目的:本研究旨在探讨束特异性扩散张量成像(DTI)指标在确定脊髓型颈椎病(CSM)神经功能障碍的相关节段中的有效性。
方法:该研究包括19名被诊断为CSM的参与者,包括10名男性和9名女性。此外,纳入由10名健康护理人员(5名男性和5名女性)组成的对照组,他们没有症状,也没有对磁共振成像(MRI)进行按压.所有参与者都接受了全面的体检,MRI评估,和由高级主任医师进行的DTI检查。从MR图像中收集了几个参数,包括纵横比(定义为相应节段脊髓的前后直径/横向直径),横向比(定义为相应节段脊髓的横向直径/C2/3处脊髓的横向直径),脊髓的T2高信号。此外,定量DTI指标,如轴向扩散系数(AD),平均扩散率(MD),径向扩散系数(RD),和分数各向异性(FA),使用自动感兴趣区域(ROI)分析计算整个脊髓柱和背柱。构建受试者工作特征(ROC)曲线,评价长宽比的诊断效能,横向比,和DTI参数。曲线下面积(AUC),灵敏度,并计算特异性。术中脊髓电生理检查作为术中脊髓功能的客观指标。
结果:通过电生理检查确定,2例患者因C3/4压迫导致神经功能障碍,在10名患者中,由于C4/5压缩,6例患者因C5/6压迫,1例患者因C6/7压迫。CSM组改良的日本骨科协会量表(mJOA)为12.71±1.55,感觉神经功能为4.87±0.72,运动神经功能为5.05±1.35。对于对照组,志愿者均无神经功能障碍.在CSM组的13例患者中,在最狭窄的部分发现了T2高信号。考虑到所有的子宫颈段,纵横比(AUC=0.823,P=0.001,灵敏度=68.42%,特异性=82.47%)比横向比率(AUC=0.661,P=0.027,灵敏度=68.42%,特异性=67.01%)。AD,MD,与不负责任段相比,有责任段的RD和RD显着升高,而FA显着降低(P<0.05)。DTI-背柱参数的AUC(AD,MD,RD,FA)大于DTI(整个脊髓)的相应参数。DTI-背柱的AD具有最大的疗效(AUC=0.823,灵敏度=84.21%,特异性=77.32%)确定责任段,DTI大于全脊髓AD(AUC=0.822,P=0.001,敏感性=89.47%,特异性=77.32%),纵横比(AUC=0.823,P=0.001,灵敏度=68.42%,特异性=82.47%)和横向比率(AUC=0.661,P=0.027,敏感性=68.42%,特异性=67.01%)。亚组分析显示,DTI和MRI参数的诊断效能受颈椎节段的影响。
结论:当考虑所有宫颈节段时,来自DTI-背柱的AD在识别负责区段方面表现出最显著的潜力。发现这种潜力优于DTI-整个脊髓,纵横比,最狭窄的节段,T2高信号,横向比,运动神经功能障碍,和感觉神经功能障碍。DTI和MRI参数的诊断有效性均受特定颈椎节段的影响。
OBJECTIVE: This study aimed to investigate the effectiveness of tract-specific diffusion tensor imaging (DTI) metrics in identifying the responsible segments for neurological dysfunction in cervical spondylotic myelopathy (CSM).
METHODS: The study encompassed nineteen participants diagnosed with CSM, including 10 males and 9 females. Additionally, a control group consisting of ten healthy caregivers (5 males and 5 females) were recruited with no symptoms and no compressions on magnetic resonance imaging (MRI). All participants underwent a comprehensive physical examination, MRI assessment, and DTI examination conducted by a senior chief physician. Several parameters were collected from the MR images, including the aspect ratio (defined as the anteroposterior diameter / the transverse diameter of the corresponding segment\'s spinal cord), transverse ratio (defined as the transverse diameter of the corresponding segment\'s spinal cord / the transverse diameter of the spinal cord at C2/3), and T2 high signal of the spinal cord. Furthermore, quantitative DTI metrics, such as axial diffusivity (AD), mean diffusivity (MD), radial diffusivity (RD), and fractional anisotropy (FA), were calculated using automatic region-of-interest (ROI) analysis for both whole spinal cord column and dorsal column. Receiver operating characteristic (ROC) curves were constructed to evaluate the diagnostic efficacy of the aspect ratio, transverse ratio, and DTI parameters. The area under the curve (AUC), sensitivity, and specificity were calculated. Intraoperative spinal cord electrophysiological examination was performed as the objective measure of spinal cord function during surgery.
RESULTS: As determined by electrophysiological examination, neurological dysfunction was found in 2 patients due to C3/4 compression, in 10 patients due to C4/5 compression, in 6 patients due to C5/6 compression, and in 1 patient due to C6/7 compression. The modified Japanese Orthopedic Association scale (mJOA) was 12.71 ± 1.55 in the CSM group, with 4.87 ± 0.72 for sensory nerve function and 5.05 ± 1.35 for motor nerve function. For the control group, none of the volunteers had neurological dysfunction. T2 high signal was found at the most stenotic segment in 13 patients of the CSM group. Considering all the cervical segments, the aspect ratio (AUC = 0.823, P = 0.001, Sensitivity = 68.42%, Specificity = 82.47%) was more capable of determining the responsible segment than transverse ratio (AUC = 0.661, P = 0.027, Sensitivity = 68.42%, Specificity = 67.01%). AD, MD, and RD were significantly higher while FA was significantly lower in the responsible segment than in the irresponsible segment (P < 0.05). The AUC of DTI-Dorsal column parameters (AD, MD, RD, FA) was larger than the corresponding parameters of the DTI (Whole spinal cord). AD of DTI-Dorsal Column possessed the greatest efficacy (AUC = 0.823, sensitivity = 84.21%, specificity = 77.32%) to determine the responsible segment, larger than AD of DTI-Whole spinal cord (AUC = 0.822, P = 0.001, Sensitivity = 89.47%, Specificity = 77.32%), aspect ratio (AUC = 0.823, P = 0.001, Sensitivity = 68.42%, Specificity = 82.47%) and transverse ratio (AUC = 0.661, P = 0.027, Sensitivity = 68.42%, Specificity = 67.01%). Subgroup analysis revealed that the diagnostic efficacy of DTI and MRI parameters was influenced by cervical spine segment.
CONCLUSIONS: When considering all cervical segments, AD from the DTI-Dorsal Column exhibited the most significant potential in identifying responsible segments. This potential was found to be superior to that of DTI-Whole spinal cord, aspect ratio, the most stenotic segment, T2 high signals, transverse ratio, motor nerve dysfunction, and sensory nerve dysfunction. The diagnostic effectiveness of both DTI and MRI parameters was notably influenced by the specific cervical spine segment.