diffusion MRI

磁共振弥散
  • 文章类型: Journal Article
    流线牵引成像局部跟踪从纤维取向分布(FOD)函数提取的峰值方向,缺乏关于整个纤维束趋势的全球信息。因此,它容易产生错误的轨道,而错过真正的正连接。在这项工作中,我们提出了一种新的基于束特异性束图分布(BTD)函数的束特异性束图成像(BST)方法,通过在光纤束掩模中结合全局信息,直接重建从起始区域到终止区域的光纤轨迹。提出了任何高阶流线微分方程的统一框架,以描述基于扩散矢量场定义的具有不相交流线的纤维束。在全球范围内,通过最小化能量优化模型,将纤维束成像过程简化为BTD系数的估计,并通过引入束束信息来提供解剖先验,从而在先验指导下表征BTD与扩散张量向量之间的关系。在模拟霍夫上进行了实验,Sine,圈数据,ISMRM2015Tractography挑战数据,FiberCup数据,以及来自人类连接体项目(HCP)的体内数据,用于定性和定量评估。结果表明,我们的方法可以更准确地重建复杂的纤维几何结构。BTD在局部水平上减少了误差偏差和积累,在重建远程,扭曲,和大扇面。
    Streamline tractography locally traces peak directions extracted from fiber orientation distribution (FOD) functions, lacking global information about the trend of the whole fiber bundle. Therefore, it is prone to producing erroneous tracks while missing true positive connections. In this work, we propose a new bundle-specific tractography (BST) method based on a bundle-specific tractogram distribution (BTD) function, which directly reconstructs the fiber trajectory from the start region to the termination region by incorporating the global information in the fiber bundle mask. A unified framework for any higher-order streamline differential equation is presented to describe the fiber bundles with disjoint streamlines defined based on the diffusion vectorial field. At the global level, the tractography process is simplified as the estimation of BTD coefficients by minimizing the energy optimization model, and is used to characterize the relations between BTD and diffusion tensor vector under the prior guidance by introducing the tractogram bundle information to provide anatomic priors. Experiments are performed on simulated Hough, Sine, Circle data, ISMRM 2015 Tractography Challenge data, FiberCup data, and in vivo data from the Human Connectome Project (HCP) for qualitative and quantitative evaluation. Results demonstrate that our approach reconstructs complex fiber geometry more accurately. BTD reduces the error deviation and accumulation at the local level and shows better results in reconstructing long-range, twisting, and large fanning tracts.
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  • 文章类型: Journal Article
    在成年和衰老过程中,白质(WM)结构和组织的特征是缓慢的降解过程,例如脱髓鞘和收缩。这种衰老过程的加速与一系列疾病的发展有关。因此,对大脑健康成熟的准确描述,特别是在WM特征方面,是理解衰老的基础。
    我们使用纵向扩散磁共振成像来概述英国生物库(UKB)中不同时空尺度的WM变化(n=2678;年龄1=62.38±7.23年;年龄2=64.81±7.1年)。为了检查WM结构与常见临床状况之间的遗传重叠,我们测试了最常见的神经退行性疾病的WM结构和多基因风险评分之间的关联,老年痴呆症,和常见的精神疾病(单相和双相抑郁症,焦虑,强迫症,自闭症,精神分裂症,注意缺陷/多动障碍)在纵向(n=2329)和横截面(n=31,056)UKB验证数据中。
    我们的发现表明整个大脑空间分布的WM变化,以及多基因风险评分与WM的分布关联。重要的是,大脑纵向变化比使用的横断面措施更好地反映了疾病发展的遗传风险,与全球平均水平相比,区域差异为基因-大脑变化关联提供了更具体的见解。
    我们通过提供不同空间水平上的WM微观结构退化的详细概述来扩展最近的发现,帮助了解基本的大脑衰老过程。需要进一步的纵向研究来检查与衰老相关的基因-大脑关联。
    在他们的研究中,Korbmacher等人。大脑白质中健康衰老过程的基准。在较高年龄时白质退化的发现与最近的横截面和纵向发现一致,特别是概述了脑室附近和小脑白质的变化。还发现退化过程在更高的年龄加速。最后,在健康衰老的参与者中,多基因风险发展为精神病和神经退行性疾病与白质改变弱相关。
    UNASSIGNED: During the course of adulthood and aging, white matter (WM) structure and organization are characterized by slow degradation processes such as demyelination and shrinkage. An acceleration of such aging processes has been linked to the development of a range of diseases. Thus, an accurate description of healthy brain maturation, particularly in terms of WM features, is fundamental to the understanding of aging.
