本文選題：彌散張量成像 + 脊髓型頸椎病��； 參考：《皖南醫(yī)學(xué)院》2017年碩士論文

【摘要】：第一部分彌散張量成像在正常人頸髓中的初步研究目的:應(yīng)用磁共振掃描儀進(jìn)行正常頸髓的彌散張量成像(diffusion tensor imaging,DTI)研究,探討正常頸髓白質(zhì)各部位的表觀彌散系數(shù)(apparent diffusion coefficient,ADC)及各向異性分?jǐn)?shù)(fractional anisotropy,FA)的特征。材料與方法:選取37例健康人群作為志愿者。男21例,女16例,年齡20~70歲,平均年齡(41.4±1.3)歲。按年齡劃分為三組:青年組(20~30歲,12例),中年組(31~60歲,10例),老年組(61~70歲,15例)。所有志愿者均無(wú)頸髓受壓、外傷、腫瘤及其他神經(jīng)系統(tǒng)疾病。選用GE Signa HDxt 3.0T超導(dǎo)型磁共振掃描儀,頭頸聯(lián)合線圈。對(duì)37例志愿者行頸髓矢狀位FSE-T1WI、FSE-T2WI掃描及軸位FSE-T2WI掃描。橫斷位DTI掃描:范圍為C1上緣至C7下緣,彌散敏感梯度方向設(shè)置為15,彌散敏感系數(shù)(b值)設(shè)定600s/mm2,掃描時(shí)間4min23s。將DTI原始圖像傳輸至GE ADW4.4工作站,應(yīng)用自帶functool軟件中的Correct程序?qū)υ紙D像校對(duì),減少相關(guān)偽影影響,閾值設(shè)定為下限600,上限最高值。由2名放射科醫(yī)師進(jìn)行數(shù)據(jù)測(cè)量,共測(cè)量C2/3~C6/7五個(gè)椎間盤節(jié)段水平;在b0圖像上手動(dòng)劃取感興趣區(qū)(region of interest,ROI),白質(zhì)的前索、后索各劃1個(gè)ROI,左右側(cè)索前后對(duì)稱性各劃1個(gè)ROI及整個(gè)白質(zhì)區(qū)劃1個(gè)ROI(其中前索、后索及側(cè)索共六個(gè)ROI設(shè)定為4mm2,整個(gè)白質(zhì)ROI設(shè)定為35mm2),測(cè)量相應(yīng)ROI的ADC和FA值;ROI盡可能置于頸髓白質(zhì)區(qū),避免腦脊液及相關(guān)偽影等影響。采用SPSS21.0軟件包對(duì)所測(cè)數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)分析,首先對(duì)所測(cè)數(shù)值進(jìn)行正態(tài)性檢驗(yàn)和方差齊性檢驗(yàn)。頸髓白質(zhì)各部位ADC及FA值符合正態(tài)分布,用(`X±S)表示。采用單因素方差分析正常成人椎間盤同一節(jié)段頸髓白質(zhì)各部位間ADC、FA值的差異,椎間盤不同節(jié)段間及不同年齡組間頸髓白質(zhì)各部位ADC、FA值的差異,組間多重比較采用LSD-t檢驗(yàn);采用兩獨(dú)立樣本t檢驗(yàn)分析正常成人男女間頸髓白質(zhì)各部位ADC、FA值的差異。P0.05,認(rèn)為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:37例志愿者頸髓常規(guī)矢狀位T1WI、T2WI、軸位T2WI圖及軸位ADC、FA偽彩圖圖像均顯示良好。1、椎間盤同一節(jié)段水平頸髓白質(zhì)各部位間的ADC、FA值的差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。進(jìn)一步多重比較示,C2/3椎間盤節(jié)段水平頸髓左前側(cè)索與整個(gè)白質(zhì)ADC值差異有統(tǒng)計(jì)學(xué)意義(P=0.033),左前側(cè)索與后索、整個(gè)白質(zhì)FA值差異有統(tǒng)計(jì)學(xué)意義(分別為P=0.02、P=0.029);C3/4椎間盤節(jié)段水平頸髓前索與左前側(cè)索ADC值差異有統(tǒng)計(jì)學(xué)意義(分別為P=0.026);C5/6椎間盤節(jié)段水平頸髓前索與左前側(cè)索FA值差異有統(tǒng)計(jì)學(xué)意義(P=0.014);C6/7椎間盤節(jié)段水平頸髓前索與后索ADC值差異有統(tǒng)計(jì)學(xué)意義(P=0.002),后索與整個(gè)白質(zhì)ADC值差異有統(tǒng)計(jì)學(xué)意義(P=0.027),后索與前索FA值差異有統(tǒng)計(jì)學(xué)意義(P0.001)。2、椎間盤不同節(jié)段間頸髓前索、左前側(cè)索及整個(gè)白質(zhì)的ADC、FA值差異有統(tǒng)計(jì)學(xué)意義(P0.05),余頸髓白質(zhì)所選部位ADC、FA值的差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。進(jìn)一步多重比較示:與C3/4及C4/5相比,C6/7椎間盤節(jié)段水平頸髓前索、左前側(cè)索及整個(gè)白質(zhì)的ADC值上升(分別為P0.001、P0.001、P=0.036),FA值下降(P分別為0.001、0.001、0.006)。3、不同年齡組間頸髓白質(zhì)各部位ADC、FA值差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。4、正常成人男女間頸髓白質(zhì)各部位ADC、FA值差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:1、正常成人椎間盤同一節(jié)段頸髓白質(zhì)各部位間ADC、FA值有統(tǒng)計(jì)學(xué)差異,進(jìn)一步比較示前索、后索、左前側(cè)索三者之間的彌散或各向異性有差異;左前側(cè)索、后索、整個(gè)白質(zhì)三者之間的彌散或各向異性有差異。2、正常成人椎間盤不同節(jié)段間頸髓白質(zhì)前索、左前側(cè)索及整個(gè)白質(zhì)ADC、FA值有統(tǒng)計(jì)學(xué)差異。進(jìn)一步比較示,較C3/4與C4/5,C6/7椎間盤節(jié)段水平頸髓前索、左前側(cè)索及整個(gè)白質(zhì)的彌散及各向異性有差異。3、年齡、性別因素對(duì)正常成人頸髓白質(zhì)各部位ADC、FA值影響不明顯。第二部分彌散張量成像在脊髓型頸椎病的早期診斷應(yīng)用目的:探討彌散張量成像在脊髓型頸椎病(cervical spondylotic myelopathy,CSM)早期診斷中的應(yīng)用研究。材料與方法:選取CSM患者60例作為研究組。男39例,女21例,年齡25~70歲,平均年齡(45.1±2.6)歲。依據(jù)日本骨科學(xué)會(huì)17分法,對(duì)頸髓損害程度進(jìn)行評(píng)分并分為四組:輕度組,JOA=13-16分,22例;中度組,JOA=9-12分,19例;重度組,JOA=5-8分,13例;嚴(yán)重組,JOA=0-4分,6例。對(duì)照組為本研究第一部分的37例志愿者。