脊髓型颈椎病患者减压术后躯体感觉传导纤维损伤的纵向研究Longitudinal study of somatosensory conduction fiber structure after decompression in patients with cervical spondylotic myelopathy
吴开富;何来昌;谭永明;
摘要(Abstract):
目的利用扩散张量成像(diffusion tensor imaging,DTI)技术观测脊髓型颈椎病(cervical spondylotic myelopathy,CSM)患者减压术前、术后躯体感觉传导纤维表观弥散系数(apparent diffusion coefficient,ADC)、各向异性分数(anisotropy fraction,FA)及平均扩散系数(diffusion coefficient, MD)变化,探究CSM患者感觉障碍、术后神经功能恢复的结构变化基础。材料与方法 27例CSM术前患者与27名年龄、性别相匹配的健康志愿者接受大脑MRI扫描(DTI数据),27例CSM患者术后6个月再次进行同样扫描,将双侧丘脑皮质束及脊髓丘脑束(丘脑-中脑)作为感兴趣区,对三组ADC、MD及FA值的独立或配对样本t检验,分析各组间传导束FA值、MD值及ADC值的变化,以期揭示慢性颈髓压迫、减压对损伤远端的感觉传导纤维影响。结果与健康对照组相比,CSM术前患者的丘脑皮质束及脊髓丘脑束的FA值均减低(P<0.05),丘脑皮质束及脊髓丘脑束ADC、MD值升高(P<0.05);术后6个月,术后CSM患者丘脑皮质束较术前、对照组FA值均减低(P<0.05),脊髓丘脑束FA值较术前和对照组升高(P<0.05)。结论 DTI数据值可以量化反映继发脊髓损伤远端神经微细损伤,对判断CSM病情及揭示病理生理机制有重要意义;CSM可致脊髓丘脑束及丘脑皮质束发生继发性、逆行性损害,减压术后丘脑皮质神经束康复效能不明显,但是术后脊髓丘脑神经束存在重塑。
关键词(KeyWords): 脊髓型颈椎病;磁共振成像;丘脑皮质束;脊髓丘脑束
基金项目(Foundation): 国家自然基金项目(编号:81460329);; 江西省自然科学基金(编号:20181BAB205063)~~
作者(Author): 吴开富;何来昌;谭永明;
Email:
参考文献(References):
- [1]Luo DK,Zhou NX,Zhao HW,et al.Imaging changes and treatment of cervical spondylotic myelopathy.Chin J Clin Res,2017,30(2):229-233.罗登科,周纳新,赵红卫,等.脊髓型颈椎病的影像学改变及治疗.中国临床研究,2017,30(2):229-233.
- [2]Song CY,Wang XM.Preliminary study of diffusion tensor imaging in cervical spondylotic myelopathy.Chin J Magn Reson Imaging,2012,3(1):19-23.宋春瑶,王晓明.磁共振扩散张量成像对脊髓型颈椎病的初步研究.磁共振成像,2012,3(1):19-23.
- [3]Zheng W,Chen H,Wang N,et al.Application of diffusion tensor imaging cutoff value to evaluate the severity and postoperative neurologic recovery of cervical spondylotic myelopathy.World Neurosurgery,2018,118:e849-e855.
- [4]Ries M,Jones RA,Dousset V,et al.Diffusion tensor MRI of the spinal cord.Magn Reson Med,2015,44(6):884-892.
- [5]Maxwell WL,Bartlett E,Morgan H.Wallerian degeneration in the optic nerve stretch-injury model of traumatic brain injury:a stereological analysis.J Neurotrauma,2015,32(11):780-790.
- [6]Liang Z,Zeng J,Zhang C,et al.Longitudinal investigations on the anterograde and retrograde degeneration in the pyramidal tract following pontine infarction with diffusion tensor imaging.Cerebrovasc Dis,2008,25(3):209-216.
- [7]Groisser BN,Copen WA,Singhal AB,et al.Corticospinal tract diffusion abnormalities early after stroke predict motor outcome.Neurorehabil Neural Repair,2014,28(8):751-760.
- [8]Koyama T,Marumoto K,Miyake H,et al.Relationship between diffusion tensor fractional anisotropy and long-term motor outcome in patients with hemiparesis after middle cerebral artery infarction.J Stroke Cerebrovasc Dis,2014,23(9):2397-2404.
- [9]Nukala M,Abraham J,Khandige G,et al.Efficacy of diffusion tensor imaging in identification of degenerative cervical spondylotic myelopathy.Eur J Radiol Open,2018,6:16-23.
- [10]Dong F,Wu Y,Song P,et al.A preliminary study of 3.0-T magnetic resonance diffusion tensor imaging in cervical spondylotic myelopathy.Eur Spine J,2018,27(8):1839-1845.
- [11]Wang Y,Liu G,Hong D,et al.White matter injury in ischemic stroke.Prog Neurobiol,2016,141:45-60.
- [12]Chaudhary N,Pandey AS,Gemmete JJ,et al.Diffusion tensor imaging in hemorrhagic stroke.Exp Neurol,2015,272(10):88-96.
- [13]Martin AR,Aleksanderek I,Cohen-Adad J,et al.Translating state-ofthe-art spinal cord MRI techniques to clinical use:a systematic review of clinical studies utilizing DTI,MT,MWF,MRS,and fMRI.Neuroimage Clin,2016,10:192-238.
- [14]Tagliaferro P,Burke RE.Retrograde axonal degeneration in parkinson disease.J Parkinsons Dis,2016,6(1):1-15.
- [15]Liu X,Tian W,Qiu X,et al.Correlation analysis of quantitative diffusion parameters in ipsilateral cerebral peduncle during Wallerian degeneration with motor function outcome after cerebral ischemic stroke.J Neuroimaging,2012,22(3):255-260.
- [16]Clark CA,Werring DJ.Diffusion tensor imaging in spinal cord:methods and applications:a review.NMR Biomed,2002,15(7-8):578-586.
- [17]Schwartz ED,Hackney DB.Diffusion-weighted MRI and the evaluation of spinal cord axonal integrity following injury and treatment.Exp Neurol,2003,184(2):570-589.
- [18]Ducreux D,Lepeintre JF,Fillard P,et al.MR diffusion tensor imaging and fiber tracking in 5 spinal cord astrocytomas.AJNR Am JNeuroradiol,2006,27(1):214-216.
- [19]Herrero MT,Barcia C,Navarro JM.Functional anatomy of thalamus and basal ganglia.Childs Nerv Syst,2002,18(8):386-404.
- [20]Yoon H,Kim J,Moon WJ,et al.Characterization of chronic axonal degeneration using diffusion tensor imaging in canine spinal cord injury:a quantitative analysis of diffusion tensor imaging parameters according to histopathological differences.J Neurotrauma,2017,34(21):3041-3050.
- [21]Lei SJ,Shen YX.Progress in new MRI technology on Wallerian degeneration after stroke.Chin J Med Technol,2011,27(3):631-634.雷松菁,申云霞.磁共振成像新技术在脑梗死后沃勒变性中的研究进展.中国医学影像技术,2011,27(3):631-634.
- [22]Wen CY,Cui JL,Lee MP,et al.Quantitative analysis of fiber tractography in cervical spondylotic myelopathy.Spine J,2013,13(6):697-705.
- [23]Guleria S,Gupta RK,Saksena S,et al.Retrograde Wallerian degeneration of cranial corticospinal tracts in cervical spinal cord injury patients using diffusion tensor imaging.J Neurosci Res,2008,86(10):2271-2280.