Application Value Of Dynamic MRI Check In Early Diagnosis Of Cervical Spondylotic Myelopathy

Objective: To explore dynamic MRI manifestations of the normal cervical vertebra.Methods: To choose 20 health volunteers as the research objective from Yijishan Hospital,9 males and 11 females,and the age is 25 years old to 49 years old,the average age is 37.3±5.3 years old.The examinee group:(1)There are no obvious displacement of image artifacts and magnetic susceptibility artifacts,basically meet the requirements of diagnosis;(2)no clinical symptoms and signs of cervical spondylosis;(3)Conventional cervical MRI examination showed no abnormality;(4)No obvious obesity,with good cooperation,(5)No severe cervical fracture and trauma history.To use the cervical phased array surface coil of Avanto1.5T superconducting magnetic resonance scanner which from SIEMENS company,for all of the examine to have as the conventional neutral position,hyperextension and hyperflexion position cervical intervertebral use MRI check at the same time.Neutral position,hyperextension and hyperflexion position selected TSE-T2 WI sequence in sagittal and transverse plane of central cervical intervertebral disc,same of the scanning parameters.Combined with the median sagittal and axial T2 WI images,C2/3?C3/4?C4/5?C5/6?C6/7of intervertebral disc central level vertebral canal sagittal diameter,and yellow ligament thickness and intervertebral disc bulge size were measured by Neusoft PACS measurement tools for all the income image.to get each data of normal lower cervical vertebrae of different position.All the data were measured in the images of sagittal T2 WI,in order to reduce the error,each data were measured for 3 times and take the average.To use SPSS 16.0 statistical software for statistical analysis of all measured results.The measurement data be said by the mean ±standard deviation((?)± s).First of all,all data were tested in normal distribution;then to compare these three kind of position and different segment's the bulging disc size,the thickness of ligamentum flavum and intervertebral disc herniation by analysis of variance,to do the further pairwise comparison by SNK-q test.Enumeration data between groups were compared with the chi square test.The difference was statistically significant when P<0.05.Results:(1)All 20 healthy volunteers in this group were good cooperation,Conventional neutral position and dynamic position MRI images meet the requirements of the research.(2)Conventional neutral posit cervical lordosis and no abnormal,no vertebral osteophyte;11 cases of patients with intervertebral disc degeneration,7 cases of patients with mild lumbar intervertebral disc prolapse,14 cases of patients with intervertebral disc herniation;the posterior longitudinal ligament have no thickened,4 cases of yellow ligament slightly thickening 5.Hyperextension position: 12 cases of patients with cervical spine with mild disc bulging 26,6 cases ligamentum with slightly thickened 9;Flexion position: 3 cases of patients with mild swelling 6 of cervical intervertebral disc,ligamentum flavum no thickening.Changes in each segment of the vertebral canal sagittal position are different:Flexion posit> neutral position>hyperextension posit.(3)In neutral position,maximum hyperflexion and hyperextension position of different segments in different parts of intervertebral disc herniation,ligamentum flavum thickening,spinal sagittal diameter were different degree changes.(4)In neutral position and hyperflexion position,the differents of Intervertebral disc bulging,ligamentum flavum thickening have the statistical significance.the differents of sagittal diameter of vertebral canal(except the C2/3 segment)have the statistical significance.(5)In neutral position and hyperextension position,the differents of Intervertebral disc herniation,yellow ligament thickening and sagittal diameter of vertebral canal(except the C2/3 segment)have the statistical significance.(6)In hyperflexion position and hyperextension position,the differents of Intervertebral disc herniation,yellow ligament thickening and sagittal diameter of vertebral canal(except the C2/3 segment)have the statistical significance.? Conclusion:1.Dynamic MRI examination can be used in normal cervical vertebra study.Through to get the normal people's cervical vertebra of C2/3?C3/4?C4/5?C5/6?C6/7 intervertebral disc level spinal sagittal and yellow ligament thickness and intervertebral disc protrusion degree of the dynamic changes data,for the normal cervical vertebra dynamic physiology studies provides a valuable imaging information2.Through the analysis of the dynamic MRI data of normal cervical vertebra,provide the basis for the pathogenesis and early diagnosis of cervical spondylotic myelopathyObjective: To explore the application value of Dynamic MRI check technique in early diagnosis of cervical spondylotic myelopathy.Methods: To collect 60 patient volunteers from Yi Ji Shan hospital since October 2014 to 2015 August who has clinical symptoms suspected cervical spondylotic myelopathy but the dynamic MRI checked with spinal cord compression,through to follow up them 6-12 months,20 patients who were the clinical manifestations and conventional MRI 's review that the diagnosis of cervical spondylotic myelopathy as the object.5 patients of them were followed upand diagnosed the cervical spondylotic myelopathy in six months,15 patients of them were followed up and diagnosed the cervical spondylotic myelopathy in one year.At last,in 20 patients of them are diagnosed the cervical spondylotic myelopathy,in which there are 8 male patients and 12 female patients,their ages is 35 to 69 years old,and the average age is 52.8±9.4 years old.The choose standard for all 20 research samples is :(1)Do the