弥散张量成像参数比值及弥散张量纤维束成像分级在脊髓型颈椎病诊断及预后预测中的评估
Evaluation of DTI Parameter Ratios and Diffusion Tensor Tractography Grading in the Diagnosis and Prognosis Prediction of Cervical Spondylotic Myelopathy.
作者信息
Wang Kun, Chen Zhi, Zhang Fan, Song Qingxin, Hou Canglong, Tang Yixing, Wang Jun, Chen Shiyue, Bian Yun, Hao Qiang, Shen Hongxing
机构信息
Orthopedics Department, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
Orthopedics Department, The First Affiliated Hospital of Kunming Medical University, Kunming, China.
出版信息
Spine (Phila Pa 1976). 2017 Feb 15;42(4):E202-E210. doi: 10.1097/BRS.0000000000001784.
STUDY DESIGN
Prospective cohort.
OBJECTIVE
To explore the correlations between diffusion tensor imaging (DTI) ratios and diffusion tensor tractography (DTT) grading with clinical symptoms and outcomes of cervical spondylotic myelopathy (CSM).
SUMMARY OF BACKGROUND DATA
In addition to magnetic resonance imaging (MRI) and computed tomography, DTI may be useful in understanding pathophysiology of spinal cord in earlier stages of the CSM but it may be confounded by age and cervical level, and previous studies had small sample sizes.
METHODS
Controls (n = 36) and patients with CSM (n = 93) underwent magnetic resonance imaging (MRI) and DTI at the Changhai Hospital of Shanghai between September 2011 and March 2013. Apparent diffusion coefficient (ADC), fractional anisotropy (FA) of white matter (WM), and central grey matter (GM) were assessed. Patients were divided into three MRI grades: no abnormal signals; increased T2WI; and increased T2WI and low T1WI. DTT images were divided into three grades: no abnormal signals; abnormal local signal cord and disordered fiber tracts; and distortion of the spinal cord and interrupted fiber tracts.
RESULTS
FA and ADC both correlated with age in all three bilateral WM funiculi and GM, whereas FA and ADC ratios only showed correlation with age in the ventral funiculus (VF) and central GM. Differences were observed in ADC ratios and FA ratios from different Japanese Orthopedic Association (JOA) score subgroups and JOA recovery subgroups. For the three WM funiculi and GM, correlations between DTI ratios, JOA scores, and JOA recovery rates were consistently higher than those between DTI values, JOA scores, and JOA recovery rates (all P < 0.05). MRI grading was correlated with the JOA scores (r = -0.674, P < 0.001) but not JOA recovery rates (r = -0.197, P = 0.058), whereas DTT grading was correlated with both JOA scores (r = -0.813, P < 0.001) and JOA recovery rate (r = -0.429, P < 0.001).
CONCLUSION
DTI parameter ratios seemed to be less influenced by age than raw DTI results and could be more valuable than absolute DTI parameters for the evaluation of CSM. DTT grading is more valuable than MRI grading for diagnosis and prognostic prediction in CSM patients.
LEVEL OF EVIDENCE
研究设计
前瞻性队列研究。
目的
探讨扩散张量成像（DTI）比率和扩散张量纤维束成像（DTT）分级与脊髓型颈椎病（CSM）临床症状及预后之间的相关性。
背景资料总结
除磁共振成像（MRI）和计算机断层扫描外，DTI可能有助于在CSM早期阶段了解脊髓的病理生理学，但可能受年龄和颈椎节段的影响，且既往研究样本量较小。
方法
2011年9月至2013年3月期间，在上海长海医院，对36名对照者和93名CSM患者进行了MRI和DTI检查。评估了表观扩散系数（ADC）、白质（WM）和中央灰质（GM）的各向异性分数（FA）。患者被分为三个MRI等级：无异常信号；T2加权像（T2WI）信号增强；T2WI信号增强且T1加权像（T1WI）信号减低。DTT图像分为三个等级：无异常信号；局部脊髓信号异常且纤维束紊乱；脊髓变形且纤维束中断。
结果
在所有三个双侧WM脊髓束和GM中，FA和ADC均与年龄相关，而FA和ADC比率仅在腹侧脊髓束（VF）和中央GM中与年龄相关。不同日本矫形外科学会（JOA）评分亚组和JOA恢复亚组的ADC比率和FA比率存在差异。对于三个WM脊髓束和GM，DTI比率、JOA评分和JOA恢复率之间的相关性始终高于DTI值、JOA评分和JOA恢复率之间的相关性（所有P<0.05）。MRI分级与JOA评分相关（r=-0.674，P<0.001），但与JOA恢复率无关（r=-0.197，P=0.058），而DTT分级与JOA评分（r=-0.813，P<0.001）和JOA恢复率（r=-0.429，P<0.001）均相关。
结论
DTI参数比率似乎比原始DTI结果受年龄的影响更小，对于CSM的评估可能比绝对DTI参数更有价值。在CSM患者的诊断和预后预测中，DTT分级比MRI分级更有价值。
证据水平
3级。
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