發(fā)布時(shí)間：2018-01-04 10:47

  本文關(guān)鍵詞：MRI對(duì)頸椎橫孔韌帶與神經(jīng)根型頸椎病神經(jīng)卡壓的相關(guān)性研究　出處：《南方醫(yī)科大學(xué)》2017年博士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 頸椎 橫孔韌帶 3D-FIESTA 神經(jīng)根型頸椎病 DTI IDEAL

【摘要】：目的:通過(guò)尸體解剖確認(rèn)頸椎橫孔韌帶為金標(biāo)準(zhǔn),評(píng)估3D-FIESTA序列對(duì)頸椎橫孔韌帶的顯示能力。通過(guò)3D-FIESTA序列顯示活體頸椎橫孔韌帶,評(píng)價(jià)橫孔韌帶卡壓臂叢神經(jīng)與神經(jīng)根型頸椎病的相關(guān)性。結(jié)合IDEAL像顯示臂叢神經(jīng),評(píng)估DTI參數(shù)對(duì)神經(jīng)受到卡壓的應(yīng)用價(jià)值。方法:取5具正常成人頸椎防腐標(biāo)本,行MR 3D-FIESTA序列掃描;放射學(xué)家在MR圖像上辨認(rèn)C4-T1橫孔韌帶,解剖學(xué)家解剖確認(rèn)C4-T1存在的橫孔韌帶;以尸體解剖確認(rèn)頸椎橫孔韌帶的結(jié)果作為金標(biāo)準(zhǔn),計(jì)算3D-FIESTA圖像辨別橫孔韌帶的相關(guān)能力。選取10例神經(jīng)根型頸椎病患者(除外間盤(pán)病變、小關(guān)節(jié)突增生硬化及外傷)和10例健康受試者,行3D-FIESTA序列掃描C4-T1椎間孔區(qū),計(jì)算橫孔韌帶的顯示率及其與神經(jīng)根型頸椎病的相關(guān)性。然后將確定的8例橫孔韌帶引起卡壓的神經(jīng)根型頸椎病患者,分別行IDEAL和DTI掃描,并行DTT后處理,確定臂叢神經(jīng)受到卡壓的位置,在該位置分別測(cè)量受到橫孔韌帶卡壓的神經(jīng)及同一水平對(duì)側(cè)未受到卡壓的神經(jīng)的FA值、ADC值。結(jié)果:MR 3D-FIESTA序列圖像能夠顯示頸椎橫孔韌帶;放射學(xué)家通過(guò)3D-FIESTA序列辨別橫孔韌帶的相關(guān)能力如下:特異性96.2%;敏感性76.5%;陽(yáng)性預(yù)測(cè)值92.9%;陰性預(yù)測(cè)值86.2%;準(zhǔn)確率88.4%。20例研究對(duì)象C4-T1包括160個(gè)椎間孔,橫孔韌帶顯示率約18.8%;10例神經(jīng)根型頸椎病患者包括80個(gè)椎間孔,17個(gè)存在橫孔韌帶,其中10個(gè)顯示橫孔韌帶增生肥厚造成神經(jīng)卡壓,與神經(jīng)根型頸椎病癥狀一致者有8條橫孔韌帶;橫孔韌帶卡壓神經(jīng)根與神經(jīng)根型頸椎病的相關(guān)性:特異性為96.8%,敏感性為80.0%,陽(yáng)性預(yù)測(cè)值為80.0%,陰性預(yù)測(cè)值為96.8%;10例健康受試者C4-T1包括80個(gè)椎間孔,13個(gè)椎間孔外存在橫孔韌帶,其中一條橫孔韌帶增生肥厚卡壓神經(jīng)根。IDEAL能夠清晰顯示臂叢神經(jīng);DTT可以顯示神經(jīng)解剖結(jié)構(gòu),亦能夠顯示橫孔韌帶卡壓造成神經(jīng)扭曲及部分中斷;受到橫孔韌帶卡壓的神經(jīng)根的平均FA值為0.232±0.046,平均ADC值為1.958±0.327mm2/s,同一水平未受到卡壓的神經(jīng)的平均FA值為0.284 ± 0.045,平均 ADC 值為1.950 ± 0.308mm2/s。結(jié)論:MR 3D-FIESTA序列確認(rèn)頸椎橫孔韌帶具有較高的臨床應(yīng)用價(jià)值;放射學(xué)家認(rèn)為頸椎椎間孔外存在橫孔韌帶時(shí),確實(shí)存在橫孔韌帶的可能性約93%;同理,如果認(rèn)為不存在時(shí),也有約14%的可能性存在橫孔韌帶。3D-FIESTA序列可以在活體頸椎清晰顯示橫孔韌帶及其與神經(jīng)根的關(guān)系;如果3D-FIESTA序列顯示神經(jīng)受到橫孔韌帶卡壓,那么這條橫孔韌帶造成神經(jīng)根型頸椎病的可能性約80.0%;同理,如果未顯示神經(jīng)受到卡壓,仍有3.2%的可能存在神經(jīng)根型頸椎病。IDEAL顯示的臂叢神經(jīng)可以提示神經(jīng)受到卡壓的位置,DTI能定量評(píng)估受到卡壓的神經(jīng)根,DTT能夠顯示神經(jīng)走行的解剖結(jié)構(gòu)和神經(jīng)可能受到卡壓的位置;DTI評(píng)估神經(jīng)根型頸椎病患者神經(jīng)受到卡壓具有潛在性臨床應(yīng)用能力。
[Abstract]:Objective: to confirm the gold standard of cervical transverse foramen ligament by autopsy. To evaluate the ability of 3D-FIESTA sequence to display the transverse foramina ligament of cervical vertebrae. 3D-FIESTA sequence was used to display the transverse foramina ligament of the cervical vertebra in vivo. To evaluate the correlation between the compression of the transverse foramen ligament and the nerve root type cervical spondylopathy, and to display the brachial plexus nerve with IDEAL image. To evaluate the value of DTI parameters in nerve compression. Methods: Mr 3D-FIESTA sequences were performed in 5 normal adult cervical spine specimens. Radiologists identified the transverse foramen ligaments of C4-T1 on Mr images, and anatomical anatomy confirmed the existence of transverse foramen ligaments in C4-T1. Based on the results of cervical vertebra transverse foramen ligament confirmed by autopsy as gold standard, the correlation ability of 3D-FIESTA image to distinguish transverse foramen ligament was calculated. Ten patients with cervical spondylopathy of nerve root type (except external disc lesion) were selected. The intervertebral foramen area of C4-T1 was scanned by 3D-FIESTA sequence in 10 healthy subjects and 10 healthy subjects. The display rate of transverse foramen ligament and its correlation with cervical spondylopathy of nerve root type were calculated. Then IDEAL and DTI scans were performed in 8 patients with cervical