磁共振彌散加權(quán)成像在腰骶部脊神經(jīng)的臨床應(yīng)用
發(fā)布時(shí)間：2018-12-11 19:45
【摘要】：研究目的： 探討彌散加權(quán)神經(jīng)成像對(duì)41名伴有單側(cè)放射性疼痛的椎間孔狹窄患者神經(jīng)根顯示及形態(tài)改變，測(cè)量受壓神經(jīng)根ADC值并與正常神經(jīng)根ADC值比較并評(píng)價(jià)彌散加權(quán)神經(jīng)成像診斷腰骶部神經(jīng)根受壓的應(yīng)用價(jià)值。 資料與方法： 本研究以2013年3月至2014年3月就診于吉林大學(xué)中日聯(lián)誼醫(yī)院的住院患者，通過體格檢查、影像學(xué)檢查及術(shù)中探查，確診為壓迫因素導(dǎo)致神經(jīng)根損傷的患者為研究對(duì)象。 采用飛利浦3.0T磁共振成像系統(tǒng)，受檢者仰臥位，采用Sense XLTorso線圈。DW-MRN掃描參數(shù)如下：重復(fù)時(shí)間（TR）=6800ms，回波時(shí)間（TE）=70ms，激勵(lì)次數(shù)（NSA）=10，反轉(zhuǎn)時(shí)間（TI）=180ms，掃描視野（FOV）=325mm，，矩陣（Matrix）=165×256，層厚=0mm，層數(shù)=12mm，EPI factor=47，SENSE factor=2，b值=0，800s/mm2。 DW-MRN序列掃描方位為軸位，然后對(duì)原始圖像行MIP處理，重建三維圖像。在ADC圖測(cè)得健康志愿者組及患者組腰4、腰5及骶1神經(jīng)根節(jié)的ADC值。感興趣區(qū)選擇兩個(gè)層面，包括節(jié)前段神經(jīng)根及節(jié)后段脊神經(jīng)。比較健康志愿者左、右兩側(cè)神經(jīng)根及同側(cè)腰4、腰5、骶1神經(jīng)根ADC值；并比較患者患側(cè)與健康志愿者任意一次神經(jīng)根的ADC值。測(cè)量健康志愿者組及患者組背根神經(jīng)節(jié)在冠狀位的成角、長(zhǎng)度及寬度，分析神經(jīng)根形態(tài)異常改變。 結(jié)果： （1）一般資料：符合納入標(biāo)準(zhǔn)的伴有單側(cè)放射性疼痛的椎間孔狹窄患者41例，對(duì)照組41例，兩組在年齡、性別、身高及體重等方面無(wú)統(tǒng)計(jì)學(xué)差異（p＞0.05），具有可比性。 （2）41例健康志愿者神經(jīng)根ADC值分析：L4（1.305±0.12×10-3mm2/s、（1.311±0.17×10-3mm2/s）；L5（1.327±0.068×10-3mm2/s、1.324±0.139×10-3mm2/s）；S1（1.296±0.09×10-3mm2/s、1.301±0.10×10-3mm2/s），相同節(jié)段神經(jīng)根左右兩側(cè)差異無(wú)顯著性（p＞0.05）；41例健康志愿者同側(cè)三組神經(jīng)根ADC值差異無(wú)顯著性（p＞0.05）。 （3）41例患者患側(cè)神經(jīng)根ADC值分析：L4（1.493±0.172×10-3mm2/s），L5（1.672±0.105×10-3mm2/s），高于健康志愿者左、右兩側(cè)神經(jīng)根ADC值，差異有顯著性（P＜0.05）。 （4）兩組82例背根神經(jīng)節(jié)成角的分析：患者組L4（46.5±10.8度，n=15）L5（48.3±12.7度，n=25），與健康志愿者組比較差異具有顯著性（P＜0.05）。 （5）兩組82例背根神經(jīng)節(jié)長(zhǎng)徑（患側(cè)）：患者組L4（10.3±4.5mm，n=15）、L5（12.7±1.5mm，n=25），與健康志愿者組比較差異具有顯著性（P＜0.05）；背根神經(jīng)節(jié)橫徑（患側(cè)）：患者組L4（7.9±2.1mm，n=15）、L5（7.1±1.1mm，n=25），與健康志愿者組比較差異具有顯著性（P＜0.05）。 （6）對(duì)健康志愿者組與患者組測(cè)量的神經(jīng)根ADC值構(gòu)建受試者工作特征曲線。最佳分割點(diǎn)＞1.41×10-3mm2/s；敏感性=71.4%；特異性=89.3%；陽(yáng)性預(yù)測(cè)值=87.0%；陰性預(yù)測(cè)值=75.8%；（p＜0.0001）。 結(jié)論： 1.磁共振彌散加權(quán)神經(jīng)成像可以直觀的顯示受壓神經(jīng)根的形態(tài)改變，如壓跡、背根神經(jīng)節(jié)膨脹及神經(jīng)根移位。 2.受壓損傷的神經(jīng)根ADC值較正常神經(jīng)根增高，且特異性比較高，因此ADC值可以定量評(píng)價(jià)神經(jīng)根壓迫損傷。
[Abstract]:Objective: to investigate the manifestation and morphologic changes of nerve root in 41 patients with unilateral radiation pain associated with stenosis of intervertebral foramen by diffusion weighted neurography. The ADC value of compressed nerve root was measured and compared with the ADC value of normal nerve root. The value of diffusion-weighted neurography in the diagnosis of lumbosacral nerve root compression was evaluated. Materials and methods: the inpatients from March 2013 to March 2014 in the Sino-Japanese Friendship Hospital of Jilin University were examined by physical examination, imaging examination and intraoperative exploration. Patients with nerve root injury due to compression were studied. Philips 3.0T magnetic resonance imaging system was used. The subjects were supine with Sense XLTorso coil. The parameters of DW-MRN scan were as follows: repeat time (TR) = 6800ms, echo time (TE) = 70ms, excitation times (NSA) = 10, inversion time (TI) = 180ms. Scan field (FOV) = 325 mm, matrix (Matrix) = 165 脳 256, slice thickness = 0 mm, layer number = 12 mm EPI factor=47,SENSE factor=2,b = 0 800 s / m 2. DW-MRN sequence scanning azimuth is axial, then the original image is processed by MIP to reconstruct three-dimensional image. The ADC values of lumbar 4 lumbar 5 and sacral 1 nerve root ganglion in healthy volunteers and patients were measured by ADC. The region of interest selects two layers, including the anterior segment of the nerve root and the posterior segment of the spinal nerve. The ADC values of left, right and