    UNASSIGNED: We used longitudinal diffusion magnetic resonance imaging to provide an overview of WM changes at different spatial and temporal scales in the UK Biobank (UKB) (n = 2678; agescan 1 = 62.38 ± 7.23 years; agescan 2 = 64.81 ± 7.1 years). To examine the genetic overlap between WM structure and common clinical conditions, we tested the associations between WM structure and polygenic risk scores for the most common neurodegenerative disorder, Alzheimer\'s disease, and common psychiatric disorders (unipolar and bipolar depression, anxiety, obsessive-compulsive disorder, autism, schizophrenia, attention-deficit/hyperactivity disorder) in longitudinal (n = 2329) and cross-sectional (n = 31,056) UKB validation data.
    UNASSIGNED: Our findings indicate spatially distributed WM changes across the brain, as well as distributed associations of polygenic risk scores with WM. Importantly, brain longitudinal changes reflected genetic risk for disorder development better than the utilized cross-sectional measures, with regional differences giving more specific insights into gene-brain change associations than global averages.
    UNASSIGNED: We extend recent findings by providing a detailed overview of WM microstructure degeneration on different spatial levels, helping to understand fundamental brain aging processes. Further longitudinal research is warranted to examine aging-related gene-brain associations.
    In their study, Korbmacher et al. benchmark healthy aging processes in the brain’s white matter. Findings of degrading white matter at higher ages were consistent with recent cross-sectional and longitudinal findings, particularly outlining changes in ventricle-near and cerebellar white matter. Degenerative processes were also found to accelerate at a higher age. Finally, the polygenic risk to develop psychiatric and neurodegenerative disorders was weakly associated with the white matter change in the otherwise healthily aging participants.
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  • 文章类型: Journal Article
    青春期皮质的神经解剖学变化已经用核磁共振成像有了很好的记录,揭示了随着年龄的增长正在进行的皮质变薄和体积损失。然而,潜在的细胞机制在传统的神经成像中仍然难以捉摸。MRI硬件的最新进展和由扩散MRI数据提供信息的组织的新生物物理模型有望识别驱动这些形态学观察的细胞变化。本研究采用超强梯度MRI获得高分辨率,体内评估典型发育中的儿童和青少年样本中的皮质神经突和体细胞微结构。皮质神经突信号分数,归因于神经元和神经胶质过程,随着年龄的增长而增加(平均R2神经突=.53,p<3.3e-11,随着年龄的增长11.91%),而在特定领域的网络中,表观体细胞半径下降(平均R2Rsoma=.48,p<4.4e-10,随年龄下降1%)。为了补充这些发现,分析了两个独立的死后数据库中皮质基因表达的发育模式。这表明少突胶质细胞中表达的基因表达增加,和兴奋性神经元,伴随着星形胶质细胞中表达的基因表达的相对减少,小胶质细胞和内皮细胞类型。年龄相关基因在皮质少突胶质细胞中显著富集,少突胶质细胞祖细胞和5-6层神经元(pFDR<.001)在青春期和青年期显著表达。少突胶质细胞细胞型基因表达与神经突和体细胞微结构变化的时空排列表明,正在进行的皮质髓鞘形成过程有助于青少年皮质发育。这些发现强调了皮质内髓鞘形成在青春期和成年期皮质成熟中的作用。
    Neuroanatomical changes to the cortex during adolescence have been well documented using MRI, revealing ongoing cortical thinning and volume loss with age. However, the underlying cellular mechanisms remain elusive with conventional neuroimaging. Recent advances in MRI hardware and new biophysical models of tissue informed by diffusion MRI data hold promise for identifying the cellular changes driving these morphological observations. This study used ultra-strong gradient MRI to obtain high-resolution, in vivo estimates of cortical neurite and soma microstructure in sample of typically developing children and adolescents. Cortical neurite signal fraction, attributed to neuronal and glial processes, increased with age (mean R2 fneurite=.53, p<3.3e-11, 11.91% increase over age), while apparent soma radius decreased (mean R2 Rsoma=.48, p<4.4e-10, 1% decrease over age) across domain-specific networks. To complement these findings, developmental patterns of cortical gene expression in two independent post-mortem databases were analysed. This revealed increased expression of genes expressed in oligodendrocytes, and excitatory neurons, alongside a relative decrease in expression of genes expressed in astrocyte, microglia and endothelial cell-types. Age-related genes were significantly enriched in cortical oligodendrocytes, oligodendrocyte progenitors and Layer 5-6 neurons (pFDR<.001) and prominently expressed in adolescence and young adulthood. The spatial and temporal alignment of oligodendrocyte cell-type gene expression with neurite and soma microstructural changes suggest that ongoing cortical myelination processes contribute to adolescent cortical development. These findings highlight the role of intra-cortical myelination in cortical maturation during adolescence and into adulthood.