對(duì)60例CSM患者行頸椎常規(guī)MRI及DTI檢查(掃描參數(shù)及方法同第一部分)。將DTI原始圖像傳輸至GE ADW 4.4工作站,應(yīng)用自帶functool軟件中的Correct程序?qū)υ紙D像校對(duì),減少相關(guān)偽影影響,閾值設(shè)定為下限600,上限最高值。由2名影像科醫(yī)師對(duì)DTI圖像進(jìn)行數(shù)據(jù)ADC和FA值測(cè)量,測(cè)量受壓程度最重平面(ROI選取同第一部分)。采用SPSS 21.0軟件包對(duì)所測(cè)數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)分析,首先對(duì)所測(cè)數(shù)值進(jìn)行正態(tài)性檢驗(yàn)和方差齊性檢驗(yàn)。頸髓白質(zhì)各部位ADC及FA值符合正態(tài)分布,用(`X±S)表示。采用單因素方差分析JOA評(píng)分組與對(duì)照組、JOA評(píng)分各組間頸髓白質(zhì)各部位ADC、FA值的差異,組間多重比較采用LSD-t檢驗(yàn)。P0.05,認(rèn)為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:60例CSM患者頸髓的常規(guī)矢狀位T1WI、T2WI、軸位T2WI及軸位ADC、FA偽彩圖圖像均顯示良好。1、對(duì)照組與輕度組、中度組、重度組及嚴(yán)重組比較,頸髓白質(zhì)各部位平均ADC及FA值的差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。進(jìn)一步比較示:與對(duì)照組相比,輕度組頸髓白質(zhì)前索ADC值上升(P=0.025),右后側(cè)索FA值下降(P=0.038)。與對(duì)照組及輕度組相比,中度組頸髓白質(zhì)后索及右前側(cè)索ADC值上升(P分別為0.008、0.017),左前側(cè)索及整個(gè)白質(zhì)FA值下降(P分別為0.033、0.026);與對(duì)照組、輕度組及中度組相比,重度組間頸髓白質(zhì)右前側(cè)索及整個(gè)白質(zhì)ADC值上升(P分別為0.011、0.006),前索FA值下降(P=0.004);與其余四組相比,嚴(yán)重組間頸髓白質(zhì)右后側(cè)索ADC值上升(P=0.001),前索、后索及左前側(cè)索FA值下降(P分別為0.01、0.002、0.023)。2、從輕度組至重度組,隨著臨床癥狀的加重,頸髓白質(zhì)各部位平均ADC值呈現(xiàn)上升趨勢(shì),FA值呈現(xiàn)下降趨勢(shì)。結(jié)論:1、對(duì)照組與輕度組、中度組、重度組及嚴(yán)重組比較,頸髓白質(zhì)各部位平均ADC及FA值的差異均有統(tǒng)計(jì)學(xué)意義。從輕度組至重度組,隨著臨床癥狀的加重,頸髓白質(zhì)各部位平均ADC值呈現(xiàn)上升趨勢(shì),FA值呈現(xiàn)下降趨勢(shì),表明ADC及FA值是反映CSM患者微細(xì)結(jié)構(gòu)變化的敏感指標(biāo)。2、與對(duì)照組相比,輕度組頸髓白質(zhì)前索ADC值上升(P=0.025),右后側(cè)索FA值下降(P=0.038),表明DTI較常規(guī)T2WI能早期、準(zhǔn)確評(píng)估脊髓損傷程度,更好的服務(wù)于臨床制定相應(yīng)的治療方案及評(píng)估預(yù)后。
[Abstract]:The primary study of the first part of diffusion tensor imaging in normal human cervical spinal cord: the diffusion tensor imaging (DTI) study of normal cervical spinal cord was performed by magnetic resonance scanner (MRI), and the apparent diffusion coefficient (apparent diffusion coefficient, ADC) and the anisotropic fraction (fractional ANI) in the parts of normal cervical marrow were investigated. Sotropy, FA) characteristics. Materials and methods: 37 healthy people were selected as volunteers. 21 men and 16 women, age 20~70, average age (41.4 + 1.3) years. The age group was divided into three groups: young group (20~30 years, 12 cases), middle age group (31~60 years, 10 cases), aged group (61~70 years, 15 cases). All volunteers had no cervical compression, trauma, tumor and other gods. The GE Signa HDxt 3.0T superconducting magnetic resonance scanner and the head and neck coils were selected for the systemic disease. The cervical spinal cord sagittal FSE-T1WI, FSE-T2WI scan and axial FSE-T2WI scan were performed on 37 volunteers. The transverse DTI scan: the range from the upper margin to the C7 lower margin, the dispersion sensitive gradient direction was set to 15, the dispersion sensitivity coefficient (b value) set 600s/mm2, scanning. Time 4min23s. transfers the original DTI image to the GE ADW4.4 workstation, and uses the Correct program in the functool software to proofread the original image to reduce the correlation artifact. The threshold is set to the lower limit of 600, the upper limit is maximum. The data is measured by 2 radiologists, and