磁共振弥散加权成像在腰骶部脊神经的临床应用

发布时间：2018-12-11 19:45

【摘要】：研究目的：探讨弥散加权神经成像对41名伴有单侧放射性疼痛的椎间孔狭窄患者神经根显示及形态改变，测量受压神经根ADC值并与正常神经根ADC值比较并评价弥散加权神经成像诊断腰骶部神经根受压的应用价值。资料与方法：本研究以2013年3月至2014年3月就诊于吉林大学中日联谊医院的住院患者，通过体格检查、影像学检查及术中探查，确诊为压迫因素导致神经根损伤的患者为研究对象。采用飞利浦3.0T磁共振成像系统，受检者仰卧位，采用Sense XLTorso线圈。DW-MRN扫描参数如下：重复时间（TR）=6800ms，回波时间（TE）=70ms，激励次数（NSA）=10，反转时间（TI）=180ms，扫描视野（FOV）=325mm，，矩阵（Matrix）=165×256，层厚=0mm，层数=12mm，EPI factor=47，SENSE factor=2，b值=0，800s/mm2。 DW-MRN序列扫描方位为轴位，然后对原始图像行MIP处理，重建三维图像。在ADC图测得健康志愿者组及患者组腰4、腰5及骶1神经根节的ADC值。感兴趣区选择两个层面，包括节前段神经根及节后段脊神经。比较健康志愿者左、右两侧神经根及同侧腰4、腰5、骶1神经根ADC值；并比较患者患侧与健康志愿者任意一次神经根的ADC值。测量健康志愿者组及患者组背根神经节在冠状位的成角、长度及宽度，分析神经根形态异常改变。结果：（1）一般资料：符合纳入标准的伴有单侧放射性疼痛的椎间孔狭窄患者41例，对照组41例，两组在年龄、性别、身高及体重等方面无统计学差异（p＞0.05），具有可比性。（2）41例健康志愿者神经根ADC值分析：L4（1.305±0.12×10-3mm2/s、（1.311±0.17×10-3mm2/s）；L5（1.327±0.068×10-3mm2/s、1.324±0.139×10-3mm2/s）；S1（1.296±0.09×10-3mm2/s、1.301±0.10×10-3mm2/s），相同节段神经根左右两侧差异无显著性（p＞0.05）；41例健康志愿者同侧三组神经根ADC值差异无显著性（p＞0.05）。（3）41例患者患侧神经根ADC值分析：L4（1.493±0.172×10-3mm2/s），L5（1.672±0.105×10-3mm2/s），高于健康志愿者左、右两侧神经根ADC值，差异有显著性（P＜0.05）。（4）两组82例背根神经节成角的分析：患者组L4（46.5±10.8度，n=15）L5（48.3±12.7度，n=25），与健康志愿者组比较差异具有显著性（P＜0.05）。（5）两组82例背根神经节长径（患侧）：患者组L4（10.3±4.5mm，n=15）、L5（12.7±1.5mm，n=25），与健康志愿者组比较差异具有显著性（P＜0.05）；背根神经节横径（患侧）：患者组L4（7.9±2.1mm，n=15）、L5（7.1±1.1mm，n=25），与健康志愿者组比较差异具有显著性（P＜0.05）。（6）对健康志愿者组与患者组测量的神经根ADC值构建受试者工作特征曲线。最佳分割点＞1.41×10-3mm2/s；敏感性=71.4%；特异性=89.3%；阳性预测值=87.0%；阴性预测值=75.8%；（p＜0.0001）。结论： 1.磁共振弥散加权神经成像可以直观的显示受压神经根的形态改变，如压迹、背根神经节膨胀及神经根移位。 2.受压损伤的神经根ADC值较正常神经根增高，且特异性比较高，因此ADC值可以定量评价神经根压迫损伤。
[Abstract]:Objective: to investigate the manifestation and morphologic changes of nerve root in 41 patients with unilateral radiation pain associated with stenosis of intervertebral foramen by diffusion weighted neurography. The ADC value of compressed nerve root was measured and compared with the ADC value of normal nerve root. The value of diffusion-weighted neurography in the diagnosis of lumbosacral nerve root compression was evaluated. Materials and methods: the inpatients from March 2013 to March 2014 in the Sino-Japanese Friendship Hospital of Jilin University were examined by physical examination, imaging examination and intraoperative exploration. Patients with nerve root injury due to compression were studied. Philips 3.0T magnetic resonance imaging system was used. The subjects were supine with Sense XLTorso coil. The parameters of DW-MRN scan were as follows: repeat time (TR) = 6800ms, echo time (TE) = 70ms, excitation times (NSA) = 10, inversion time (TI) = 180ms. Scan field (FOV) = 325 mm, matrix (Matrix) = 165 脳 256, slice thickness = 0 mm, layer number = 12 mm EPI factor=47,SENSE factor=2,b = 0 800 s / m 2. DW-MRN sequence scanning azimuth is axial, then the original image is processed by MIP to reconstruct three-dimensional image. The ADC values of lumbar 4 lumbar 5 and sacral 1 nerve root ganglion in healthy volunteers and patients were measured by ADC. The region of interest selects two layers, including the anterior segment of the nerve root