Department of Radiology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, China; Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong City, Sichuan Province, 637000, China.
North Sichuan Medical College, Nanchong City, Sichuan Province, 637000, China.
Clin Radiol. 2019 Nov;74(11):899.e1-899.e6. doi: 10.1016/j.crad.2019.07.025. Epub 2019 Sep 5.
To assess differences in bilateral great occipital nerves (GONs) in patients with unilateral cervicogenic headache (CEH) using diffusion tensor imaging (DTI).
Twenty-three patients with unilateral CEH underwent GON magnetic resonance imaging (MRI). The clinical characteristics and fractional anisotropy (FA) and the apparent diffusion coefficient (ADC) values in bilateral GONs were determined by two observers with 7 and 3 years of experience in MRI. Three segments of GON were defined based on anatomy. The correlation of DTI measurements to the clinical characteristics and inter-/intra-observer performance were also evaluated.
The mean GON FA for the symptomatic side was significantly lower (0.198±0.056) than that on the other side (0.311±0.04; p=0.000). The mean GON ADC for the symptomatic side was significantly higher (0.682±0.174) than that on the other side (0.465±0.138; p=0.000). Among the three defined segments of GON, statistically significant differences of ADC values were not found at segment S3 (0.692±0.257 versus 0.557±0.230; p=0.068). There were statistically significant differences of FA and ADC values in bilateral GON of segments S1 and S2. The intraclass correlation coefficient (ICC) of intra-/interobserver statistical analysis showed excellent inter/intra-observer agreement for FA and ADC. Significant correlation was only found between the duration and ADC.
In patients with unilateral CEH, quantitative evaluation of the GON using DTI demonstrated FA decreases and ADC increases of the symptomatic side. Larger population and other occipital nerve neuropathy can be included in future research.
使用弥散张量成像（DTI）评估单侧颈源性头痛（CEH）患者双侧枕大神经（GON）的差异。
23 例单侧 CEH 患者行 GON 磁共振成像（MRI）检查。由两位具有 7 年和 3 年 MRI 经验的观察者确定双侧 GON 的临床特征和各向异性分数（FA）和表观扩散系数（ADC）值。根据解剖结构定义了 GON 的三个节段。还评估了 DTI 测量值与临床特征的相关性以及观察者间/内的表现。
症状侧 GON 的 FA 平均值（0.198±0.056）明显低于对侧（0.311±0.04；p=0.000）。症状侧 GON 的 ADC 平均值（0.682±0.174）明显高于对侧（0.465±0.138；p=0.000）。在 GON 的三个定义节段中，节段 S3 的 ADC 值没有统计学差异（0.692±0.257 与 0.557±0.230；p=0.068）。GON 的节段 S1 和 S2 的 FA 和 ADC 值存在统计学差异。观察者内/间统计分析的组内相关系数（ICC）显示 FA 和 ADC 的观察者内/间一致性极好。仅在持续时间和 ADC 之间发现显著相关性。
在单侧 CEH 患者中，使用 DTI 对 GON 进行定量评估显示，症状侧的 FA 降低，ADC 升高。未来的研究可以纳入更大的人群和其他枕大神经病。