the level of the five intervertebral segments of the C2 /3~C6/7 is measured, and the hands are on the B0 image. Region of interest (ROI), the anterior cable of white matter, 1 ROI of the posterior cable, 1 ROI for the left and right lateral cord, and 1 ROI for the whole white matter division (among which six ROI are set as 4mm2, and the whole white matter ROI is set as 35mm2). To avoid the influence of cerebrospinal fluid and related artifacts. The SPSS21.0 software package was used to analyze the measured data. First, the measured values were tested by normality test and variance homogeneity test. The ADC and FA values of the different parts of the white matter in the cervical marrow were in the normal distribution and were expressed with (`X + S). The same segment cervical pulp of normal adult intervertebral discs was analyzed by the single factor variance. The difference of ADC and FA values between different parts of the white matter, the difference of ADC and FA value between the different segments of the intervertebral disc and the different age groups of the white matter in the cervical marrow, and the LSD-t test for multiple comparison between the groups, and the t test of two independent samples were used to analyze the difference of ADC and FA in the different parts of the cervical pulp white matter between men and women in normal adults. The difference was statistically significant. The result was that 37 The normal sagittal T1WI, T2WI, axial T2WI map and axial ADC, FA pseudo color images showed good.1. The difference of ADC and FA values between the different parts of the cervical disc of the same segment of the intervertebral disc was statistically significant (P0.05). Further multiple comparison showed that the C2/3 vertebral disc segment level left anterior cervical cord and the whole white matter ADC value was poor. The difference was statistically significant (P=0.033). The difference in the FA value of the whole white matter was statistically significant (P=0.02, P=0.029), and the difference between the level of the cervical spinal cord anterior cord and the ADC of the left anterior lateral cord was statistically significant (P=0.026, respectively), and the difference between the level of the anterior cervical cord and the left anterior lateral cord in C5/6 intervertebral disc level was statistically significant. The difference between the ADC value of the anterior cord and the posterior cord of the C6/7 disc segment was statistically significant (P=0.002), and the difference between the posterior cord and the whole white matter ADC value was statistically significant (P=0.027), the difference between the posterior cord and the anterior cable FA value was statistically significant (P0.001).2, the cervical spinal cord anterior cord between the different segments of the intervertebral disc, the ADC of the left anterior lateral cord and the whole white matter, and FA difference. There was no statistical significance (P0.05). There was no significant difference in the value of ADC and FA in the selected parts of the white matter of the residual cervical marrow (P0.05). Further multiple comparisons