神经突方向分散和密度成像在评估和预测退行性颈椎病手术结果中的应用。
Application of Neurite Orientation Dispersion and Density Imaging to Evaluate and Predict the Surgical Outcome for Degenerative Cervical Myelopathy.
机构信息
Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China.
Beijing Research Institute of Traumatology and Orthopaedics, Beijing, China.
出版信息
Orthop Surg. 2022 Jul;14(7):1482-1488. doi: 10.1111/os.13326. Epub 2022 Jun 10.
OBJECTIVES
Although the neurite orientation dispersion and density imaging (NODDI) has been shown useful to evaluate the spinal cord dysfunction, there are few prospective studies on analyzing the operation recovery of degenerative cervical myelopathy (DCM) disease using NODDI. This study aims to investigate the preoperative evaluation and predictive ability of NODDI in DCM patients who received posterior cervical laminoplasty.
METHODS
This prospective study included 55 patients with DCM from January to December 2017. NODDI metrics, including intracellular volume fraction (Vic), isotropic volume fraction (Viso), and orientation dispersion index (ODI) were measured at the maximally compressed (MC) level and the non-compressed C2 level in each patient at the preoperative and the 3- and 6-month postoperative follow-up stages. Neurological function was assessed using the modified Japanese Orthopaedic Association (mJOA) scoring system at each stage. Spearman's correlation and Kendall's tau-b correlation were used to analyze the relationship between NODDI metrics and mJOA scores. Wilcoxon signed rank test was used to examine the changes in the NODDI and mJOA scores between the preoperative and 6-month follow-up stages. ROC analysis was used to further evaluate the predictive capability.
RESULTS
Preoperative Vic at the level of C2 has a significant correlation with the preoperative mJOA score (r = 0.278, p = 0.048). Vic and Viso at the MC level were significantly different between the preoperative period and 6-month follow-up. Viso at the MC level was correlated with the mJOA score at 6-month follow-up (r = -0.302, p = 0.044). Vic and ODI at the C2 level predicted the surgical prognosis, with areas under the receiver-operating characteristic curve of 0.663 (p = 0.042) and 0.716 (p = 0.014).
CONCLUSIONS
The preoperative NODDI metrics at the C2 level are capable of evaluating the severity of spinal cord dysfunction and predict the surgical outcome.
目的
尽管神经突方向分散与密度成像（NODDI）已被证明可用于评估脊髓功能障碍，但很少有前瞻性研究使用 NODDI 分析退行性颈椎脊髓病（DCM）患者的手术恢复情况。本研究旨在探讨接受后路颈椎板成形术的 DCM 患者的 NODDI 术前评估和预测能力。
方法
本前瞻性研究纳入了 2017 年 1 月至 12 月期间的 55 例 DCM 患者。在每个患者的术前以及术后 3 个月和 6 个月的随访阶段，在最大受压（MC）水平和每个患者的非受压 C2 水平测量 NODDI 指标，包括细胞内容积分数（Vic）、各向同性容积分数（Viso）和方向分散指数（ODI）。在每个阶段，使用改良日本骨科协会（mJOA）评分系统评估神经功能。使用 Spearman 相关系数和 Kendall's tau-b 相关系数分析 NODDI 指标与 mJOA 评分之间的关系。使用 Wilcoxon 符号秩检验检验术前与 6 个月随访阶段 NODDI 和 mJOA 评分的变化。ROC 分析进一步评估预测能力。
结果
C2 水平的术前 Vic 与术前 mJOA 评分有显著相关性（r=0.278，p=0.048）。MC 水平的 Vic 和 Viso 在术前和 6 个月随访时差异有统计学意义。MC 水平的 Viso 与 6 个月随访时的 mJOA 评分相关（r=-0.302，p=0.044）。C2 水平的 Vic 和 ODI 可预测手术预后，ROC 曲线下面积分别为 0.663（p=0.042）和 0.716（p=0.014）。
结论
术前 C2 水平的 NODDI 指标可评估脊髓功能障碍的严重程度，并预测手术结果。
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