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    文章类型: Journal Article
    早期评估肿瘤治疗反应是精准医学优化个性化治疗方案、减少不必要毒性的重要课题。成本,和延迟。尽管扩散MRI(dMRI)已经显示出解决这一需求的潜力,它的预测准确性是有限的,可能是由于其对整体病理变化的非特异性敏感性。在这项工作中,我们提出了一种新的基于定量dMRI的方法,称为交换(水交换的MRI,在任意梯度波形编码下的受限和受阻扩散),用于同时映射单元尺寸,细胞密度,和跨细胞膜水交换。这种丰富的微结构信息在细胞水平上全面评估肿瘤病理。使用数值模拟和体外细胞实验进行的验证证实,EXCHANGE方法可以准确估计平均细胞大小,密度,和水汇率常数。来自体内动物实验的结果显示EXCHANGE用于监测肿瘤治疗反应的潜力。最后,在乳腺癌新辅助化疗患者中实施了EXCHANGE方法,证明其在临床上评估肿瘤治疗反应的可行性。总之,一个新的,提出了基于dMRI的定量EXCHANGE方法,以在细胞水平上全面表征肿瘤的微观结构特性,提示在临床实践中监测肿瘤治疗反应的独特手段。
    Early assessment of tumor therapeutic response is an important topic in precision medicine to optimize personalized treatment regimens and reduce unnecessary toxicity, cost, and delay. Although diffusion MRI (dMRI) has shown potential to address this need, its predictive accuracy is limited, likely due to its unspecific sensitivity to overall pathological changes. In this work, we propose a new quantitative dMRI-based method dubbed EXCHANGE (MRI of water Exchange, Confined and Hindered diffusion under Arbitrary Gradient waveform Encodings) for simultaneous mapping of cell size, cell density, and transcytolemmal water exchange. Such rich microstructural information comprehensively evaluates tumor pathologies at the cellular level. Validations using numerical simulations and in vitro cell experiments confirmed that the EXCHANGE method can accurately estimate mean cell size, density, and water exchange rate constants. The results from in vivo animal experiments show the potential of EXCHANGE for monitoring tumor treatment response. Finally, the EXCHANGE method was implemented in breast cancer patients with neoadjuvant chemotherapy, demonstrating its feasibility in assessing tumor therapeutic response in clinics. In summary, a new, quantitative dMRI-based EXCHANGE method was proposed to comprehensively characterize tumor microstructural properties at the cellular level, suggesting a unique means to monitor tumor treatment response in clinical practice.