showed that the ADC value of the cervical spinal cord anterior cord, left anterior lateral cord and the whole white matter increased (P0.001, P0.001, P=0.036) compared with C3/4 and C4/5. .3, there was no significant difference in the value of ADC and FA between different parts of the cervical pulp white matter in different age groups (P0.05).4. There was no significant difference between the ADC and FA values of the white matter in the normal adult male and female adults (P0.05). Conclusion: 1, there was a statistical difference between the normal adult intervertebral discs of the same segment of the cervical medullary white matter, and the value of FA was statistically different, and further compared the anterior and posterior cord. The dispersion or anisotropy of the left anterior lateral cord between the three is different. The dispersion or anisotropy of the left anterior lateral cord, the posterior cable and the whole white matter is different.2. The normal adult intervertebral disc between the different segments of the cervical spinal cord, the left anterior lateral cord and the whole white matter ADC, and the FA value are statistically different. Further comparison is compared with C3/4 and C4/5, C6/7 intervertebral discs. The diffusion and anisotropy of the segment level cervical cord anterior cord, the left anterior lateral cord and the whole white matter were different.3, age, sex factors had no significant influence on the ADC and FA values of the normal adult cervical marrow white matter. The second part of diffusion tensor imaging in the early diagnosis of cervical spondylotic myelopathy was to explore the diffusion tensor imaging in the cervical spondylotic myelopathy (cervical Spondylotic myelopathy, CSM) application research in early diagnosis. Materials and methods: 60 cases of CSM patients were selected as study group. 39 men and 21 women, age 25~70 years, average age (45.1 + 2.6) years old. According to the 17 division of the Japanese Department of orthopedics, the degree of cervical spinal cord injury was scored and divided into four groups: mild group, JOA=13-16 score, 22 cases, moderate group, JOA=9-12 Scores, 19 cases, severe group, JOA=5-8, 13 cases, severe group, JOA=0-4, 6. The control group was 37 volunteers in the first part of this study. The cervical vertebra routine MRI and DTI examination (scanning parameters and methods and the first part) were performed on 60 cases of CSM patients. The original DTI images were transferred to the GE ADW 4.4 workstation, and the Correct program in the functool software was applied to the original. The initial image is proofed to reduce the correlation artifact. The threshold is set to the lower limit of 600 and the upper limit. The ADC and FA values of the DTI image are measured by 2 radiologists and the most heavy plane of compression is measured (ROI is selected as the first part). SPSS 21 software package is used to carry out statistical analysis of the measured data, first of all the measured values are normal. The ADC and FA values of all parts of the white matter of the cervical marrow were in accordance with the normal distribution, with