[1]蒋雯,韩骁,王晋超,等.常规序列和弥散张量成像序列MRI在颈椎后路椎管扩大成形术 治疗脊髓型颈椎病疗效评价中的应用[J].中医正骨,2018,30(02):37-40.
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常规序列和弥散张量成像序列MRI在颈椎后路椎管扩大成形术 治疗脊髓型颈椎病疗效评价中的应用()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第30卷
期数:
2018年02期
页码:
37-40
栏目:
影像诊断
出版日期:
2018-02-20

文章信息/Info

作者:
蒋雯1; 韩骁1; 王晋超1; 马晓栋2; 史晓林3; 梁博程3; 刘钟4; 宋卿鹏1; 郭华2; 于爱红1; 程晓光1
1.北京积水潭医院,北京 100035; 2.清华大学医学院,北京 100084; 3.浙江中医药大学 附属第二医院,浙江 杭州 310005; 4.浙江中医药大学,浙江 杭州 310053
关键词:
颈椎病;  椎管;  减压术; 外科;  磁共振成像;  弥散张量成像
摘要:
目的:探讨常规序列及弥散张量成像(diffusion tensor imaging,DTI)序列MRI在颈椎后路椎管扩大成形术治疗脊髓型颈椎病疗效评价中的应用价值。方法:脊髓型颈椎病患者59例,均为接受过颈椎后路椎管扩大成形术治疗的患者,手术至本次检查时间12～14个月。按日本骨科学会脊髓型颈椎病评分计算患者术后临床改善率,根据改善率将患者分为2组,2组患者均行颈椎常规序列及DTI序列MRI检查。分析术后病变节段最狭窄层面脊髓MRI表现,记录2组患者T2加权像高信号影情况,采集DTI序列各向异性分数(fractional anisotropy,FA)、平均弥散率(mean diffusivity,MD)、轴向弥散率(axial diffusivity,AD)及纵向弥散率(radial diffusivity,RD)参数图像,测量FA、MD、AD及RD参数值,并分别做两组间对比。结果:59例患者中临床改善较好29例(改善较好组)、改善较差30例(改善较差组)。2组患者常规序列MRI检查均示手术减压彻底,但部分患者T2加权像可见高信号影,其中改善较好组17例、改善较差组25例; 改善较好组T2加权像出现高信号影的比例较改善较差组低(χ2=4.390,P=0.036)。DTI序列上,改善较好组FA信号强度较改善较差组高,MD、AD及RD信号强度较改善较差组低。2组患者间MD、RD参数值比较,差异有统计学意义,改善较好组低于改善较差组[(0.86±0.13)×10-3mm2·s-1,(0.93±0.13)×10-3mm2·s-1,t=-2.231,P=0.030;(0.58±0.16)×10-3mm2·s-1,(0.67±0.16)×10-3mm2·s-1,t=﹣2.142,P=0.036]; 2组患者间FA、AD参数值比较,差异无统计学意义[0.54±0.10,0.49±0.10,t=1.704,P=0.094;(1.42±0.12)×10-3mm2·s-1,(1.47±0.13)×10-3mm2·s-1,t=-1.677,P=0.099]。结论:脊髓型颈椎病患者行颈椎后路椎管扩大成形术后,尽管手术减压彻底,但部分患者的脊髓仍可能存在不同程度的损伤,临床改善较好者的脊髓损伤发生率低于改善较差者,且前者脊髓微结构的破坏程度较后者轻。常规序列和DTI序列MRI检查有助于颈椎后路椎管扩大成形术治疗脊髓型颈椎病的疗效评估。

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备注/Memo

备注/Memo:
基金项目:国家自然科学基金面上项目(81271558); 北京市自然科学基金面上项目(7132061); 北京市卫生系统高层次卫生技术人才培养计划项目(2013-3-033,2009-2-03); 北京市科学技术委员会首都临床特色应用研究与成果推广项目(Z161100000516134) 通讯作者:程晓光 E-mail:xiao65@263.net
更新日期/Last Update: 2018-07-02