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  • 文章类型: Journal Article
    人类大脑在整个生命周期中经历与年龄相关的微观结构改变。Soma和神经元密度成像(SANDI),一种新的扩散磁共振成像的生物物理模型,提供细胞体(体细胞)半径和密度的估计,和灰质中的神经突密度。这项横断面研究的目的是使用SANDI评估高梯度扩散MRI对成人寿命中与年龄相关的皮质微结构改变的敏感性。在3TConnectomeMRI扫描仪上扫描了72名认知未受损的健康受试者(年龄19-85岁;40名女性),使用多壳扩散MRI方案,最大梯度强度为300mT/m,其中包含8b值和19ms的扩散时间。从SANDI模型拟合数据获得的胞内信号分数与所有主要皮质叶的年龄密切相关(r=-0.69至-0.60,FDR-p<0.001)。体内信号分数(r=0.48-0.63,FDR-p<0.001)和体半径(r=0.28-0.40,FDR-p<0.04)与前额叶皮质的皮质体积显着相关,额叶,顶叶,和颞叶。SANDI指标与年龄之间的关系强度大于或相当于皮质区域的皮质体积与年龄之间的关系,特别是在枕叶和前扣带回。与SANDI指标相比,扩散张量成像(DTI)和扩散峰度成像指标与年龄之间的所有关联均为低至中度.这些结果表明,与DTI和传统的皮质体积和厚度等神经变性的宏观测量方法相比,高梯度扩散MRI对衰老大脑中神经变性的潜在底物可能更敏感。
    The human brain undergoes age-related microstructural alterations across the lifespan. Soma and Neurite Density Imaging (SANDI), a novel biophysical model of diffusion MRI, provides estimates of cell body (soma) radius and density, and neurite density in gray matter. The goal of this cross-sectional study was to assess the sensitivity of high-gradient diffusion MRI toward age-related alterations in cortical microstructure across the adult lifespan using SANDI. Seventy-two cognitively unimpaired healthy subjects (ages 19-85 years; 40 females) were scanned on the 3T Connectome MRI scanner with a maximum gradient strength of 300mT/m using a multi-shell diffusion MRI protocol incorporating 8 b-values and diffusion time of 19 ms. Intra-soma signal fraction obtained from SANDI model-fitting to the data was strongly correlated with age in all major cortical lobes (r = -0.69 to -0.60, FDR-p < 0.001). Intra-soma signal fraction (r = 0.48-0.63, FDR-p < 0.001) and soma radius (r = 0.28-0.40, FDR-p < 0.04) were significantly correlated with cortical volume in the prefrontal cortex, frontal, parietal, and temporal lobes. The strength of the relationship between SANDI metrics and age was greater than or comparable to the relationship between cortical volume and age across the cortical regions, particularly in the occipital lobe and anterior cingulate gyrus. In contrast to the SANDI metrics, all associations between diffusion tensor imaging (DTI) and diffusion kurtosis imaging metrics and age were low to moderate. These results suggest that high-gradient diffusion MRI may be more sensitive to underlying substrates of neurodegeneration in the aging brain than DTI and traditional macroscopic measures of neurodegeneration such as cortical volume and thickness.
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  • 文章类型: Journal Article
    在纤维束造影中,冗余构成了重大挑战,通常会导致包括解剖学上令人难以置信的流线或无法准确代表大脑白质结构的示踪图。当前的过滤方法旨在通过解决这些问题来完善跟踪图,但是它们缺乏统一的冗余度量,并且计算要求很高。
    我们提出了一种新颖的框架,用于基于过滤示波图子集来量化示波图冗余,而无需认可特定的过滤算法。我们的方法根据流线的解剖合理性和扩散信号表示定义冗余,确定假阳性流线数量和示踪图冗余的下限和上限。
    我们将此框架应用于HumanConnectome项目的示踪图,使用几何合理性和统计方法,由简化的属性和集合共识提供信息。我们的结果为示踪图的冗余和示踪图的错误发现率建立了界限。
    这项研究促进了对牵引图冗余的理解,并支持了牵引图方法的改进。未来的研究将集中在进一步验证提出的框架和探索示波图压缩的可能性。
    UNASSIGNED: In tractography, redundancy poses a significant challenge, often resulting in tractograms that include anatomically implausible streamlines or those that fail to represent the brain\'s white matter architecture accurately. Current filtering methods aim to refine tractograms by addressing these issues, but they lack a unified measure of redundancy and can be computationally demanding.
    UNASSIGNED: We propose a novel framework to quantify tractogram redundancy based on filtering tractogram subsets without endorsing a specific filtering algorithm. Our approach defines redundancy based on the anatomical plausibility and diffusion signal representation of streamlines, establishing both lower and upper bounds for the number of false-positive streamlines and the tractogram redundancy.
