| 弥散张量成像相关参数及参数组合对脊髓型颈椎病脊髓压迫症的诊断价值研究 |
| 投稿时间：2016-01-26 修订日期：2016-03-29 点此下载全文 |
| 引用本文：李建军,徐科超,张振显,王忻.弥散张量成像相关参数及参数组合对脊髓型颈椎病脊髓压迫症的诊断价值研究[J].医学研究杂志,2016,45(10):132-136 |
| DOI：
10.11969/j.issn.1673-548X.2016.10.035 |
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| 中文摘要:目的 评估弥散张量成像技术对存在脊髓压迫但常规MRI检查无异常的脊髓型颈椎病（CSM）患者脊髓压迫症的诊断价值。方法 按照排除纳入标准，从笔者医院就诊行MRI常规检查及弥散张量成像检查的患者中筛选出符合条件的研究对象。统计DTI相关参数平均扩散系数（MD）、纵向扩散系数（LD）、径向扩散系数（RD）和各向异性分数（FA），评估患者的脊髓压迫等级以及最狭窄平面。计算DTI相关参数以及参数组合MD∩FA、LD∩FA和RD∩FA诊断CSM的敏感度、特异性及阳性预测值PPV、阴性预测值NPV等，对比分析各项指标诊断效能。结果 共有64例患者纳入研究，平均年龄53.6±12.8岁，其中14例诊断为脊髓型颈椎病。FA值与中央管狭窄的程度呈负相关（r=-0.545，P=0.000）。RD与中央管狭窄程度呈正相关（r=0.399，P=0.000），CSM与非CSM研究对象FA分别为0.36±0.08、0.46±0.06，差异有统计学意义（P=0.001）。对于CSM患者（存在脊髓压迫，但是无T2WI信号变化）各项DTI参数以及参数组合的敏感度均为100%，多重比较结果提示DTI参数及其参数组合的特异性组间比较，差异有统计学意义（P=0.000），其中LD∩FA敏感度为100%，特异性为68.9%，诊断效能高于单个指标。结论 FA值与椎管狭窄的程度呈负相关，而RD与椎管狭窄的程度呈正相关，FA联合MD、RD或LD对于诊断CSM患者脊髓压迫症的诊断价值高于上述指标单独使用。 |
| 中文关键词:精确度 弥散张量成像 脊髓型颈椎病 MRI |
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| Accuracy of Diffusion Tensor Imaging for Diagnosing Cervical Spondylotic Myelopathy in Patients Showing Spinal Cord Compression |
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| Abstract:Objective To assess the performance of diffusion tensor imaging (DTI) for the diagnosis of cervical spondylotic myelopathy (CSM) in patients with deformed spinal cord but otherwise unremarkable conventional magnetic resonance imaging (MRI) findings. Methods A total of 33 patients who underwent MRI of the cervical spine including DTI using two-dimensional single-shot interleaved multi-section inner volume diffusion-weighted echo-planar imaging and whose spinal cords were deformed but showed no signal changes on conventional MRI were the subjects of this study. Mean diffusivity (MD), longitudinal diffusivity (LD), radial diffusivity (RD), and fractional anisotropy (FA) were measured at the most stenotic level. The calculated performance of MD, FA, MD∩FA, LD∩FA, and RD∩FA in diagnosing CSM were compared with each other based on the estimated cut-off values of MD, LD, RD, and FA from receiver operating characteristic curve analysis with the clinical diagnosis of CSM from medical records as the reference standard. Results 64 patients were included in the study, and the average age was 53.6±12.8 years.14 people were diagnosed with CSM.FA value was negatively related to the degree of central canal stenosis (r=0.545, P=0.000).RD was positively associated with the degree of central canal stenosis (r=0.399, P=0.000). FA in CSM was 0.36±0.08 while non-CSM was 0.46±0.06, which had statistically significant differences (P=0.000). The sensitivity of DTI parameters was 100% for patients with CSM who had spinal cord compression but no T2WI signal changes.The multiple comparison results suggested there were differences among the specificity of DTI parameters (P=0.000), the sensitivity of LD∩FA was 100% while the spectificity was 68.9%.The diagnostic efficiency of combined indicators was higher than single index. Conclusion FA value was negatively related to the degree of central canal stenosis.RD was positively associated with the degree of central canal stenosis.Fractional anisotropy combined with MD, RD, or LD is expected to be more useful than FA and MD for diagnosing CSM in patients who show deformed spinal cords without signal changes on MRI. |
| keywords:Accurac Diffusion Tensor Imaging CSM MRI |
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