ipsilateral lumbar 4, lumbar 5, sacral 1 nerve roots were compared in healthy volunteers, and the ADC values of affected side and healthy volunteers were compared at any one time. The angulation, length and width of dorsal root ganglion (DRG) in healthy volunteers and patients were measured in coronal position, and the abnormal morphological changes of DRG were analyzed. Results: (1) General data: 41 patients with intervertebral foramen stenosis with unilateral radiation pain and 41 patients with control group were enrolled in the study. There was no statistical difference in height and weight (p > 0.05). (2) ADC analysis of nerve root in 41 healthy volunteers: L4 (1.305 鹵0.12 脳 10-3mm-2 / s, 1.311 鹵0.17 脳 10-3mm2/s), L5 (1.327 鹵0.068 脳 10-3mm ~ 2 / s 1.324 鹵0.139 脳 10-3mm2/s); S1 (1.296 鹵0.09 脳 10 ~ (-3) mm ~ (-2) / s ~ (-1) 鹵0.10 脳 10-3mm2/s), there was no significant difference between the left and right sides of the same segment of nerve root (p > 0. 05). There was no significant difference in ADC value of nerve root among 41 healthy volunteers in ipsilateral three groups (p > 0. 05). (3) the ADC value of the affected nerve root in 41 patients: L4 (1.493 鹵0.172 脳 10-3mm2/s), L5 (1.672 鹵0.105 脳 10-3mm2/s), higher than the left and right side of the nerve root ADC, the difference was significant (P < 0. 05). (4) Analysis of the angulation of dorsal root ganglion in 82 cases in two groups: L4 (46.5 鹵10.8 degree, nong15) L5 (48.3 鹵12.7 degrees, nong25) in the patient group was significantly different from that in the healthy volunteers group (P < 0.05). (5) the long diameter of dorsal root ganglion (affected side) in 82 cases of two groups: L4 (10.3 鹵4.5mm), L5 (12.7 鹵1.5mm) in the patient group, there was significant difference between the two groups (P < 0.05). The transverse diameter of dorsal root ganglion (affected side): L4 (7.9 鹵2.1 mm) and L5 (7.1 鹵1.1 mm) in the patient group were significantly different from those in the healthy volunteers group (P < 0.05). (6) to construct the operating characteristic curve of the nerve root ADC measured by the healthy volunteers and the patients. The optimum division point was > 1.41 脳 10 ~ (-3) mm ~ 2 / s; sensitivity = 71.4; specificity = 89.3; positive predictive value = 87.0; negative predictive value = 75.8; (p < 0.0001). Conclusion: 1. Magnetic resonance diffusion weighted neurography (DWI) can visualize the morphological changes of compressed nerve roots, such as indentation, expansion of dorsal root ganglion and nerve root displacement. 2. The ADC value of the compressed nerve root was higher than that of the normal nerve root, and the specificity of the nerve root was higher than that of the normal nerve root. Therefore, the ADC value could be used to quantitatively evaluate the nerve root compression injury.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R445.2;R681.5
[Abstract]:Objective: to investigate the manifestation and morphologic changes of nerve root in 41 patients with unilateral radiation pain associated with stenosis of intervertebral foramen by diffusion weighted neurography. The ADC value of compressed nerve root was measured and compared with the ADC value of normal nerve root. The value of diffusion-weighted neurography in the diagnosis of lumbosacral nerve root compression was evaluated. Materials and methods: the inpatients from March 2013 to March 2014 in the Sino-Japanese Friendship Hospital of Jilin University were examined by physical examination, imaging examination and intraoperative exploration. Patients with nerve root injury due to compression were studied. Philips 3.0T magnetic resonance imaging system was used. The subjects were supine with Sense XLTorso