探讨扩散张量成像联合磁敏感加权成像在急性颈髓损伤中的临床应用价值

发布时间：2018-10-19 15:52

【摘要】：目的：联合SWI探讨非出血和出血型脊髓损伤DTI参数值的变化特点及与神经功能的相关性，并观察DTT图像，探讨其在显示颈髓损伤神经纤维束受累程度上的价值。方法：应用3.0T西门子磁共振机（Verio)对15例健康志愿者（E组）和28例急性脊髓损伤患者72小时内行常规MRI、SWI及DTI检查。根据常规MRI及SWI图像，，将病例组分为脊髓无出血组和有出血组，脊髓无出血组包括：脊髓正常组（A组）、脊髓水肿组（B组）；脊髓有出血组包括脊髓挫伤组（C组）、脊髓出血组（D组）。所有患者均采用美国脊髓损伤学会（American Spinal InjuryAssociation，ASIA）的分级标准进行临床评估。分析对照组及病例组DTI图像和DTT图像的特征，测量对照组不同椎体水平和病例组损伤水平脊髓的FA、ADC、λ1、λ2、λ3值，比较对照组、病例组及其各亚组之间脊髓FA、ADC、λ1、λ2、λ3值有无差别；分析无出血组（包括A组和B组）和有出血组（包括C组和D组）脊髓FA、ADC、λ1、λ2、λ3值与ASIA运动评分有无相关性。结果：急性脊髓损伤（Acute spinal cord injury，ASCI）患者常规MRI及SWI显示：脊髓正常组6例，脊髓水肿组10例，脊髓挫伤组7例，脊髓出血组5例。ASCI患者彩色编码FA图示受损脊髓信号不均匀减低，呈混杂浅绿色或红色信号，灰阶ADC图、λ2图、λ3图受损脊髓信号不均匀增高，DTT显示无出血组脊髓纤维束均匀一致的蓝色信号变为浅蓝色或黄色信号，纤维束尚连续；出血组脊髓纤维束不连续，断端呈红色。对照组不同椎体水平脊髓FA、ADC、λ1、λ2、λ3值均无统计学差异。对照组与病例组FA、ADC、λ2、λ3值有统计学差异（P0.05），λ1值无统计学差异（P0.05）。对照组与A组之间DTI各参数均无统计学差异（P0.05）；对照组与B、C、D三组间FA、ADC、λ2、λ3均存在统计学差异（P0.05），对照组与B、D组之间λ1有统计学差异（P0.05）。A、B、C、D四间组两两比较FA、λ2、λ3值均存在统计学差异（P0.05），且从A组到D组FA值呈降低趋势，λ2、λ3值呈升高趋势；ADC值在B、C两组间无统计学差异（P0.05），其余各组间均有统计学差异（P0.05）；λ1值在A组与C组、B组与D组间无统计学差异（P0.05），其余各组间均有统计学差异（P0.05）。无出血组中FA值与ASIA运动评分呈正相关(r=0.78,P0.05)， ADC值(r=-0.58,P0.05)、 λ2值(r=-0.66,P0.05)、λ3(r=-0.80,P0.05)值与ASIA运动评分呈负相关，λ1值与ASIA运动评分不相关(P0.05)。有出血组中，各DTI参数与ASIA运动评分均不相关(P均大于0.05)。结论：常规MRI联合SWI能更好区分脊髓出血与非出血性损伤。DTI较常规MRI对脊髓损伤敏感，并可利用FA值、λ2、λ3值定量分析急性脊髓损伤，急性脊髓损伤后FA值降低，λ2、λ3值升高。无出血组中FA值与ASIA运动评分呈正相关，ADC值、λ2、λ3值与ASIA运动评分呈负相关，λ1值与ASIA运动评分不相关。有出血组中，各DTI参数与ASIA运动评分均不相关。DTT能无创性直观显示脊髓纤维束损伤的部位和程度。
[Abstract]:Objective: to investigate the changes of DTI parameters and the correlation between DTI parameters and nerve function in spinal cord injury (sci) without hemorrhage and blood group combined with SWI, and to investigate the value of DTT images in showing the degree of involvement of nerve fiber bundle in cervical spinal cord injury (CBI). Methods: routine MRI,SWI and DTI were performed in 15 healthy volunteers (group E) and 28 patients with acute spinal cord injury (Asci) within 72 hours by using 3.0T Siemens magnetic resonance machine (Verio). According to conventional MRI and SWI images, the patients were divided into two groups: normal spinal cord (group A) and spinal cord edema (group B). Spinal cord hemorrhage group included spinal cord contusion group (group C), spinal cord hemorrhage group (group D). All patients were evaluated by the American Society of Spinal Cord injury (American Spinal InjuryAssociation,ASIA) classification criteria. The characteristics of DTI images and DTT images in the control group and the case group were analyzed, and the FA,ADC, 位 1, 位 2, 位 3 values of the spinal cord of the control group and the injured level of the case group were measured. The FA,ADC, 位 1, 位 2 and 位 3 values of the spinal cord were compared between the control group and the case group and their subgroups. The correlation between FA,ADC, 位 1, 位 2, 位 3 and ASIA motor score was analyzed in group A and B and group C and D