MRI扩散张量成像确定退行性脊柱侧凸责任节段的价值

Significance of MRI diffusion tensor imaging to determine responsible segments in degenerative scoliosis

摘要:

［目的］ 探讨 MR 扩散张量成像 （magnetic resonance imaging with diffusion tensor imaging, MRI-DTI） 在确定成人退行性脊柱侧凸 （adult degenerative scoliosis, ADS） 患者责任节段中的应用价值。［方法］ 选取 2017 年 6 月—2019 年 9 月本院退变性脊柱侧凸患者 36 例纳入研究，均行常规 MRI 及 MRI-DTI 检查，比较有症状神经根及无症状神经根 FA 值的差异，采用 ODI、JOA、VAS 评分及影像学参数评价临床疗效。［结果］ ADS 患者症状神经根与无症状神经根 FA 值存在显著差异 （P< 0.05），MRI-DTI 神经根定位与患者症状或神经阻滞定位基本相符。随时间推移，患者的 ODI、VAS-BP、VAS-LP 评分显著降低 （P<0.05），而 JOA 评分显著增加 （P<0.05）。术后不同时间的 JOA、ODI、VAS-BP、VAS-LP 评分差异无统计学意义 （P> 0.05）。影像测量方面，术后 Cobb 角、LL 角、SS 角、PT 角、椎间隙高度和椎间孔面积较术前明显改善 （P<0.05）。［结论］ MRI-DTI 可作为判定症状神经根节段的依据，并与临床症状高度一致。根据 MRI-DTI 结果定位责任节段，进行精准神经根减压，临床疗效良好。

Abstract:

[Objective] To investigate the significance of magnetic resonance imaging with diffusion tensor imaging (MRI- DTI) for identifying the responsible segments of adult degenerative scoliosis (ADS) . [Methods] A total of 36 patients who were undergoing surgical treatment for ADS in our hospital from June 2017 to September 2019 were enrolled in this study. All patients received conventional preoper- ative MRI and MRI-DTI examinations, and the differences of fractional anisotropy (FA) values between symptomatic and asymptomatic nerve roots were compared. In addition, ODI, JOA, VAS scores and imaging parameters were used to evaluate the clinical efficacy. [Results] There were significant differences in FA values between symptomatic nerve roots and asymptomatic nerve roots in ADS patients (P＜ 0.05) . The MRI-DTI nerve root location was basically consistent with symptoms or nerve block location. The ODI, VAS-BP and VAS-LP scores significantly decreased (P＜0.05) , while JOA scores significantly increased over time (P＜0.05) . However, there were no significant changes in JOA, ODI, VAS-BP and VAS-LP scores among different postoperative time points (P＞0.05) . In terms of image measurement, the Cobb angle, lumbar lordosis (LL) , sacral slope (SS) , pelvic title (PT) , intervertebral space height and intervertebral foramina area sig- nificantly improved after operation compared with those preoperatively (P＜0.05) . [Conclusion] MRI-DTI might be used as the basis to de- termine the nerve root segment related to symptoms, and is highly consistent with clinical symptoms. According to MRI-DTI results, respon- sible segments were located and precise nerve root decompression was performed, with good clinical efficacy.