Diagnostic value of diffusion tensor imaging parameters after ratio in cervical spondylotic myelopathy
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摘要:
目的 探究自身对比后磁共振弥散张量成像（DTI）参数对脊髓型颈椎病的诊断价值。 方法 选取2020年10月~2021年5月本院收治的56例脊髓型颈椎病患者作为病例组，同时选取62名健康志愿者作为健康组。对纳入的受试者均进行DTI成像，对不同节段颈髓参数均与颈2/3段取比值，对比健康组取比值前后各向异性分数（FA）和表观扩散系数（ADC）的差异性，探究取比值方式是否可以减小DTI成像参数的个体差异。将取比值后健康组与病例组的参数作对比，并结合常规磁共振测量脊髓纵横比，分析FA和ADC与脊髓纵横比的相关性，最后通过绘制受试者操作特征曲线，判断取比值后FA和ADC对脊髓型颈椎病的诊断效能并给出诊断临界值。 结果 健康组的FA与ADC值存在个体差异性，取比值后健康组FA与ADC的个体差异性消失（P > 0.05）。健康组和病例组对比，病例组的比值后FA降低而ADC增高，并且病例组比值后FA与脊髓纵横比成中度正相关（r= 0.617，P < 0.05），比值后ADC与脊髓纵横比呈低度负相关（r=-0.478，P < 0.05）。绘制受试者操作特征曲线显示，比值后FA对脊髓型颈椎病的诊断效能为0.821，临界值为0.917；ADC对脊髓型颈椎病的诊断效能为0.791，临界值为1.140，两者联合的诊断效能为0.896。 结论 对DTI参数取比值后可以减少个体差异的影响，在诊断脊髓型颈椎病方面更有临床实用意义；取比值后FA和ADC与脊髓压缩纵横比有一定的相关性。 Abstract:Objective To investigate the diagnostic value of diffusion tensor imaging (DTI) parameters after self- contrast in cervical spondylotic myelopathy. Methods Fifty-six patients with cervical spondylotic myelopathy admitted to our hospital from October 2020 to May 2021 were selected as the case group, while 62 healthy volunteers were selected as the healthy group. DTI imaging was performed in all included subjects, and the ratios of cervical spinal cord parameters to cervical 2/3 segments were taken to compare the differences in fractional anisotropy (FA) and apparent diffusion coefficient (ADC) before and after taking the ratios in healthy groups, and to explore whether taking the ratio method can reduce individual differences in DTI imaging parameters. The parameters of the healthy case group after taking the ratio were compared. The spinal cord aspect ratio was measured in combination with conventional magnetic resonance. The correlation between FA and ADC and spinal cord aspect ratio was analyzed. Finally, the diagnostic efficacy of FA and ADC for cervical spondylotic myelopathy after taking the ratio was judged and the diagnostic cut-off value was given by plotting the receiver operating characteristic curve. Results There were individual differences in FA and ADC values in the healthy group, and the individual differences in FA and ADC in the healthy group disappeared after taking the ratio (P > 0.05). Compared with the healthy group, FA decreased and ADC increased after the ratio in the case group, and there was a moderate positive correlation between FA and spinal cord aspect ratio after the ratio in the case group (r=0.617, P < 0.05), and a low negative correlation between ADC and spinal cord aspect ratio after the ratio (r=-0.478, P < 0.05). The diagnostic efficacy of FA for cervical spondylotic myelopathy was 0.821 and the cut-off value was 0.917 after the ratio. The diagnostic efficacy of ADC for cervical spondylotic myelopathy was 0.791 and the cut-off value was 1.140. The diagnostic efficacy of the combination of the two was 0.896. Conclusion The ratio of DTI parameters can reduce the influence of individual difference, and has more clinical practical significance in the diagnosis of cervical spondylotic myelopathy. The ratio of FA and ADC has certain correlation with the compression aspect ratio of spinal cord. -
Key words:
- cervical spondylotic myelopathy /
- MRI /
- diffusion tensor imaging
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图 2 脊髓纵横比的测量示意图（左），实测图（右）
Figure 2. Schematic diagram of measurement of spinal cord aspect ratio (left), measured diagram (right).
图 3 患者女，57岁，常规MRI显示C3/4, C4/5及C5/6椎间盘突出，以C5/6节段突出为重
A: 以矢状位3D扫描图像为背景的DTT成像效果图; B: 单独DTT成像效果图; C: 灰阶FA图像; D: 彩色FA图像; E: 灰阶ADC图像
Figure 3. A 57-year-old female patient, MRI showed C3/4, C4/5and C5/6 disc herniation, especially C5/6 segment herniation.
图 4 病例组取比值后FA（左）和ADC（右）与脊髓纵横比的散点图
Figure 4. Scatter plot of the aspect ratio of FA (left) and ADC (right) to spinal cord after taking the ratio in the case group.
图 5 取比值后FA、ADC诊断CSM的ROC曲线（左），FA、ADC联合诊断CSM的ROC曲线（右）
Figure 5. ROC curve of FA and ADC diagnosing CSM after taking the ratio, and ROC curve of FA and ADC jointly diagnosing CSM.
表 1 健康组各节段DTI参数的比较
Table 1. Comparison of DTI parameters of each segment in healthy group (Mean±SD)
节段 FA ADC C2/3 0.663±0.076 1.245±0.235 C3/4 0.669±0.078 1.211±0.228 C4/5 0.649±0.071 1.311±0.230 C5/6 0.639±0.085 1.291±0.272 C6/7 0.637±0.091 1.219±0.269 F 1.886 1.949 P 0.113 0.102 ADC: 表观扩散系数; FA: 各向异性分数. 
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表 2 健康组FA和ADC参数差异性分析
Table 2. Difference analysis of FA and ADC parameters in healthy group (Mean±SD)
组别 FA ADC I组（n=20） 0.581±0.058 1.052±0.164 II组（n=20） 0.653±0.062 1.230±0.194 III组（n=22） 0.713±0.062 1.464±0.186 F 124.716 136.269 P < 0.001 < 0.001
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表 3 取比值后健康组人群的DTI参数对比
Table 3. Comparison of DTI parameters of healthy group after taking the ratio (Mean±SD)
组别 比值后FA 比值后ADC I组（n=20） 0.982±0.130 1.063±0.218 II组（n=20） 0.978±0.132 1.002±0.226 III组（n=22） 0.994±0.097 0.016±0.145 F 0.408 2.062 P 0.665 0.129
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表 4 取比值后健康组和病例组DTI参数比较
Table 4. Comparison of DTI parameters between healthy group and case group after taking the ratio (Mean±SD)
组别 比值后FA 比值后ADC 对照组（n=62） 0.979±0.107 1.060±0.149 病例组（n=56） 0.845±0.104 1.245±0.181 Z -5.999 -5.443 P < 0.001 < 0.001
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