摘要
目的探讨MR扩散张量成像（DTI）评估腰骶神经病变的可行性。
方法本研究为前瞻性，收集经神经科通过临床症状及神经电生理表现确诊的18例腰骶神经病患者（试验组）和20名健康志愿者（对照组）。试验组按神经电生理检测结果分为试验亚组A（脱髓鞘组，6例），试验亚组B（轴索损伤伴脱髓鞘组，12例）。对两组行腰4（L4）、腰5（L5），骶1（S1）、骶2（S2）和坐骨神经（SN），以下简称＂L4-SN＂行DTI检查。分别由2名经验丰富的诊断医师于双侧L4-SN神经近、中及远处＂播点＂作ROI。以每条神经3处ROI的DTI参数的平均值作为相应神经最终DTI参数。试验组与对照组L4-SN同节段神经DTI参数符合正态分布，采用独立样本t检验进行对比分析。两试验亚组不符合正态分布，对照组、试验亚组A及试验亚组B的DTI参数行非参数独立样本Kruskal-Wallis H检验，两两比较采用Nemenyi检验。
结果（1）试验组L4-SN的分数各向异性（FA）显著低于对照组（t值范围4.11~6.36，P〈0.05）；L4、S1-SN的ADC值显著高于对照组（t值范围-4.77^-1.17，P〈0.05）；L4-SN的本征向量（λ⊥）值显著高于对照组（t值范围-5.30^-2.57,P〈0.05）。（2）对照组、试验亚组A及试验亚组B的L4-SN FA值（H值范围18.5~30.6，P〈0.05）、λ⊥值（H值范围6.8~29.2，P〈0.05）及L4、S1-SN ADC值（H值范围6.8~19.6,P〈0.05）差异有统计学意义，对照组与试验亚组B L4-SN的FA值（H值范围18.4~30.1，P〈0.05）、λ⊥值（H值范围6.2~29.0，P〈0.05）及L4、S1-SN ADC值（H值范围6.4~19.54，P〈0.05）差异有统计学意义。（3）试验组与对照组ROC分析示L4-SN的FA值AUC分别为0.834、0.745、0.860、0.772、0.811，诊断神经病变的敏感度分别为66.7%、72.2%、77.8%、83.3%、66.7%，特异度分别为91.7%、69.4%、80.6%、61.1%、88.9%；L4-SN λ⊥值AUC分别为0.796、0.656、0.791、0.701、0.843，诊断神经病变的敏感度分别为55.6%、50.0%、66.7%、97.2%、88.9%，特异度分别为91.7%、77.9%、86.1%、36.1%、66.7%。
结论DTI具有评估腰骶神经病变的可行性，且能够鉴别正常神经与轴索损伤伴脱髓鞘神经。
ObjectiveTo study the feasibility of diffusion tensor imaging（DTI） in assessment of lumbosacral neuropathy.
MethodsEighteen patients with lumbosacral neuropathy （experimental group） and 20 healthy volunteers （control group） were enrolled prospectively in the neurological department by clinical symptoms and neuroelectrophysiology. The experimental group were divided into experimental subgroup A （demyelination group, 6 cases）, subgroup B （axonal injury with demyelination group, 12 cases） based on electrophysiology. All of L4-SN nerves of the experiment group and the control group received DTI examination. ＂Sowing points＂ as ROIs were placed in the proximal, middle and distal of bilateral L4-SN nerves by two experienced physicians. The average of the DTI parameters of 3 ROIs at each nerve were used as its final DTI parameters. Independent sample t test was used to evaluate the difference of the L4-SN DTI parameters between the experimental group and the control group. The differences of DTI parameters among the control group, the experimental subgroup A and the experimental subgroup B were compared by the nonparametric independent samples Kruskal-Wallis H test and the Nemenyi test. The ROC analysis was performed on the FA values and λ⊥ values of the control and experimental groups.
Results（1） The L4-SN FA values in the experimental group was significantly lower than those in the control group （t range from 4.11 to 6.36, P〈0.05）. The L4 and S1-SN ADC values of the experimental group were significantly higher than those of the control group （t range from-4.77 to-1.17, P〈0.05）. The L4-SN λ⊥ values in the experimental group were significantly higher than those in the control group （t range from-5.30 to-2.57, P〈0.05）. （2） L4-SN FA values （H values ranged from 18.5 to 30.6, P〈0.05）, λ⊥ values （H values ranged from 6.8 to 29.2, P〈0.05） and L4, S1-SN ADC values （H values ranged from 6.8 to 19.6, P〈0.05） were significantly different among control group, experimental subgroup A and experimental subgroup B. Nemenyi test showed there were significant differences in FA values （H values ranged from 18.4 to 30.1,P〈0.05） and λ⊥ values （H values ranged from 6.2 to 29.0, P〈0.05）） of L4-SN and in ADC values （H values ranged from 6.4 to 19.54, P〈0.05） of L4, S1-SN between control group and experimental subgroup B. （3） The analysis of ROC of the experimental group and control group showed the AUC values of L4-SN FA values were 0.834, 0.745, 0.860, 0.772, 0.811 respectively, the sensitivity were 66.7%, 72.2%, 77.8%, 83.3% and 66.7% respectively, and the specificity were 91.7%,69.4%,80.6%,61.1% and 88.9% respectively. The AUC values of L4-SN λ⊥ values were 0.796, 0.656, 0.791, 0.701, 0.843 respectively, and the sensitivity were 55.6%, 50.0%, 66.7%, 97.2% and 88.9% respectively,and the specificity were 91.7%, 77.85%, 86.1%, 36.1% and 66.7% respectively.
ConclusionDTI has the feasibility to evaluate lumbosacral neuropathy and it can identify patients with axonal injury with demyelination and healthy subjects.
作者
穆庆华
孙英彩
彭志刚
马晓晖
李晓娜
Mu Qinghua;Sun Yingcai;Peng Zhigang;Ma Xiaohui;Li Xiaona(Department of CT＆MR , Third Hospital of Hebei Medical University, Shijiazhuang 050051, China)
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2017年第12期954-959,共6页
Chinese Journal of Radiology
关键词
磁共振成像
弥散
脊神经
腰椎
Diffusion magnetic resonance imaging
Spinal nerves
Lumbar vertebrae
