使用质子磁共振波谱的代谢成像作为脊髓型颈椎病手术后预后的预测指标
Metabolic Imaging Using Proton Magnetic Spectroscopy as a Predictor of Outcome After Surgery for Cervical Spondylotic Myelopathy.
作者信息
Holly Langston T, Ellingson Benjamin M, Salamon Noriko
机构信息
Departments of *Neurosurgery †Orthopaedics ‡Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA.
出版信息
Clin Spine Surg. 2017 Jun;30(5):E615-E619. doi: 10.1097/BSD.0000000000000248.
STUDY DESIGN
A single-center magnetic resonance spectroscopy (MRS) imaging and surgical outcome study involving 16 patients with cervical spondylotic myelopathy (CSM).
OBJECTIVE
In the present study, we assess the utility of MRS to quantify metabolic changes within the spinal cord and predict surgical outcome in CSM patients.
SUMMARY OF BACKGROUND DATA
MRS is an advanced spinal imaging modality that can provide pertinent metabolic and biochemical information regarding spinal cord function. Previous studies have demonstrated significant abnormalities in specific cellular metabolite concentrations in CSM patients.
METHODS
Sixteen patients with CSM were evaluated. Single voxel MRS was performed in the cervical cord. N-acetyl-aspartate (NAA) and choline metabolite concentration ratios with respect to creatine were quantified, as well as the presence or absence of a lactate peak. The modified Japanese Orthopaedic Association (mJOA) scale was used as the functional assessment measure. Correlation of MRS metabolites with change in mJOA score was performed.
RESULTS
The mean follow-up time was 19 months. There was a statistically significant improvement between mean preoperative and postoperative mJOA score after surgery (P<0.0001). The NAA/Cr ratio demonstrated a significant relationship to the change in mJOA score after surgery (P=0.0479; R=0.2513). The Cho/NAA ratio demonstrated an even stronger correlation with the change in mJOA score after surgery (P=0.0065; R=0.4219). Neither the Cho/Cr ratio, nor the presence of a lactate peak or T2-weighted signal change was significantly correlated with change in mJOA score after surgery.
CONCLUSIONS
MRS is a novel, noninvasive imaging modality that provides pertinent information regarding spinal cord cellular and metabolic function. In a cohort of operatively treated CSM patients, the NAA/Cr and Cho/NAA ratios were predictive of neurological outcome, as both were significantly associated with change in mJOA score after surgery.
研究设计
一项单中心磁共振波谱（MRS）成像与手术结果研究，纳入了16例脊髓型颈椎病（CSM）患者。
目的
在本研究中，我们评估MRS在量化脊髓内代谢变化及预测CSM患者手术结果方面的效用。
背景数据总结
MRS是一种先进的脊柱成像方式，可提供有关脊髓功能的相关代谢和生化信息。先前的研究已证实在CSM患者中特定细胞代谢物浓度存在显著异常。
方法
对16例CSM患者进行评估。在颈髓进行单体素MRS检查。定量测定相对于肌酸的N-乙酰天门冬氨酸（NAA）和胆碱代谢物浓度比，以及乳酸峰的有无。采用改良日本骨科学会（mJOA）评分作为功能评估指标。对MRS代谢物与mJOA评分变化进行相关性分析。
结果
平均随访时间为19个月。术后平均术前和术后mJOA评分之间有统计学意义的改善（P<0.0001）。NAA/Cr比值与术后mJOA评分变化呈显著相关性（P=0.0479；R=0.2513）。Cho/NAA比值与术后mJOA评分变化的相关性更强（P=0.0065；R=0.4219）。Cho/Cr比值、乳酸峰的有无或T2加权信号变化均与术后mJOA评分变化无显著相关性。
结论
MRS是一种新型的非侵入性成像方式，可提供有关脊髓细胞和代谢功能的相关信息。在一组接受手术治疗的CSM患者中，NAA/Cr和Cho/NAA比值可预测神经功能结果，因为两者均与术后mJOA评分变化显著相关。
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