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目的 :观察脊髓型颈椎病(cervical spondylotic myelopathy,CSM)患者磁共振扩散张量成像(diffusion tensor imaging,DTI)的特点,探讨DTI在评价颈脊髓慢性损伤的价值。方法:纳入2011年2月~2015年2月间收治的20例CSM患者(CSM组),并选择年龄匹配的42例健康志愿者作为对照组,均行颈椎磁共振DTI,测量CSM组病变节段以及对照组C2/3~C6/7节段颈脊髓的表观弥散系数(apparent diffusion coefficient,ADC)、各向异性分数(fractional aniostropy,FA)。比较对照组不同节段颈脊髓的ADC值和FA值,将CSM组和对照组颈脊髓的ADC值和FA值分别进行比较,并对CSM患者颈脊髓ADC、FA评分和颈椎改良JOA(m JOA)评分分别进行相关性分析。结果:对照组颈脊髓的ADC值自C2/3~C6/7节段呈上升趋势,而FA值呈下降趋势,C2/3节段颈脊髓的ADC值较C5/6和C6/7节段明显低,而FA值明显高(ADC:F=3.546,P=0.008;FA:F=13.82,P<0.001)。CSM组颈脊髓的FA值与对照组比较显著性减小(P<0.001),而ADC值则显著性增加(P<0.001)。CSM组颈脊髓的ADC值与m JOA评分无显著相关性(r=-0.287,P=0.220),而颈脊髓的FA值与m JOA评分存在显著性正相关(r=0.359,P=0.005)。结论:CSM患者颈脊髓DTI与正常人群存在差异,其ADC值较正常人群升高,而FA值则明显降低;m JOA评分与FA值呈正相关。
Objective: To observe the characteristics of diffusion tensor imaging (DTI) in patients with cervical spondylotic myelopathy (CSM) and investigate the value of DTI in evaluating the chronic injury of cervical spinal cord. Methods: Twenty CSM patients (CSM group) were enrolled from February 2011 to February 2015. 42 age-matched healthy volunteers were selected as control group. All patients underwent cervical magnetic resonance DTI, The apparent diffusion coefficient (ADC) and fractional aniostropy (FA) of C2 / 3 ~ C6 / 7 cervical spinal cord in control group were compared. ADC values and FA values of cervical spinal cord in different segments of the control group were compared. ADC value and FA value of cervical spinal cord in CSM group and control group were compared respectively. ADC, FA score and JOA (m JOA) ) Scores were analyzed separately. Results: The ADC value of cervical spinal cord increased gradually from C2 / 3 to C6 / 7 in the control group, while the FA value showed a decreasing trend. The ADC value of C2 / 3 cervical spinal cord was more than that in C5 / 6 and C6 / 7 (ADC: F = 3.546, P = 0.008; FA: F = 13.82, P <0.001). The FA value of cervical spinal cord of CSM group was significantly lower than that of the control group (P <0.001), while the ADC value was significantly increased (P <0.001). There was no significant correlation between the ADC value of cervical spinal cord and m JOA score in CSM group (r = -0.287, P = 0.220), while there was a significant positive correlation between FA value and m JOA score in cervical spinal cord (r = 0.359, P = 0.005) . CONCLUSIONS: There is a difference between cervical spinal cord DTI and normal population in CSM patients. The ADC value of CSM patients is higher than that of normal people, while the FA value is significantly lower. The m JOA score is positively correlated with FA value.