【摘要】：目的：聯(lián)合SWI探討非出血和出血型脊髓損傷DTI參數(shù)值的變化特點及與神經(jīng)功能的相關(guān)性，并觀察DTT圖像，探討其在顯示頸髓損傷神經(jīng)纖維束受累程度上的價值。 方法：應用3.0T西門子磁共振機（Verio)對15例健康志愿者（E組）和28例急性脊髓損傷患者72小時內(nèi)行常規(guī)MRI、SWI及DTI檢查。根據(jù)常規(guī)MRI及SWI圖像，，將病例組分為脊髓無出血組和有出血組，脊髓無出血組包括：脊髓正常組（A組）、脊髓水腫組（B組）；脊髓有出血組包括脊髓挫傷組（C組）、脊髓出血組（D組）。所有患者均采用美國脊髓損傷學會（American Spinal InjuryAssociation，ASIA）的分級標準進行臨床評估。分析對照組及病例組DTI圖像和DTT圖像的特征，測量對照組不同椎體水平和病例組損傷水平脊髓的FA、ADC、λ1、λ2、λ3值，比較對照組、病例組及其各亞組之間脊髓FA、ADC、λ1、λ2、λ3值有無差別；分析無出血組（包括A組和B組）和有出血組（包括C組和D組）脊髓FA、ADC、λ1、λ2、λ3值與ASIA運動評分有無相關(guān)性。 結(jié)果：急性脊髓損傷（Acute spinal cord injury，ASCI）患者常規(guī)MRI及SWI顯示：脊髓正常組6例，脊髓水腫組10例，脊髓挫傷組7例，脊髓出血組5例。ASCI患者彩色編碼FA圖示受損脊髓信號不均勻減低，呈混雜淺綠色或紅色信號，灰階ADC圖、λ2圖、λ3圖受損脊髓信號不均勻增高，DTT顯示無出血組脊髓纖維束均勻一致的藍色信號變?yōu)闇\藍色或黃色信號，纖維束尚連續(xù)；出血組脊髓纖維束不連續(xù)，斷端呈紅色。對照組不同椎體水平脊髓FA、ADC、λ1、λ2、λ3值均無統(tǒng)計學差異。對照組與病例組FA、ADC、λ2、λ3值有統(tǒng)計學差異（P0.05），λ1值無統(tǒng)計學差異（P0.05）。對照組與A組之間DTI各參數(shù)均無統(tǒng)計學差異（P0.05）；對照組與B、C、D三組間FA、ADC、λ2、λ3均存在統(tǒng)計學差異（P0.05），對照組與B、D組之間λ1有統(tǒng)計學差異（P0.05）。A、B、C、D四間組兩兩比較FA、λ2、λ3值均存在統(tǒng)計學差異（P0.05），且從A組到D組FA值呈降低趨勢，λ2、λ3值呈升高趨勢；ADC值在B、C兩組間無統(tǒng)計學差異（P0.05），其余各組間均有統(tǒng)計學差異（P0.05）；λ1值在A組與C組、B組與D組間無統(tǒng)計學差異（P0.05），其余各組間均有統(tǒng)計學差異（P0.05）。無出血組中FA值與ASIA運動評分呈正相關(guān)(r=0.78,P0.05)， ADC值(r=-0.58,P0.05)、 λ2值(r=-0.66,P0.05)、λ3(r=-0.80,P0.05)值與ASIA運動評分呈負相關(guān)，λ1值與ASIA運動評分不相關(guān)(P0.05)。有出血組中，各DTI參數(shù)與ASIA運動評分均不相關(guān)(P均大于0.05)。 結(jié)論：常規(guī)MRI聯(lián)合SWI能更好區(qū)分脊髓出血與非出血性損傷。DTI較常規(guī)MRI對脊髓損傷敏感，并可利用FA值、λ2、λ3值定量分析急性脊髓損傷，急性脊髓損傷后FA值降低，λ2、λ3值升高。無出血組中FA值與ASIA運動評分呈正相關(guān)，ADC值、λ2、λ3值與ASIA運動評分呈負相關(guān)，λ1值與ASIA運動評分不相關(guān)。有出血組中，各DTI參數(shù)與ASIA運動評分均不相關(guān)。DTT能無創(chuàng)性直觀顯示脊髓纖維束損傷的部位和程度。
[Abstract]:Objective: to investigate the changes of DTI parameters and the correlation between DTI parameters and nerve function in spinal cord injury (sci) without hemorrhage and blood group combined with SWI, and to investigate the value of DTT images in showing the degree of involvement of nerve fiber bundle in cervical spinal cord injury (CBI). Methods: routine MRI,SWI and DTI were performed in 15 healthy volunteers (group E) and 28 patients with acute spinal cord injury (Asci) within 72 hours by using 3.0T Siemens magnetic resonance machine (Verio). According to conventional MRI and SWI images, the patients were divided into two groups: normal spinal cord (group A) and spinal cord edema (group B). Spinal cord hemorrhage group included spinal cord contusion group (group C), spinal cord hemorrhage group (group D). All patients were evaluated by the American Society of Spinal Cord injury (American Spinal InjuryAssociation,ASIA) classification criteria. The characteristics of DTI images and DTT images in the control group and the case group were analyzed, and the FA,ADC, 位 1, 位 2, 位 3 values of the spinal cord of the control group and the injured level of the case group were measured. The FA,ADC, 位 1, 位 2 and 位 3 values of the spinal cord were compared between the control group and the case group and their subgroups. The correlation between FA,ADC, 位 1, 位 2, 位 3 and