conventional MRI imaging and dynamic magnetic resonance imaging at the same time;(2)Conventional MRI check showed no radiographic signs of cervical spondylotic myelopathy,but dynamic MRI check for suspected cervical spondylotic myelopathy(by the impact of spinal cord compression);(3)The clinical and MRI follow-up recheck 6 months to 12 months: a.Conventional MRI check with cervical spondylotic myelopathy imaging manifestations(by the impact of spinal cord compression);b.Refer to the CSM diagnosis standard produced from the Third National Symposium for Cervical Spondylosis,according to clinical onset form,the first symptom,the characteristics of symptoms and signs,electrophysiological examination,diagnosis of cervical spondylotic myelopathy and to scored the clinical JOA score,JOA score assisted by two senior doctors in the Department of Orthopedics;(4)No severe cervical trauma;(5)No mental illness;(6)Except muscle atrophy amyotrophic lateral sclerosis,spinal cord tumors,secondary adhesive arachnoiditis,multiple neuritis cable such as spinal cord lesions;(7)No obvious obesity,with good cooperation;(8)There are no obvious displacement of image artifacts and magnetic susceptibility artifacts,basically meet the requirements of diagnosis.To use the cervical phased array surface coil of Avanto 1.5T superconducting magnetic resonance scanner which from SIEMENS company,for all of the examine to have as the conventional neutral position,hyperextension and hyperflexion position cervical intervertebral use MRI check at the same time.Neutral position,hyperextension and hyperflexion position selected TSE-T2 WI sequence in sagittal and transverse plane of central cervical intervertebral disc,same of the scanning parameters.Combined with the median sagittal and axial T2 WI images,C2/3?C3/4?C4/5?C5/6?C6/7 of intervertebral disc central level vertebral canal sagittal diameter,and yellow ligament thickness and intervertebral disc bulge size were measured by Neusoft PACS measurement tools for all the income image.to get each data of normal lower cervical vertebrae of different position.All the data were measured in the images of sagittal T2 WI,in order to reduce the error,each data were measured for 3 times and take the average.To use SPSS 16 statistical software for statistical analysis of all measured results.The measurement data be said by the mean ±standard deviation((?)± s);first of all,all data were tested in normal distribution;then to compare these three kind of position and different segment's the bulging disc size,the thickness of ligamentum flavum and intervertebral disc herniation by analysis of variance,to do the further pairwise comparison by SNK-q test.Enumeration data between groups were compared with the chi square test.The difference was statistically significant when P<0.05.Results:(1)The 20 subjects were first time MRI conventional neutral position showed no obvious signs of spinal cord compression CSM,but in hyperextension position and/or hyperflexion position showed the impaction of spinal cord compression.18 cases found from hyperextension position,2 cases found from hyperflexion position.All the objects are well cooperation,the conventional MRI images and dynamic MRI images,all as the required of the research.(2)Conventional neutral position: the physiological curvature of cervical spine straight 11 cases,Mild anti bow 1 case,no vertebral osteophyte;intervertebral disc of all 20 cases have changed,17 cases of them was slightly prominent 29,no cervical spinal cord compression,no thickening of the posterior longitudinal ligament;10 cases' s ligamentum flavum slightly thickened.The largest hyperextension: 15 cases of patients with lumbar disc herniation 24,9 cases with hypertrophy of ligamentum flavum 12 and cervical spinal cord compression,10 cases of them just with intervertebral disc of cervical spinal cord compression,4 cases of them with cervical spinal cord compression of yellow ligament,5 cases of them with intervertebral disc and and the yellow ligament cord compress the cervical spinal,no thickening of the posterior longitudinal ligament.Maximum hypeflexion: 2 cases with lumbar disc herniation 3 and with intervertebral disc of cervical spinal cord compression,1 cases of posterior longitudinal ligament slightly thickened,2 cases of yellow ligament slightly thickened,(3)In the maximum hypeflexion position and the largest hyperextension position,the size and the nomber of the different segments of cervical disc,the thickness of ligamentum flavum and vertebral canal sagittal had different degrees of change.(4)The differences of neutral position and hypeflexion position,protrusion of the intervertebral disc size,yellow ligament thickness and spinal canal radius vector(except for C2/3)has the statistically significant.(5)The differences of neutral position and largest hyperextension position,protrusion of the intervertebral disc size,yellow ligament thickness and spinal canal radius vector(except for C2/3)has the statistically significant..(6)The differences of hypeflexion position and largest hyperextension position,protrusion of the intervertebral disc size,yellow ligament thickness and spinal canal radius vector(except for C2/3)has the statistically significant.Conclusion: 1.Dynamic cervical MRI check can compared with the conventional neutral MRI check in early diagnosis of cervical spondylotic myelopathy2.Hyperextension of cervical MRI check is superior to conventional flexion and neutral MRI check,and more objectively reflect the signs of spinal cord compression.3.The dynamic cervical MRI check can accurately shows the responsible segments of spinal cord compression factor and compression factor,good for guard the determination of the operation plan,and improve the operation method choose.