and the posterior segment of the spinal nerve. The ADC values of left, right and ipsilateral lumbar 4, lumbar 5, sacral 1 nerve roots were compared in healthy volunteers, and the ADC values of affected side and healthy volunteers were compared at any one time. The angulation, length and width of dorsal root ganglion (DRG) in healthy volunteers and patients were measured in coronal position, and the abnormal morphological changes of DRG were analyzed. Results: (1) General data: 41 patients with intervertebral foramen stenosis with unilateral radiation pain and 41 patients with control group were enrolled in the study. There was no statistical difference in height and weight (p > 0.05). (2) ADC analysis of nerve root in 41 healthy volunteers: L4 (1.305 卤0.12 脳 10-3mm-2 / s, 1.311 卤0.17 脳 10-3mm2/s), L5 (1.327 卤0.068 脳 10-3mm ~ 2 / s 1.324 卤0.139 脳 10-3mm2/s); S1 (1.296 卤0.09 脳 10 ~ (-3) mm ~ (-2) / s ~ (-1) 卤0.10 脳 10-3mm2/s), there was no significant difference between the left and right sides of the same segment of nerve root (p > 0. 05). There was no significant difference in ADC value of nerve root among 41 healthy volunteers in ipsilateral three groups (p > 0. 05). (3) the ADC value of the affected nerve root in 41 patients: L4 (1.493 卤0.172 脳 10-3mm2/s), L5 (1.672 卤0.105 脳 10-3mm2/s), higher than the left and right side of the nerve root ADC, the difference was significant (P < 0. 05). (4) Analysis of the angulation of dorsal root ganglion in 82 cases in two groups: L4 (46.5 卤10.8 degree, nong15) L5 (48.3 卤12.7 degrees, nong25) in the patient group was significantly different from that in the healthy volunteers group (P < 0.05). (5) the long diameter of dorsal root ganglion (affected side) in 82 cases of two groups: L4 (10.3 卤4.5mm), L5 (12.7 卤1.5mm) in the patient group, there was significant difference between the two groups (P < 0.05). The transverse diameter of dorsal root ganglion (affected side): L4 (7.9 卤2.1 mm) and L5 (7.1 卤1.1 mm) in the patient group were significantly different from those in the healthy volunteers group (P < 0.05). (6) to construct the operating characteristic curve of the nerve root ADC measured by the healthy volunteers and the patients. The optimum division point was > 1.41 脳 10 ~ (-3) mm ~ 2 / s; sensitivity = 71.4; specificity = 89.3; positive predictive value = 87.0; negative predictive value = 75.8; (p < 0.0001). Conclusion: 1. Magnetic resonance diffusion weighted neurography (DWI) can visualize the morphological changes of compressed nerve roots, such as indentation, expansion of dorsal root ganglion and nerve root displacement. 2. The ADC value of the compressed nerve root was higher than that of the normal nerve root, and the specificity of the nerve root was higher than that of the normal nerve root. Therefore, the ADC value could be used to quantitatively evaluate the nerve root compression injury.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.2;R681.5

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