    UNASSIGNED: We applied this framework to tractograms from the Human Connectome Project, using geometrical plausibility and statistical methods informed by the streamlined attributes and ensemble consensus. Our results establish bounds for the tractogram redundancy and the false-discovery rate of the tractograms.
    UNASSIGNED: This study advances the understanding of tractogram redundancy and supports the refinement of tractography methods. Future research will focus on further validating the proposed framework and exploring tractogram compression possibilities.
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  • 文章类型: Journal Article
    晚年抑郁症(LLD)既常见又致残,使痴呆发作的风险加倍。冷漠可能构成认知能力下降的额外风险,但缺乏对其病理生理学的清晰了解。虽然已经使用扩散张量成像(DTI)评估了白质(WM)改变,该模型不能准确表示WM微观结构。我们假设更复杂的多室模型将提供LLD和冷漠的新生物标志物。56个人(LLDn=35,26名女性,75.2±6.4年,冷漠评估量表得分(41.8±8.7)和健康对照,n=21,16名女性,包括74.7±5.2年)。在这篇文章中,通过直接沿纤维束内插微观结构指标,采用基于束的方法研究LLD和冷漠的新型扩散模型生物标志物.我们进行了多元统计分析,结合主成分分析进行维度数据降维。然后,我们通过证明从文献中经典报道的LDD修改,同时报告LLD中冷漠的生物学基础的新结果,来测试我们框架的实用性。最后,我们旨在研究不同纤维束的冷漠与微观结构之间的关系。我们的研究表明,新的纤维束,例如条纹运动前的运动束,可能参与LLD和冷漠,这给重度抑郁症的冷漠机制带来了新的启示。我们还确定了5个不同区域的扩散MRI指标的统计变化,以前报道的主要认知障碍痴呆症,这表明,这些片段之间的这些改变都与动机和认知有关,并可能解释了冷漠是退行性疾病的前驱阶段。
    Late-life depression (LLD) is both common and disabling and doubles the risk of dementia onset. Apathy might constitute an additional risk of cognitive decline but clear understanding of its pathophysiology is lacking. While white matter (WM) alterations have been assessed using diffusion tensor imaging (DTI), this model cannot accurately represent WM microstructure. We hypothesized that a more complex multi-compartment model would provide new biomarkers of LLD and apathy. Fifty-six individuals (LLD n = 35, 26 females, 75.2 ± 6.4 years, apathy evaluation scale scores (41.8 ± 8.7) and Healthy controls, n = 21, 16 females, 74.7 ± 5.2 years) were included. In this article, a tract-based approach was conducted to investigate novel diffusion model biomarkers of LLD and apathy by interpolating microstructural metrics directly along the fiber bundle. We performed multivariate statistical analysis, combined with principal component analysis for dimensional data reduction. We then tested the utility of our framework by demonstrating classically reported from the literature modifications in LDD while reporting new results of biological-basis of apathy in LLD. Finally, we aimed to investigate the relationship between apathy and microstructure in different fiber bundles. Our study suggests that new fiber bundles, such as the striato-premotor tracts, may be involved in LLD and apathy, which bring new light of apathy mechanisms in major depression. We also identified statistical changes in diffusion MRI metrics in 5 different tracts, previously reported in major cognitive disorders dementia, suggesting that these alterations among these tracts are both involved in motivation and cognition and might explain how apathy is a prodromal phase of degenerative disorders.