spondylopathy whose transverse foramen ligament was compressed by transverse foramen ligament. DTT postprocessing was performed to determine the position where the brachial plexus nerve was compressed, and the FA values of the nerve compressed by the transverse foramen ligament and the nerve without compression on the contralateral side were measured respectively at this position. ADC value. Results the transverse foramen ligament of cervical vertebra could be shown by the image of the 3D-FIESTA sequence of Mr 3D-Festa. The ability of radiologists to identify the transverse foramen ligament by 3D-FIESTA sequence is as follows: specificity 96.2kb; Sensitivity 76. 5; The positive predictive value was 92.9%; Negative predictive value was 86.2; The accuracy of C4-T1 included 160 intervertebral foramina, and the display rate of transverse foramen ligament was about 18.8%. Ten patients with cervical spondylopathy of nerve root type included 80 intervertebral foramen and 17 transverse foramen ligaments. Among them 10 cases showed hypertrophy of transverse foramen ligament which resulted in nerve compression. There were 8 transverse foramen ligaments in patients with cervical spondylopathy of nerve root type. The correlation between nerve root compression of transverse foramen ligament and cervical spondylosis of nerve root type: specificity was 96.8, sensitivity was 80.0, positive predictive value was 80.0and negative predictive value was 96.8; In 10 healthy subjects, C4-T1 consisted of 80 intervertebral foramina, and 13 had transverse foramen ligaments outside intervertebral foramen, one of which was hypertrophic and compressed nerve root. Idea could clearly display brachial plexus nerve. DTT could display the anatomical structure of the nerve, and also showed that the compression of the transverse foramen ligament caused the distortion and partial interruption of the nerve. The mean FA value and ADC value of the nerve roots compressed by the transverse foramen ligament were 0.232 鹵0.046 and 1.958 鹵0.327mm-2 / s respectively. The average FA value of the nerve without compression at the same level was 0.284 鹵0.045. The average ADC value was 1.950 鹵0.308 mm-2 / s.Conclusion the confirmation of cervical transverse foramen ligament by WMR3D-FIESTA sequence is of high clinical value. Radiologists believe that when the transverse foramen ligament exists outside the intervertebral foramen of the cervical vertebrae, the possibility of the existence of the transverse foramen ligament is about 93. Similarly, if there is no existence of the transverse foramen ligament, there is a possibility that the transverse foramen ligament. 3D-FIESTA sequence can clearly display the transverse foramen ligament and its relationship with the nerve root in the cervical vertebrae in vivo. If the 3D-FIESTA sequence shows that the nerve is compressed by the transverse foramen ligament, the possibility of this transverse foramen ligament causing radicular cervical spondylosis is about 80. 0%. Similarly, if the nerve was not shown to be compressed, 3.2% of the brachial plexus nerves displayed in the presence of radicular cervical spondylosis could indicate the location of the nerve being compressed. DTI can quantitatively evaluate the anatomical structure of the nerve and the position where the nerve may be compressed. DTI evaluation of nerve compression in patients with radicular cervical spondylopathy has potential clinical application.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2017
【分類號(hào)】：R681.5;R445.2

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