| Objective: 1.To investigate the parameters and characteristics of DTI of normal cervical spinal cord,and to study the correlation between DTI parameters and age,gender of healthy cervical spinal cord.2.To carry out comparative analysis of changes in DTI image and parameter values of patients with cervical spondylotic myelopathy(CSM),to investigate the correlation between the above changes and the scores of neurological function,and to evaluate the application value of DTI in the diagnosis of early phase CSM.Methods: 1.According to the inclusion criteria[1],a total of 36 cases of patients diagnosed with CSM in spinal surgery department of our hospital from March 2016 to December 2016 were collected as experimental group,male 23,Female 13,and the patients were divided into group a(20-to 40-years old),group b(40-to 60-years old),group c(60-years old and upwards)according to their age.The neurological functions of the 36 cases of patients were assessed by modified Japanese Orthopaedic Association Scores for Assessment of Cervical Myelopathy(m JOA)[2]and Neck Disability Index(NDI)[3].2.24 cases of healthy people undergone physical examination were randomly selected as control group of this study(age range of control group was similar to that of experimental group,male13,female 11),and performed conventional MRI and DTI scan to get fractional anisotropy(FA)map,apparent diffusion coefficient(ADC)map and FA pseudo color map,meanwhile,ADC and FA values of cervical cords in canalis vertebralis corresponding to C1-7 intervertebral disc layer were measured,and diffusion tensor tractography was used to draw spinal white matter fiber tracts.3.A total of 36 cases of patients in experimental group were performed conventional MRI and DTI scan,and divided into group A(simple dural sac compression),group B(spinal cord compression,no signal enhancement in compressive zone T2)and group C(spinal cord compression,signal enhancement in compressive zone T2)according to the degree of spinal canal compression and the changes of spinal cord signal in conventional MRI T2 weighted image.ADC and FA values of cervical cords in the compressive zone of the three groups were measured,besides,the compression,deviation or fracture of spinal white matter fiber tracts were observed.4.Statistic analysis was carried out on all the gathered data using SPSS 22.0 statistical software,and measurement data was denoted by mean plus or minus standard deviation(x ±s).independent-samples T test and variance analysis test was used to analyze the difference between measurement data.Meanwhile,regression correlation analysis was conducted on the DTI image indexes and neurological function scores of the 36 cases of patients.Results: 1.The average ADC value of cervical cords in C1-7 intervertebral disc layer of healthy control group was about(0.900×10-3)mm2/s,and the average FA value was about 0.731;with independent-samples T test,the difference between the two values and gender was not statistically significant(t=-0.036,p>0.05;t=0.646,p>0.05);with one-way analysis of variance,the difference between the two values and age was not statistically significant(F=0.861,p>0.05;F=0.2,p>0.05).2.The average ADC value of cervical cord in the site of dural sac under the most compression in C1-7 intervertebral disc layer in experimental group A was about(0.891×10-3)mm2/s,the average FA value was about 0.662,and the difference in the two values between experimental group A and control group was not statistically significant(P>0.05);for experimental group B,the average ADC value was about(1.145×10-3)mm2/s,the average FA value was about 0.602,and the difference in the two values between experimental group B and control group was statistically significant(P <0.05);for experimental group C,the average ADC value was about(1.324×10-3)mm2/s,the average FA value was about 0.507,and the difference in the two values between experimental group C and control group was statistically significant(P <0.05);the difference between data of experimental group A,B and C was statistically significant(P <0.05),and pairwise comparisons were further made as below: the average ADC value of cervical cord of patients with CSM was higher than that of healthy people,and the average FA value was lower than that of healthy people,and the difference was statistically significant(P<0.05);the average ADC value of cervical cord of patients with CSM in combination with cervical spinal cord compression was higher than that of patients with pure dural sac compression,the average FA value was lower than that of patients with pure dural sac compression,and the difference was statistically significant(P<0.05);the average ADC value of patients with spinal cord compression and T2 W signal enhancement was higher than that of patients with pure spinal cord compression,the average FA value was lower,and the difference was statistically significant(P <0.05).3.The cervical spinal white matter tracts of healthy people and patients with pure dural sac compression were smooth,uniform,and possess plump and complete structure;the T2 WI sequence confirmed that the patients were CSM patients with different degrees of dural sac and spinal cord compression,the cervical spinal white matter tracts bore different degrees of compression,flattening and displacement,arc impressions of different sizes can be seen,the tracts had coarse edges,and disruption of tracts can be seen in patients with serious symptoms.4.Pearson correlation analysis and regression as well as multivariate regression analysis were conducted on the m JOA scores,NDI scores,ADC values and FA values of the patients,respectively,and the results showed that:The ADC value and FA value were respectively significantly correlated with m JOA score and NDI score,meanwhile,the influence of ADC and FA values on the two scores was studied and the following conclusions were drawn:(1)74.6% of m JOA score change can be explained by changes in ADC and FA values,i.e.,Y=13.901-0.009X1+0.013X2;(2)72.2% of NDI score change can be explained by changes in ADC and FA values,i.e.,Y=11.78+0.023X1-0.4X2.Conclusion: 1.There was no significant difference in ADC value and FA value of cervical cords in all intervertebral disc layers of healthy people with different ages and genders.2.Quantitative index ADC value and FA value have great clinical significance for the early diagnosis of CSM spinal cord injury.The severer the spinal cord injury,the lower the FA value and the higher the ADC value,and the measurement of ADC and FA values can be helpful to predict the prognosis of spinal cord injury.3.The spinal white matter tracts is of great value in revealing microstructure changes inside the spinal cord and evaluating injury status of the white matter tracts.4.With the increase of ADC value and decrease of FA value,NDI score shows an increasing tendency,while JOA score shows an decreasing tendency,indicating that the higher the degree of cervical spinal cord disorders,the more obvious the neurologic disorders and the poorer the prognosis.The measurement of ADC and FA values can help to judge the neurological functional status of patients to some extent,and provide some reference information for preliminary evaluation of prognosis of the patients. |
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