Aota Yoichi, Niwa Tetsu, Uesugi Masaaki, Yamashita Takayuki, Inoue Tomio, Saito Tomoyuki
Department of Orthopaedic Surgery, Yokohama City University, Kanagawa Prefecture, Japan.
Spine (Phila Pa 1976). 2008 Apr 1;33(7):814-20. doi: 10.1097/BRS.0b013e318169505e.
A retrospective evaluation of diffusion-weighted imaging, apparent diffusion coefficient (ADC) maps, and T2-weighted images in patients with cervical compression myelopathy.
To correlate high signal intensity on ADC maps and T2-weighted images to neurologic severity and radiologic spinal cord compression.
Previous studies indicated that the ADC map was more sensitive in detection of cervical compressive myelopathy than T2-weighted imaging. The relationship to neurologic severity has not been previously published.
In 100 patients with or without cervical compressive myelopathy, the magnetic resonance appearance of the spinal cord on ADC maps and T2-weighted images was evaluated independently by 2 readers. On the basis of the presence or absence of abnormality, patients were categorized into 4 groups by type of intramedullary change. The degree of canal compression and the Japanese Orthopedic Association (JOA) score for cervical myelopathy were compared among the 4 types.
The type I group consisted of 32 patients without signal change on either ADC maps or T2-weighted images. The type II group had 33 patients with high signal intensity only on the ADC map. The type III group contained 28 patients with high signal intensity on both the ADC map and the T2-weighted images. The type IV group comprised 7 patients with high signal intensity only on T2-weighted images. The degree of canal compression and the JOA scores were significantly different among the 4 groups (P < 0.005). Most type III (25 of 28) and type IV (7 of 7) patients had severe cord compression. Average JOA scores in each type were (I) 16.0, (II) 14.7, (III) 11.7, and (IV) 8.7.
ADC maps demonstrated internal changes in the early stages of chronic spinal cord compression, but had limitations for the detection of intramedullary changes in late-stage myelopathy.
对颈椎压迫性脊髓病患者的扩散加权成像、表观扩散系数（ADC）图和T2加权图像进行回顾性评估。
将ADC图和T2加权图像上的高信号强度与神经功能严重程度及放射学脊髓压迫相关联。
先前的研究表明，ADC图在检测颈椎压迫性脊髓病方面比T2加权成像更敏感。与神经功能严重程度的关系此前尚未发表。
在100例有或无颈椎压迫性脊髓病的患者中，由2名阅片者独立评估ADC图和T2加权图像上脊髓的磁共振表现。根据有无异常，按髓内改变类型将患者分为4组。比较4种类型之间的椎管压迫程度和日本骨科学会（JOA）颈椎脊髓病评分。
I型组由32例在ADC图和T2加权图像上均无信号改变的患者组成。II型组有33例仅在ADC图上有高信号强度的患者。III型组包含28例在ADC图和T2加权图像上均有高信号强度的患者。IV型组由7例仅在T2加权图像上有高信号强度的患者组成。4组之间的椎管压迫程度和JOA评分有显著差异（P < 0.005）。大多数III型（28例中的25例）和IV型（7例中的7例）患者有严重的脊髓压迫。各类型的平均JOA评分分别为（I）16.0、（II）14.7、（III）11.7和（IV）8.7。
ADC图显示了慢性脊髓压迫早期的内部变化，但在检测晚期脊髓病的髓内变化方面存在局限性。
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