significant (P0.05). The comparison showed that the mild group of white matter anterior to the cervical marrow was compared with the control group. The ADC value increased (P=0.025) and the right posterior lateral cord FA value decreased (P=0.038). Compared with the control group and the mild group, the ADC value of the posterior cervical cord and the right anterior lateral cord increased (P respectively 0.008,0.017), the left anterior lateral cord and the whole white matter FA value decreased (P respectively 0.033,0.026). Compared with the control group, the mild group and the moderate group, the right front of the neck pulp white matter right front was compared with the control group. The ADC value of the lateral cord and the whole white matter increased (P 0.011,0.006 respectively) and the FA value of the anterior cord decreased (P=0.004). Compared with the other four groups, the ADC value of the right posterior side of the white matter in the cervical spinal cord increased (P=0.001), the anterior cord, the posterior cord and the left anterior lateral cord FA value decreased (P respectively 0.01,0.002,0.023).2, from the mild group to the severe group, with the aggravation of the clinical symptoms, the white matter of cervical pulp with the aggravation of the clinical symptoms. The average ADC value of each part showed an upward trend, and the FA value showed a downward trend. Conclusion: 1, the average ADC and FA value of the white matter in the neck pulp of the control group were compared with the mild group, the moderate group, the severe group and the severe group. The average ADC value of the white matter in the cervical marrow was presented with the aggravation of the clinical symptoms. The FA value showed a downward trend, indicating that the value of ADC and FA was a sensitive indicator of the microstructural changes in CSM patients,.2. Compared with the control group, the ADC value of the anterior cord of the white matter in the mild group increased (P=0.025) and the right posterior side of the cord decreased (P=0.038), indicating that DTI was earlier than the conventional T2WI, to accurately assess the degree of spinal cord injury and better serve the clinical formulation. The corresponding treatment and evaluation of the prognosis.
【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.2;R681.55

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