respectively. Results: routine MRI and SWI showed that 6 cases of normal spinal cord, 10 cases of spinal cord edema, 7 cases of spinal cord contusion and 5 cases of spinal cord hemorrhage. The color coded FA of ASCI patients showed that the signal intensity of injured spinal cord was uneven. There were mixed light green or red signals, gray-scale ADC, 位 _ 2, 位 _ 3 images damaged spinal cord signal increased inhomogeneously. DTT showed that the uniform blue signal of spinal cord fiber bundle changed to light blue or yellow signal in no bleeding group, and the fiber bundle was continuous. In the bleeding group, the spinal cord fiber bundle was discontinuous and the broken end was red. There was no significant difference in FA,ADC, 位 1, 位 2, 位 3 between the control group and the control group. The FA,ADC, 位 2 and 位 3 values of the control group and the case group were significantly different (P0.05), while the 位 1 value had no statistical difference (P0.05). There was no significant difference in DTI parameters between control group and group A (P0.05). There were significant differences in FA,ADC, 位 2 and 位 3 between the three groups (P0.05), and there were statistical differences in 位 1 between the two groups (P0.05). There were significant differences in FA, 位 2 and 位 3 between the four groups (P0.05), and the FA value decreased from A group to D group, and 位 2 and 位 3 values increased. There was no significant difference in ADC between the two groups (P0.05), while the other groups had statistical difference (P0.05); 位 1 had no statistical difference between group A and C, group B and group D (P0.05), and there was statistical difference between other groups (P0.05). There was a positive correlation between FA value and ASIA motor score in no bleeding group (r = 0.78P, P < 0.05), 位 _ 2 value (r ~ (-0.66) P 0.05), 位 _ 3 (r ~ + -0.80) value and ASIA motor score, while 位 _ 1 value was not correlated with ASIA motor score (P0.05). In the bleeding group, the DTI parameters were not correlated with the ASIA motor score (P > 0. 05). Conclusion: conventional MRI combined with SWI can better distinguish spinal cord hemorrhage from non-hemorrhagic injury, DTI is more sensitive to spinal cord injury than conventional MRI, and FA value, 位 2, 位 3 value can be used to quantitatively analyze acute spinal cord injury. FA value decreases and 位 2 and 位 3 value increase after acute spinal cord injury. There was a positive correlation between FA value and ASIA motor score in no bleeding group, but negative correlation between ADC value, 位 2, 位 3 value and ASIA motor score, but no correlation between 位 1 value and ASIA motor score. In the bleeding group, no correlation was found between DTI parameters and ASIA motor score. DTT could show the location and degree of spinal cord fiber bundle injury in a noninvasive manner.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.2;R651.2

【参考文献】