The Value Of 3.0TMR-DTI In Adult Normal Cervical Cord And CSM

Part Ⅰ The application of DTI in normal adult cervical spinal cord with 3.0T DTIObjective:Through the application of 3.0T-DTI in normal adult cervical spinal cord, to investigate the characteristics of normal cervical spinal isotropic and anisotropic diffusion, to investigate the characteristics of apparent diffusion coefficient(ADC), fractional anisotropy(FA) in different segments of the normal cervical spinal cord, to investigate the characteristics of apparent diffusion coefficient fractional anisotropy in the same segment of normal cervical spinal cord, and to investigate the characteristics of apparent diffusion coefficient、fractional anisotropy at different age in normal cervical spinal cord.Materials and Methods:40 cases of healthy people were selected as the research object, including 21 cases male and 19 cases female, aged from 19 to 68 years, an average 40.4 years. They were divided into three age groups:less than 30 years old for one group(12 cases),30-60 years old for one group (16 cases),60 years and over the older group(12 cases). Cervical cord and intervertebral disc of all volunteers are normal, they did not have neurological positive signs and symptoms. All the subjects were Performed by using GE 3.0T Discovery 750MR. Four cases were choosed to do experimental research of cervical spinal DTI, the method is as follows:fixed scanning, gathering matrix, scanning field and scanning parameters, diffusion sensitive gradient direction respectively chooses 12,15,20. B value chooses 500,1000,1500, and then compared transverse DTI image quality. When diffusion sensitive gradient direction is 15, b value is 500, image quality is the best. All the data of DTI were analyzed with GE functool ADW 4.6 software, and which were corrected by a certain procedure to reduce the artifact and distortion of DTI. The values of ADC, FA were measured at C2 to C7 inter-vertebral disc levels of the cervical spinal cord according to ADC map,FA map and b=500 map in healthy volunteers. Regions of interest (ROIs) include the cervical spinal cord. Every level were measured four times, except for measuring value very differences, to calculate the average value of three measurements. The data of DTI were analyzed with a software package SPSS 17.0. All quantitative data were expressed by mean± standard deviations. It was used two independent sample t test and single factor analysis of variance. The difference was statistically significant in all statistical analysis(P<0.05).Result:1.40 volunteers were completed conventional MR and DTI inspection. All images of normal cervical spinal cord displayed well.2. DTI parameters images is no distortion, b=500 images show that normalcervical spinal is equal signal, cervical spinal cerebrospinal fluid and nerve roots were high signal. ADC images show normal cervical spinal and nerve roots were blue-green signal, cervical spinal cerebrospinal fluid was red-yellow. FA images show normal cervical spinal was deep red signal, nerve roots were red and cervical spinal cerebrospinal fluid was blue.3.1 The normal parameters values of ADC, FA in normal cervical spinal cord were acquired, ADC=1.149±0.100, FA=0.642±0.032.3.2 There were no statistical difference in values of ADC, FA at the same level between men and women(P>0.05). There were no statistical difference in values of ADC, FA at the same level at C2 to C7 different levels. There were no statistical difference in values of ADC, FA among the three different age group(P>0.05).Conclusion:1. The normal reference values of DTI parameters(ADC, FA value) provides reference information for clinical research and application.2. Experiment shows that the spread of the normal adult same level cervical spinal was no significant gender differences. The spread ability of the cervical spinal between different levels were basically the same. Age had no significant effect on the spread of the cervical spinal. These information was good for the following cervical spinal-DTI studies.3. ADC, FA value were the sensitive indicator to evaluate the intensity of molecular diffusion in cervical spinal nerve cells, it can make up for the drawback that the conventional MR in cervical spinal lesion cannot analyze quantitatively. images of normal cervical spinal cord displayed well.2. DTI parameters images is no distortion, b=500 images show that normalcervical spinal is equal signal, cervical spinal cerebrospinal fluid and nerve roots were high signal. ADC images show normal cervical spinal and nerve roots were blue-green signal, cervical spinal cerebrospinal fluid was red-yellow. FA images show normal cervical spinal was deep red signal, nerve roots were red and cervical spinal cerebrospinal fluid was blue.3.1 The normal parameters values of ADC, FA in normal cervical spinal cord were acquired, ADC=1.149±0.100, FA=0.642±0.032.3.2 There were no statistical difference in values of ADC, FA at the same level between men and women(P>0.05). There were no statistical difference in values of ADC, FA at the same level at C2 to C7 different levels. There were no statistical