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  • 文章类型: Journal Article
    我们提出了两种基于深度神经网络的方法来加速白质交叉束的微结构特征的估计。这两种方法都专注于加速多字典匹配问题,这是微观结构指纹的核心,磁共振指纹到扩散磁共振成像的扩展。第一种加速方法使用有效的稀疏优化和专用的前馈神经网络来规避指纹估计的固有组合复杂性。第二加速方法依赖于前馈神经网络,其使用DW-MRI信号的球面谐波表示作为输入。第一种方法表现出高的可解释性,而第二种方法实现了更大的加速因子。结果的准确性和在体内大脑数据上获得的几个数量级的加速因子表明,我们的方法具有快速定量估计复杂白质构型中微观结构特征的潜力。
    We proposed two deep neural network based methods to accelerate the estimation of microstructural features of crossing fascicles in the white matter. Both methods focus on the acceleration of a multi-dictionary matching problem, which is at the heart of Microstructure Fingerprinting, an extension of Magnetic Resonance Fingerprinting to diffusion MRI. The first acceleration method uses efficient sparse optimization and a dedicated feed-forward neural network to circumvent the inherent combinatorial complexity of the fingerprinting estimation. The second acceleration method relies on a feed-forward neural network that uses a spherical harmonics representation of the DW-MRI signal as input. The first method exhibits a high interpretability while the second method achieves a greater speedup factor. The accuracy of the results and the speedup factors of several orders of magnitude obtained on in vivo brain data suggest the potential of our methods for a fast quantitative estimation of microstructural features in complex white matter configurations.
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  • 文章类型: Journal Article
    目的:本研究的目的是描述局部前列腺癌(PCa)局灶性治疗(FT)后随访期间在多参数磁共振成像(mpMRI)中观察到的解剖和功能变化。
    方法:在这项前瞻性研究中,我们分析了10例患者在FT后(7天;3,6,9,12个月)的术前和术后获得的mpMRI.7/10(70%)患者接受了血管靶向光动力疗法(VTP)。3/10(30%)患者行高强度聚焦超声(HIFU)。使用半自动软件进行MpMR图像分析,以分割前列腺(PG)和肿瘤区。T2加权(T2w)的信号强度(SI),T1加权(T1w),在每个时间点评估扩散加权(DWI)和动态对比增强(DCE)图像以及前列腺体积(PGV)和肿瘤体积(TV).
    结果:结果显示,FT后7天PGV显着增加(p=0.042),FT后7天和6、9和12个月之间PGV显着降低(p<0.001)。FT后7天,TV显着增加(p<0.001),FT后7天至12个月之间显着降低(p<0.001)。FT后6、9和12个月后消融区ADC的SI显着增加(p<0.001)。1/9例患者(11%)在重新活检时肿瘤复发,其特征是在mpMRI上有较小的局灶性病变,具有很强的扩散限制(ADC图上的低SI和b值DWI上的高SI)。
    结论:MpMRI能够反映FT后消融区的形态学变化,可能有助于检测复发肿瘤。
    OBJECTIVE: The aim of this study is to describe the anatomical and functional changes observed in multiparametric magnetic resonance imaging (mpMRI) during follow-up after focal therapy (FT) for localized prostate cancer (PCa).
    METHODS: In this prospective study, we analyzed pre- and postoperatively acquired mpMRI of 10 patients after FT (7 days; 3, 6, 9, 12 months). 7/10 (70%) patients underwent vascular-targeted photodynamic therapy (VTP). 3/10 (30%) patients underwent high-intensity focused ultrasound (HIFU). MpMR image analysis was performed using a semi-automatic software for segmentation of the prostate gland (PG) and tumor zones. Signal intensities (SI) of T2-weighted (T2w), T1-weighted (T1w),diffusion-weighted (DWI) and dynamic contrast-enhanced (DCE) images as well as volumes of the prostate gland (PGV) and tumor volumes (TV) were evaluated at each time point.
    RESULTS: The results showed a significant increase of PGV 7 days after FT (p = 0.042) and a significant reduction of PGV between 7 days and 6, 9 and 12 months after FT (p < 0.001). The TV increased significantly 7 days after FT (p < 0.001) and decreased significantly between 7 days and 12 months after FT (p < 0.001). There was a significant increase in SI of the ADC in the ablation zone after 6, 9 and 12 months after FT (p < 0.001). 1/9 patients (11%) had recurrent tumor on rebiopsy characterized as a a small focal lesion on mpMRI with strong diffusion restriction (low SI on ADC map and high SI on b-value DWI).
    CONCLUSIONS: MpMRI is able to represent morphologic changes of the ablated zone after FT and might be helpful to detect recurrent tumor.
