UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9178, USA.
Medi-Rad Associates Ltd, Radiologic Clinic, Mt Elizabeth Hospital, 3 Mount Elizabeth, Singapore, 228510, Singapore.
Skeletal Radiol. 2019 Nov;48(11):1705-1713. doi: 10.1007/s00256-019-03182-4. Epub 2019 Mar 7.
To qualitatively and quantitatively characterize the nerves of patients with diabetic amyotrophy (DA) using magnetic resonance neurography (MRN) with diffusion tensor imaging (DTI).
Forty controls and 13 DA cases were analyzed. 1.5-Tesla and 3.0-Tesla MRN with DTI was used. Qualitative data from 13 patient records were recorded. Region of interest (ROI) measurements were taken of bilateral L3 through S2 lumbosacral nerve roots, femoral nerves, and sciatic nerves. An ANOVA and multiple linear regression analysis were performed. An intraclass correlation coefficient (ICC) was calculated between two readers.
In DA cases, abnormalities of the lumbosacral nerve roots (n = 11 patients), sciatic (n = 10), femoral (n = 13), and obturator nerves (n = 4) were seen; denervation changes of the abdominopelvic muscles were also identified. Quantitatively, minimum and mean nerve signals on B600 were significantly less than controls (p < 0.001). Minimum and mean ADC values were significantly greater in cases than in controls (p < 0.001 and p = 0.002 respectively). Mean fractional anisotropy (FA) values were significantly lower in cases than in controls (p = 0.041). There were no significant differences in the minimum FA values between cases and controls. Minimum and mean ADCs correlated positively with highest recorded hemoglobin A1 (HbA1c) while controlling for sex, age, and BMI (β = 0.518, p < 0.001 and β = 0.302, p = 0.020 respectively). ICCs were 0.892 (B600), 0.717 (ADC), and 0.730 (FA).
Neuromuscular lesions secondary to DA are qualitatively and quantitatively identified on MRN with DTI, and a positive correlation of ADC levels with serum HbA1c levels exists. Thus, MRN with DTI can be employed as a non-invasive diagnostic tool, if DA is suspected.
使用磁共振神经成像（MRN）结合扩散张量成像（DTI）对糖尿病性肌萎缩（DA）患者的神经进行定性和定量分析。
对 40 名对照者和 13 名 DA 患者进行分析。采用 1.5T 和 3.0T MRN 结合 DTI。记录 13 例患者的定性数据。对双侧 L3 至 S2 腰骶神经根、股神经和坐骨神经进行了感兴趣区域（ROI）测量。进行了方差分析和多元线性回归分析。计算了两位读者之间的组内相关系数（ICC）。
在 DA 病例中，观察到腰骶神经根（n=11 例）、坐骨神经（n=10 例）、股神经（n=13 例）和闭孔神经（n=4 例）异常；还发现了腹盆腔肌肉的去神经改变。定量分析显示，B600 时的最小和平均神经信号明显低于对照组（p<0.001）。病例组的最小和平均 ADC 值明显大于对照组（p<0.001 和 p=0.002）。病例组的平均分数各向异性（FA）值明显低于对照组（p=0.041）。病例组和对照组之间的最小 FA 值无显著差异。最小和平均 ADC 值与最高记录的血红蛋白 A1（HbA1c）呈正相关，同时控制性别、年龄和 BMI（β=0.518，p<0.001 和 β=0.302，p=0.020）。ICC 值分别为 0.892（B600）、0.717（ADC）和 0.730（FA）。
通过 MRN 结合 DTI 可以定性和定量地识别出 DA 引起的神经肌肉病变，并且 ADC 水平与血清 HbA1c 水平呈正相关。因此，如果怀疑有 DA，MRN 结合 DTI 可以作为一种非侵入性诊断工具。