difference in values of ADC, FA among the three different age group(P>0.05).Conclusion:1. The normal reference values of DTI parameters(ADC, FA value) provides reference information for clinical research and application.2. Experiment shows that the spread of the normal adult same level cervical spinal was no significant gender differences. The spread ability of the cervical spinal between different levels were basically the same. Age had no significant effect on the spread of the cervical spinal. These information was good for the following cervical spinal-DTI studies.3. ADC, FA value were the sensitive indicator to evaluate the intensity of molecular diffusion in cervical spinal nerve cells, it can make up for the drawback that the conventional MR in cervical spinal lesion cannot analyze quantitatively.Part Ⅱ The application of DTI in cervical spondylotic myelopathy with 3.0T DTIObjective:Through the application of 3.0T-DTI in cervical spondylotic myelopathy, to Investigate the diagnostic value of DTI which was used as a quantitative analysis technique to CSM patients of conventional MR intramedullary no abnormal signal, to investigate the parameter characteristics of different compression degree of cervical spinal with CSM patients and to investigate the correlation between ADC, FA value and intramedullary signal about patient with CSM cervical spinal compression degree of the same or similar.Materials and Methods:34 cases of cervical spondylotic myelopathy have multiple lesion-segments, lesions were in 71 intervertebral disc corresponding segments, including 18 cases male and 16 cases female, aged from 20 to 72 years, an average 49.3 years. Normal control group (group A):choosing from 40 normal volunteers in this experiment.34 patients with the same spinal cord compression section were divided into a group on the basis of routine MR scan (sagittal T2WI) show. They can be divided into 3 groups, the grouping was as follows:group B (pathological sections were all 25):the intervertebral disc is outstanding, dural sac is different degree compression, cervical spinal is no compression and its morphology and signal were normal; group C (pathological sections were all 27):the intervertebral disc is outstanding, cervical spinal was mild compression, compression degree of cervical spinal was less than 30% of the cervical spinal diameter, spinal cord signal is normal; group D (pathological sections were all 19):the intervertebral disc is outstanding, cervical spinal was moderate compression, compression degree of cervical spinal was more than 30% of the cervical spinal diameter, cervical spinal cord can have abnormal signal (8 segments T2WI have high signal,11 segments is normal). Scan and post-procesing equipment are with the first part of this experiment, scanning method and scanning parameters of 34 patients are the same with the first part of the experiment. The data of DTI were analyzed with a software package SPSS 17.0. All quantitative data were expressed by mean±standard deviations. It was used two independent sample t test and single factor analysis of variance. The difference was statistically significant in all statistical analysis(P<0.05).Result:1. DTI post-treatment images of B、C、D groups were visible on the image of different degree compression of cervical spinal around different degree deformation and signal change.2.1 There were statistical difference in values of ADC, FA between CSM 38 lesion section group and the control group (P<0.05). There were no statistical difference in values of ADC, FA between A group and B group(P>0.05), there were statistical difference in values of ADC, FA between A group and C、D group (P<0.05), and from B group to D group, the ADC values gradually increase, FA values gradually reduce.2.2 There were no statistical difference in values of ADC, FA between 8 cervical spinal with abnormal signal segments and 11 cervical spinal with no normal signal segments in the cervical spinal moderate compression group(P>0.05).Conclusion:1. ADC, FA value in DTI technology were quantifiable data. It provided the objective index of early cervical spinal cord injury with cervical spondylosis myelopathic. It can more early, more accurately assess the spinal cord injury than conventional MRI. It was a good method to assess early cervical spinal cord injury.2. The change degree of ADC、FA values can reflect the damage degree of the spinal cord. It was sensitive to diagnosis the cervical spinal microstructure change and evaluate the degree of cervical spinal compression. It is a kind of quantitative and visual technology of functional imaging to evaluate the degree of cervical spinal injury. It provides important value for the planning of treatment and predicting prognosis. It will have broad application value in clinical in the future.3. In the same or similar cervical spinal compression degree, the changes of ADC、 FA value are similar. It has nothing to do with the change of the cervical spinal signal. These data are preliminary experimental results, however, it has no histopathology confirmed and the cases are small, therefore, further studies are needed.