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  • 文章类型: Journal Article
    目的:优化脊髓型颈椎病(CSM)患者护理的一个主要缺点是缺乏常规MRI提供的可靠定量成像工具。先进的核磁共振成像模式,如扩散磁共振成像(dMRI),包括扩散张量成像(DTI)和扩散基谱成像(DBSI),通过提供脊髓微观结构的颗粒评估,可能有助于解决这一限制。
    方法:47例CSM患者接受了全面的临床评估和dMRI,其次是DTI和DBSI建模。传统的MRI指标包括矢状面和轴向平面中脊髓压迫的10个总体定性和定量评估。dMRI指标包括12种独特的措施,包括各向异性张量,反射轴突扩散,和各向同性张量,描述轴突外扩散。主要结果是在术后2年测量的改良的日本骨科协会(mJOA)评分。使用极端梯度增强监督分类算法将患者分为疾病组,并在2年随访时预测手术结果。
    结果:47例CSM患者,包括24名(51%)轻度mJOA评分,12(26%),mJOA得分中等,11(23%)有严重的mJOA评分,以及21名对照受试者被包括在内。在分类任务中,传统的MRI指标正确地将患者分配到健康对照,轻度CSM和中度/重度CSM队列,准确度为0.647(95%CI0.64-0.65)。相比之下,DTI模型的准确度为0.52(95%CI0.51-0.52),DBSI模型的准确度为0.81(95%CI0.808-0.814).在预测任务中,传统的MRI指标根据mJOA的变化正确地预测了CSM患者在2年随访时的改善,准确度为0.58(95%CI0.57-0.58)。相比之下,DTI模型的准确度为0.62(95%CI0.61-0.62),DBSI模型的准确度为0.72(95%CI0.718-0.73).
    结论:常规MRI是评估CSM结构异常的有力工具,但其表征脊髓组织损伤的能力固有地受到限制。这项研究的结果表明,先进的成像技术,即来自dMRI的DBSI衍生指标,提供脊髓微观结构的颗粒评估,可以提供更好的诊断和预后效用。
    OBJECTIVE: A major shortcoming in optimizing care for patients with cervical spondylotic myelopathy (CSM) is the lack of robust quantitative imaging tools offered by conventional MRI. Advanced MRI modalities, such as diffusion MRI (dMRI), including diffusion tensor imaging (DTI) and diffusion basis spectrum imaging (DBSI), may help address this limitation by providing granular evaluations of spinal cord microstructure.
    METHODS: Forty-seven patients with CSM underwent comprehensive clinical assessments and dMRI, followed by DTI and DBSI modeling. Conventional MRI metrics included 10 total qualitative and quantitative assessments of spinal cord compression in both the sagittal and axial planes. The dMRI metrics included 12 unique measures including anisotropic tensors, reflecting axonal diffusion, and isotropic tensors, describing extraaxonal diffusion. The primary outcome was the modified Japanese Orthopaedic Association (mJOA) score measured at 2 years postoperatively. Extreme gradient boosting-supervised classification algorithms were used to classify patients into disease groups and to prognosticate surgical outcomes at 2-year follow-up.
    RESULTS: Forty-seven patients with CSM, including 24 (51%) with a mild mJOA score, 12 (26%) with a moderate mJOA score, and 11 (23%) with a severe mJOA score, as well as 21 control subjects were included. In the classification task, the traditional MRI metrics correctly assigned patients to healthy control versus mild CSM versus moderate/severe CSM cohorts, with an accuracy of 0.647 (95% CI 0.64-0.65). In comparison, the DTI model performed with an accuracy of 0.52 (95% CI 0.51-0.52) and the DBSI model\'s accuracy was 0.81 (95% CI 0.808-0.814). In the prognostication task, the traditional MRI metrics correctly predicted patients with CSM who improved at 2-year follow-up on the basis of change in mJOA, with an accuracy of 0.58 (95% CI 0.57-0.58). In comparison, the DTI model performed with an accuracy of 0.62 (95% CI 0.61-0.62) and the DBSI model had an accuracy of 0.72 (95% CI 0.718-0.73).
    CONCLUSIONS: Conventional MRI is a powerful tool to assess structural abnormality in CSM but is inherently limited in its ability to characterize spinal cord tissue injury. The results of this study demonstrate that advanced imaging techniques, namely DBSI-derived metrics from dMRI, provide granular assessments of spinal cord microstructure that can offer better diagnostic and prognostic utility.
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