coil. The parameters of DW-MRN scan were as follows: repeat time (TR) = 6800ms, echo time (TE) = 70ms, excitation times (NSA) = 10, inversion time (TI) = 180ms. Scan field (FOV) = 325 mm, matrix (Matrix) = 165 脳 256, slice thickness = 0 mm, layer number = 12 mm EPI factor=47,SENSE factor=2,b = 0 800 s / m 2. DW-MRN sequence scanning azimuth is axial, then the original image is processed by MIP to reconstruct three-dimensional image. The ADC values of lumbar 4 lumbar 5 and sacral 1 nerve root ganglion in healthy volunteers and patients were measured by ADC. The region of interest selects two layers, including the anterior segment of the nerve root and the posterior segment of the spinal nerve. The ADC values of left, right and ipsilateral lumbar 4, lumbar 5, sacral 1 nerve roots were compared in healthy volunteers, and the ADC values of affected side and healthy volunteers were compared at any one time. The angulation, length and width of dorsal root ganglion (DRG) in healthy volunteers and patients were measured in coronal position, and the abnormal morphological changes of DRG were analyzed. Results: (1) General data: 41 patients with intervertebral foramen stenosis with unilateral radiation pain and 41 patients with control group were enrolled in the study. There was no statistical difference in height and weight (p > 0.05). (2) ADC analysis of nerve root in 41 healthy volunteers: L4 (1.305 鹵0.12 脳 10-3mm-2 / s, 1.311 鹵0.17 脳 10-3mm2/s), L5 (1.327 鹵0.068 脳 10-3mm ~ 2 / s 1.324 鹵0.139 脳 10-3mm2/s); S1 (1.296 鹵0.09 脳 10 ~ (-3) mm ~ (-2) / s ~ (-1) 鹵0.10 脳 10-3mm2/s), there was no significant difference between the left and right sides of the same segment of nerve root (p > 0. 05). There was no significant difference in ADC value of nerve root among 41 healthy volunteers in ipsilateral three groups (p > 0. 05). (3) the ADC value of the affected nerve root in 41 patients: L4 (1.493 鹵0.172 脳 10-3mm2/s), L5 (1.672 鹵0.105 脳 10-3mm2/s), higher than the left and right side of the nerve root ADC, the difference was significant (P < 0. 05). (4) Analysis of the angulation of dorsal root ganglion in 82 cases in two groups: L4 (46.5 鹵10.8 degree, nong15) L5 (48.3 鹵12.7 degrees, nong25) in the patient group was significantly different from that in the healthy volunteers group (P < 0.05). (5) the long diameter of dorsal root ganglion (affected side) in 82 cases of two groups: L4 (10.3 鹵4.5mm), L5 (12.7 鹵1.5mm) in the patient group, there was significant difference between the two groups (P < 0.05). The transverse diameter of dorsal root ganglion (affected side): L4 (7.9 鹵2.1 mm) and L5 (7.1 鹵1.1 mm) in the patient group were significantly different from those in the healthy volunteers group (P < 0.05). (6) to construct the operating characteristic curve of the nerve root ADC measured by the healthy volunteers and the patients. The optimum division point was > 1.41 脳 10 ~ (-3) mm ~ 2 / s; sensitivity = 71.4; specificity = 89.3; positive predictive value = 87.0; negative predictive value = 75.8; (p < 0.0001). Conclusion: 1. Magnetic resonance diffusion weighted neurography (DWI) can visualize the morphological changes of compressed nerve roots, such as indentation, expansion of dorsal root ganglion and nerve root displacement. 2. The ADC value of the compressed nerve root was higher than that of the normal nerve root, and the specificity of the nerve root was higher than that of the normal nerve root. Therefore, the ADC value could be used to quantitatively evaluate the nerve root compression injury.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R445.2;R681.5
【共引文獻(xiàn)】
相關(guān)期刊論文 前10條
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