| Part one: The preliminary study of diffusion tensor imaging in normal cervical spinal cordObjective:To reasearch the application of diffusion tensor imaging(DTI)in normal cervical spinal cord with MR scanner,and to discuss the features of apparent diffusion coefficient(ADC)and fractional anisotropy(FA)of each part of white matter of normal cervical spinal cord.Methods:Selection of 37 cases of healthy people as volunteers,including 21 male cases and 16 female cases,aged from 20 to 70 years with an average age of(41.4±1.3).Divided into three groups according to age,the young group(20 to 30 years old,12 cases),the middle aged group(31 to 60 years old,10 cases),the older group(61 to70 years old,15 cases).All volunteers are no compression and trauma of cervical spinal,tumor,and other neurological diseases.Sagittal FSE-T1 WI,FSE-T2 WI and axial T2 WI of cervical spinal cord were performed in 37 volunteers by using GE Signa HDxt 3.0T MR machine with head and neck joint coil.The range of Axial DTI scanning is from the top edge of CI to the lower edge of T1,with diffusion sensitivity gradient in 15 different directions,diffusion weighting coefficient b=600s/mm2,and the scanner time is 4 minutes and 23 seconds.The DTI original image were transmitted into the GE ADW4.4 workstation,corrected by the Correct corrector to reduce the relate artifacts.Threshold is set to minimum 600,maximum peak.C2/3 ~ C6/7 five disc segment level were selected to analyze.To sketch region of interest(ROI)in the b0 image,Place each a ROI in the ventral funiculus and dorsal funiculus,before and after symmetry each a ROI in left and right lateral funiculi,and a ROI in the whole white matter(ROI were setted to 4mm2 among the ventral funiculus,dorsal funiculus and lateral funiculi,35mm2 in the whole white matter).Measure ADC and FA value of each ROI shall be conducted by two radiologists.To avoid the influence of cerebrospinal fluid and relate artifacts,ROI should be palced in cervical spinal white matter area as much as possible.All test data were analyzed by SPSS21.0 statistical package,first to nomality test and f test.ADC and FA values of each part of white matter conforms to mormal distribution,expressed in(`X±S).The differences in ADC,FA values among each part of white matter at the same segments of normal intervertebral discs were compared with One-Way ANOVA.The differences in ADC,FA values of each part of white matter among different intervertebral discs segments and different age groups were compared with One-Way ANOVA,multiple comparison between groups with LSD-t check.The differences in ADC,FA values of each part of white matter between male and female were compared with Independent-Samples T Test.The statistically significant difference was set at P<0.05.Results:The routine Sagittal FSE-T1 WI,FSE-T2 WI,axial T2 WI and ADC,FA images of 37 normal cervical spinal cord displayed well.1.There were statistical difference in ADC,FA values among each part of white matter at the same segments of normal intervertebral discs(P<0.05).Further multiple comparison.There were statistical difference in values of ADC between Left front lateral funiculi and the whole white matter(P=0.033),values of FA between Left front lateral funiculi and dorsal funiculus,the whole white matter(P=0.02,P=0.029 respectively)at C2/3 intervertebral discs segment level.There were statistical difference in values of ADC between Left front lateral funiculi and tventral funiculus(P=0.026)at C3/4 intervertebral discs segment level.There were statistical difference in values of FA between Left front lateral funiculi and ventral funiculus(P=0.014)at C5/6 intervertebral discs segment level.There were statistical difference in values of ADC between ventral funiculus and dorsal funiculus(P=0.002),values of ADC between dorsal funiculus and the whole white matter(P=0.002),values of FA between ventral funiculus and dorsal funiculus(P<0.001)at C6/7 intervertebral discs segment level.2.There were statistical difference in ADC,FA values of ventral funiculus,dorsal funiculus and the whole white matter of white matter among different intervertebral discs segments.There were no statistical difference in ADC,FA values of the rest selected area of the cervical spinal white matter.Further multiple comparison.Compared with the C3/4 and C4/5,ADC values of ventral funiculus,Left front lateral funiculi and the whole white matter increase and FA values of those decrease at C6/7 intervertebral discs segment level.3.There were no statistical difference in ADC,FA values of each part of white matter of cervical spinal cord among different age groups.4.There were no statistical difference in ADC,FA values of each part of white matter of cervical spinal cord between male and female.Conclusion: 1.There were statistical difference in ADC,FA values among each part