ASIA motor score was analyzed in group A and B and group C and D respectively. Results: routine MRI and SWI showed that 6 cases of normal spinal cord, 10 cases of spinal cord edema, 7 cases of spinal cord contusion and 5 cases of spinal cord hemorrhage. The color coded FA of ASCI patients showed that the signal intensity of injured spinal cord was uneven. There were mixed light green or red signals, gray-scale ADC, 位 _ 2, 位 _ 3 images damaged spinal cord signal increased inhomogeneously. DTT showed that the uniform blue signal of spinal cord fiber bundle changed to light blue or yellow signal in no bleeding group, and the fiber bundle was continuous. In the bleeding group, the spinal cord fiber bundle was discontinuous and the broken end was red. There was no significant difference in FA,ADC, 位 1, 位 2, 位 3 between the control group and the control group. The FA,ADC, 位 2 and 位 3 values of the control group and the case group were significantly different (P0.05), while the 位 1 value had no statistical difference (P0.05). There was no significant difference in DTI parameters between control group and group A (P0.05). There were significant differences in FA,ADC, 位 2 and 位 3 between the three groups (P0.05), and there were statistical differences in 位 1 between the two groups (P0.05). There were significant differences in FA, 位 2 and 位 3 between the four groups (P0.05), and the FA value decreased from A group to D group, and 位 2 and 位 3 values increased. There was no significant difference in ADC between the two groups (P0.05), while the other groups had statistical difference (P0.05); 位 1 had no statistical difference between group A and C, group B and group D (P0.05), and there was statistical difference between other groups (P0.05). There was a positive correlation between FA value and ASIA motor score in no bleeding group (r = 0.78P, P < 0.05), 位 _ 2 value (r ~ (-0.66) P 0.05), 位 _ 3 (r ~ + -0.80) value and ASIA motor score, while 位 _ 1 value was not correlated with ASIA motor score (P0.05). In the bleeding group, the DTI parameters were not correlated with the ASIA motor score (P > 0. 05). Conclusion: conventional MRI combined with SWI can better distinguish spinal cord hemorrhage from non-hemorrhagic injury, DTI is more sensitive to spinal cord injury than conventional MRI, and FA value, 位 2, 位 3 value can be used to quantitatively analyze acute spinal cord injury. FA value decreases and 位 2 and 位 3 value increase after acute spinal cord injury. There was a positive correlation between FA value and ASIA motor score in no bleeding group, but negative correlation between ADC value, 位 2, 位 3 value and ASIA motor score, but no correlation between 位 1 value and ASIA motor score. In the bleeding group, no correlation was found between DTI parameters and ASIA motor score. DTT could show the location and degree of spinal cord fiber bundle injury in a noninvasive manner.
【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R445.2;R651.2

【參考文獻】

相關(guān)期刊論文 前10條

1 劉昌盛;g品

本文編號：2281598