CAJ | 학술논문

目的探讨3 T MR DTI各测量值与脊髓型颈椎病临床症状的相关性.方法选取颈椎病患者104例,根据日本骨科学会17分法脊髓损害功能评定标准(JOA评分)将其分为轻(31例、13～16分),中(27例、9～12分),重度(25例、5～8分)及严重(21例、0～4分)4组.按病变部位脊髓信号特征分为3组:A组33例,T1WI、T2WI均未见异常信号；B组30例,T1WI无异常信号,T2WI呈高信号；C组41例,T1WI呈低信号,T2WI呈高信号.所有患者均行DTI,测量受压严重节段脊髓的各向异性分数(FA)、ADC值及本征值(λ1、λ2、λ3),并行颈髓纤维束成像.采用Spearman相关性分析法分析各测量参数值与JOA评分的相关性,采用单因素方差分析比较各组间测量参数.结果所有受检者DTI显示满意.轻、中、重度及严重4组FA值分别为0.69±0.13、0.58±0.03、0.46±0.08、0.37 ±0.11,组间比较差异有统计学意义(F=100.59,P＜0.05).JOA评分与FA值呈正相关(r=0.883,P＜0.05).JOA评分与ADC及入1、λ2、λ3值无相关性(r值分别为0.232、0.217、0.113、0.127,P值均＞0.05).A、B、C3组FA值分别为0.67±0.33、0.51±0.21、0.38±0.03,组间比较差异有统计学意义(F=50.05,P＜0.05).随着临床症状加重,即JOA评分降低,FA值呈降低趋势；且随着T2高信号的出现,其FA值也呈降低趋势,FA值越低,其纤维束损害越明显.ADC、λ2、λ3值在轻、中、重度及严重4组间及在A、B、C3组间比较,差异均有统计学意义,λ1在各组间比较差异均无统计学意义.结论 FA值的改变与临床症状呈正相关,且FA值越低,其纤维束损害越明显.DyTI可以反映病变的严重程度及脊髓纤维束受压损伤的范围.
목적 탐토3 T MR DTI각측량치여척수형경추병림상증상적상관성.방법 선취경추병환자104례,근거일본골과학회17분법척수손해공능평정표준(JOA평분)장기분위경(31례、13～16분),중(27례、9～12분),중도(25례、5～8분)급엄중(21례、0～4분)4조.안병변부위척수신호특정분위3조:A조33례,T1WI、T2WI균미견이상신호；B조30례,T1WI무이상신호,T2WI정고신호；C조41례,T1WI정저신호,T2WI정고신호.소유환자균행DTI,측량수압엄중절단척수적각향이성분수(FA)、ADC치급본정치(λ1、λ2、λ3),병행경수섬유속성상.채용Spearman상관성분석법분석각측량삼수치여JOA평분적상관성,채용단인소방차분석비교각조간측량삼수.결과 소유수검자DTI현시만의.경、중、중도급엄중4조FA치분별위0.69±0.13、0.58±0.03、0.46±0.08、0.37 ±0.11,조간비교차이유통계학의의(F=100.59,P＜0.05).JOA평분여FA치정정상관(r=0.883,P＜0.05).JOA평분여ADC급입1、λ2、λ3치무상관성(r치분별위0.232、0.217、0.113、0.127,P치균＞0.05).A、B、C3조FA치분별위0.67±0.33、0.51±0.21、0.38±0.03,조간비교차이유통계학의의(F=50.05,P＜0.05).수착림상증상가중,즉JOA평분강저,FA치정강저추세；차수착T2고신호적출현,기FA치야정강저추세,FA치월저,기섬유속손해월명현.ADC、λ2、λ3치재경、중、중도급엄중4조간급재A、B、C3조간비교,차이균유통계학의의,λ1재각조간비교차이균무통계학의의.결론 FA치적개변여림상증상정정상관,차FA치월저,기섬유속손해월명현.DyTI가이반영병변적엄중정도급척수섬유속수압손상적범위.
Objective To evaluate the correlation between diffusion tensor imaging(DTI)measurements,fiber tracking(FT)and the clinical symptoms in patients with cervical spondylotic myelopathy.Methods According to the Japanese orthopaedics association score(JOA),104 patients with cervical spondylopathy were divided into 4 groups:mild in 31 patients with 13-16 scores,moderate in 27 with 9-12 scores,severe in 25 with 5-8 scores,and serious in 21 with 0-4 scores.According to the lesion signal characters,all patients were divided into 3 groups:Group A with normal signal in both T1 WI and T2WI in 33 patients,Group B with normal signal in T1WI but high signal in T2WI in 30 patients,and Group C with low signal in T1 WI and high signal in T2WI in 41 patients.Apparent diffusion coefficient (ADC),fractional anisotropy(FA),λ1,λ2,λ3 were measured in the spinal cord at the serious pressed section,and fiber tractography was performed.The Spearman correlation analyses was used to correlate each of the DTI measurement with JOA score.Group difference was tested with one-way ANOVA method.Results High quality of DTI was acquired in all patients.The FA values in the mild,moderate,severe,and serious groups were respectively 0.69 ±0.13,0.58 ±0.03,0.46 ±0.08,and 0.37 ±0.11 and significant difference was found in different groups(F =100.59,P ＜ 0.05)and positively correlated with JOA scores (r =0.883,P ＜ 0.05).There was no statistical significance between JOA scores and ADC,λ1,λ2,λ3(r=0.232,0.217,0.113,0.127,P ＞0.05).The FA values in group A,B,and C were respectively 0.67 ±0.33,0.51 ±0.21,0.38 ±0.03,and significant difference was found among different groups(F =50.05,P ＜ 0.05).Decrease of JOA score and high signal in T2 companied with decrease of FA value.Decrease of FA values was found associated with increase of fiber bundle damage.The ADC,λ2,λ3 but not λ1 were significantly different among the JOA groups and the group A,B,and C.Conclusions The FA values are positively correlated with clinical symptoms.Decrease of FA values is found associated with increase of fiber bundle damage.DTI can show the severity and extent of damage of spinal cord in patients with cervical spondylotic myelopathy.