the normal distribution and (`X + S). The difference of ADC and FA in the various parts of the white matter of the neck pulp between the JOA score group and the control group was analyzed by the single factor variance analysis JOA score group. The multiple comparison between the groups was compared with the LSD-t test.P0.05, and the difference was statistically significant. The result: CSM 60 cases. The normal sagittal T1WI, T2WI, axial T2WI and axis position ADC of the cervical spinal cord showed good.1. Compared with the mild group, the control group and the mild group, the moderate group, the severe group and the severe group, the difference of the average ADC and FA value of the white matter in the cervical marrow was statistically significant (P0.05). The comparison showed that the mild group of white matter anterior to the cervical marrow was compared with the control group. The ADC value increased (P=0.025) and the right posterior lateral cord FA value decreased (P=0.038). Compared with the control group and the mild group, the ADC value of the posterior cervical cord and the right anterior lateral cord increased (P respectively 0.008,0.017), the left anterior lateral cord and the whole white matter FA value decreased (P respectively 0.033,0.026). Compared with the control group, the mild group and the moderate group, the right front of the neck pulp white matter right front was compared with the control group. The ADC value of the lateral cord and the whole white matter increased (P 0.011,0.006 respectively) and the FA value of the anterior cord decreased (P=0.004). Compared with the other four groups, the ADC value of the right posterior side of the white matter in the cervical spinal cord increased (P=0.001), the anterior cord, the posterior cord and the left anterior lateral cord FA value decreased (P respectively 0.01,0.002,0.023).2, from the mild group to the severe group, with the aggravation of the clinical symptoms, the white matter of cervical pulp with the aggravation of the clinical symptoms. The average ADC value of each part showed an upward trend, and the FA value showed a downward trend. Conclusion: 1, the average ADC and FA value of the white matter in the neck pulp of the control group were compared with the mild group, the moderate group, the severe group and the severe group. The average ADC value of the white matter in the cervical marrow was presented with the aggravation of the clinical symptoms. The FA value showed a downward trend, indicating that the value of ADC and FA was a sensitive indicator of the microstructural changes in CSM patients,.2. Compared with the control group, the ADC value of the anterior cord of the white matter in the mild group increased (P=0.025) and the right posterior side of the cord decreased (P=0.038), indicating that DTI was earlier than the conventional T2WI, to accurately assess the degree of spinal cord injury and better serve the clinical formulation. The corresponding treatment and evaluation of the prognosis.
【學(xué)位授予單位】：皖南醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R445.2;R681.55

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