高分辨弥散RESOLVE-DWI序列在脊髓型颈椎病早期诊断中的应用

发布时间：2018-03-21 22:36

本文选题：脊髓型颈椎病　切入点：磁共振成像　出处：《吉林大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨RESOLVE-DWI序列成像优势,并初步研究其在早期诊断脊髓型颈椎病(cervical spondylotic myelopathy,CSM)中的应用价值。材料与方法:连续收集2014年11月-2015年10月,临床确诊脊髓型颈椎病患者共62例,其中男性38名,女性24名,年龄范围39-71岁,平均年龄(56±11.9)岁。所有实验组患者均于临床诊断为脊髓型颈椎病,存在脊髓受压,锥体束征阳性表现(肢体无力、肌张力及腱反射异常、存在步行困难等),发病时间数年至数月不等。并选取非脊髓型颈椎病健康志愿者30例,年龄范围30-65岁,其中男性19名,女性11名,平均年龄(50±7.8)岁,无明确临床表现或仅有颈痛、肢端麻木状态,无锥体束征阳性表现,临床肌电图(EMG)检查提示不存在神经源性损害状态。对以上共92名受检者均于德国西门子公司MAGNETOM Skyra超导3.0T MR扫描仪下行常规T1WI、T2WI矢状位、T2WI轴位、单次激发快速自旋回波(Single-shot Echo-palnar Imaging,ss-EPI)DWI及多次激发(RESOLVE,Readout Segmentation Of Long Variable Echo-trains)DWI矢状位扫描,两种DWI序列FOV均设置为220mm,层厚3.0mm,选择b值0,600 s/mm2。分别对所得ss-EPI DWI及RESOLVE-DWI图像信噪比、对比噪声比进行测量、评估,对典型解剖结构进行对比观察,并进行评分、计算;于上述比较所得优势DWI序列中进行脊髓受压(病变)部位、脊髓相邻相对正常部位及相应对照组正常脊髓位置中进行图像信号观察以及ADC值测量分析,并将DWI图像与常规T2WI成像进行对比,综合评估此DWI序列在CSM早期诊断中的应用。结果:RESOLVE-DWI较ss-EPI DWI序列而言,RESOLVE-DWI图像在信噪比、对比噪声比、图像解剖变形程度及分辨率中均具明显优势,图像所示伪影较轻,信号均匀,标志性解剖结构显示较清晰,未出现明显变形状况,图像质量明显提高。实验组62名患者颈髓病变(受压)部位共19例出现T2WI信号增高改变,相应RESOLVE-DWI及ADC值出现异常者共59例,其中共56例仅表现为ADC值升高,RESOLVE-DWI呈现等或低信号。主观评估运用单独传统T2WI成像及其与RESOLVE-DWI联合成像对CSM所致脊髓损伤进行诊断,通过ROC曲线对两种成像表现进行分析,发现RESOLVE DWI成像对CSM诊断敏感度明显高于T2WI成像,其诊断准确度也有明显更高。结论:RESOLVE-DWI序列较常规ss-EPI序列相比具有较高的图像质量,对脊髓及解剖结构显示清晰,具有更加明显的成像优势。RESOLVE-DWI较常规T2WI成像可更早地对CSM进行检测诊断,敏感性更强,准确度更高,减少了由单独T2WI成像而引起的脊髓型颈椎病脊髓变性的漏诊现象。
[Abstract]:Objective: to investigate the advantages of RESOLVE-DWI sequence imaging and to study its application value in the early diagnosis of cervical spondylotic myelopathy of cervical Spondylotic myelopathy (CSM). Materials and methods: 62 patients with cervical Spondylotic myelopathy were collected from November 2014 to October 2015. There were 38 males and 24 females, aged from 39 to 71 years, with an average age of 56 卤11.9 years. All the patients in the experimental group were diagnosed as cervical Spondylotic myelopathy clinically, with compression of spinal cord and positive sign of pyramidal tract sign (limb weakness). There were abnormal muscular tension and tendon reflex, difficulty in walking and so on. The onset time ranged from several years to several months. Thirty healthy volunteers with non-myeloid cervical spondylosis were selected. The age ranges from 30 to 65 years, including 19 males and 11 females, with an average age of 50 卤7.8 years. There were no definite clinical manifestations or only neck pain, numbness at the extremities, and no positive sign of pyramidal tract sign. The clinical electromyography (EMG) showed that there was no neurogenic damage. All of the 92 subjects were examined with MAGNETOM Skyra superconducting 3.0T Mr scanner. The sagittal T _ 2WI axis of T _ 1W _ I _ I _ T _ T _ 2WI was examined by routine T _ 1W _ I _ T _ T _ 2WI. Single-shot Echo-palnar imagings-EPII-DWI and multiple excitations of Readout Segmentation of Long Variable Echo-trains)DWI sagittal scanning. The FOV of both DWI sequences was set to 220mm and the layer thickness was 3.0mm. The b value was 0600 s / mm2. The SNR of ss-EPI DWI and RESOLVE-DWI images were measured, and the contrast noise ratio was measured. To evaluate, compare and observe the typical anatomical structure, evaluate and calculate the typical anatomical structure, and carry out the compression (lesion) of spinal cord in the superior DWI sequence. The relative normal position of the spinal cord and the normal spinal cord position of the corresponding control group were observed and the ADC values were measured and analyzed. The DWI images were compared with the conventional T2WI images. The application of this DWI sequence in the early diagnosis of CSM was comprehensively evaluated. Results compared with ss-EPI DWI sequence, the DWI sequence had obvious advantages in SNR, contrast noise ratio, anatomic deformation degree and resolution of the image, and the artifact was lighter and the signal was uniform. In the experimental group, 19 patients with cervical spinal cord lesion (compression) had increased T2WI signal, 59 patients had abnormal RESOLVE-DWI and ADC. A total of 56 cases showed only equal or low signal intensity on ADC increased RESOLVE-DWI. Subjective evaluation was performed to diagnose spinal cord injury induced by CSM by single conventional T2WI imaging and combined imaging with RESOLVE-DWI. The two imaging manifestations were analyzed by ROC curve. It was found that the sensitivity of RESOLVE DWI imaging to CSM diagnosis was significantly higher than that of T2WI imaging, and the diagnostic accuracy was significantly higher. Conclusion the RESOLVE DWI sequence has higher image quality than conventional ss-EPI sequence, and it is clear to spinal cord and anatomical structure. Compared with conventional T2WI imaging, RESOLVE-DWI can detect and diagnose CSM earlier, which is more sensitive and accurate, and reduces the missed diagnosis of myelopathy of cervical Spondylotic myelopathy caused by single T2WI imaging.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.2;R681.55

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