of white matter at the same segments of normal intervertebral discs.Further multiple comparison.There were statistical difference in dispersion or anisotropy among ventral funiculus,dorsal funiculus and Left front lateral funiculi,also Left front lateral funiculi,dorsal funiculus and the whole white matter.2.There were statistical difference in ADC,FA values of ventral funiculus,dorsal funiculus and the whole white matter of white matter among different intervertebral discs segments.Further multiple comparison.Compared with the C3/4 and C4/5,there were statistical difference in dispersion or anisotropy of ventral funiculus,Left front lateral funiculi and the whole white matter increase at C6/7 intervertebral discs segment level.3.Age,gender factors influence on ADC,FA values of each part of white matter of normal cervical spinal cord is not obvious.Part two:The early diagnositic application of diffusion tensor imaging on cervical spondylotic myelopathyObjective:To discuss the application of diffusion tensor imaging in the early diagnosis of cervical spondylotic myelopathy.Methods:Selection of 37 cases of healthy people as volunteers,including 39 male cases and 21 female cases,aged from 25 to 70 years with an average age of(45.1±2.6).Frist,to rate the damage of spinal cord according to the Japannese orthopaedic society 17 point method,then divided into four groups according to Clinical symptoms:Mild group,JOA=13-16 points,22 cases;Moderate group,JOA=9-12 points,19 cases;Severe group,JOA=5-8 points,13 cases;Serious group,JOA=0-4 points,6 cases.The control group for the first part of 37 cases of volunteers.Cervical vertebra of all reseach object on conventional MRI and DTI examination(with the first part of scanning parameters and method).The DTI original image were transmitted into the GE ADW4.4 workstation,corrected by the Correct corrector to reduce the relate artifacts.Threshold is set to minimum 600,maximum peak.Measure ADC and FA value shall be conducted by two radiologists,the heaviest plane compression levels were selected to analyze(ROI choice with the first part).All test data were analyzed by SPSS21.0 statistical package,first to nomality test and f test.ADC and FA values of each part of white matter conforms to mormal distribution,expressed in(`X±S).The differences in ADC,FA values of each part of white matter between JOA group and the control group,and among JOA group were compared with One-Way ANOVA,multiple comparison between groups with LSD-t check.The statistically significant difference was set at P<0.05.Results:The routine Sagittal FSE-T1 WI,FSE-T2 WI,axial T2 WI and ADC,FA images of 60 CSM displayed well.1.There were statistical difference in ADC,FA values of each part of white matter of cervical spinal cord between the control group and mild group,moderate group,severe group,serious group.Further multiple comparison.Compared with the control group,ADC values of ventral funiculus increase(P=0.025)and FA values of Right rear lateral funiculi decrease(P=0.038)with mild group.Compared with the control group and mild group,ADC values of dorsal funiculus and Right front lateral funiculi increse(P=0.008,0.017 respectively),FA values of Left front lateral funiculi and the whole white matter decrease(P=0.033,0.026 respectively)with moderate group.Compared with the control group,mild group and moderate group,ADC values of Right front lateral funiculi and the whole white matter increse(P=0.033,0.026 respectively),FA values of ventral funiculus decrease(P=0.004)with severe group.Compared with the rest of the four groups,ADC values of Right rear lateral funiculi increase(P=0.001),FA values of ventral funiculus,dorsal funiculus and Left front lateral funiculi decrease(P=0.01,0.002,0.023 respectively)with serious group.2.From mild to serious group,with the deterioration of the clinical symptoms,ADC values rise in each part of the white matter of cervical spinal average,FA values showed a trend of decline.Conclusion: 1.There were statistical difference in ADC,FA values of each part of white matter of cervical spinal cord between the control group and mild group,moderate group,severe group,serious group.From mild to serious group,with the deterioration of the clinical symptoms,ADC values rise and FA values decline in each part of the white matter of cervical spinal average,show the ADC and FA was sensitive indicator of micro structure change in patients with CSM.2.Compared with the control group,ADC values of ventral funiculus increase(P=0.025)and FA values of Right rear lateral funiculi decrease(P=0.038)with mild group,suggest that DTI can early and accurately assess the degree of spinal cord injury than routine T2 WI,to better service in the clinical setting corresponding treatment and estimating prognosis. |
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