体素内不相干运动弥散加权成像在受压腰骶神经根诊断中的应用

doi:10.3760/cma.j.issn.2095-7041.2019.06.004

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摘要目的探讨MR体素内不相干运动(IVIM)弥散加权成像(DWI)在受压腰骶神经根诊断中应用的可行性。方法前瞻性对照研究。纳入2017年4—10月30例腰椎间盘突出致神经根受压患者(观察组)的常规腰椎MR序列及3D-Fiesta序列、IVIM-DWI序列图像;另按性别、年龄匹配纳入30名健康志愿者作为对照组。在GE ADW 4.6工作站,使用MADC软件包测量对照组双侧L₄、L₅、S₁神经节的扩散系数(D)、灌注相关扩散系数(D*)、灌注分数(f)和表观扩散系数(ADC)值,以及观察组患者受压侧及其对侧神经根的D、D*、f、ADC值。比较对照组同节段左右两侧神经节和不同节段神经节各观察项目测量值,以及观察组受压侧神经根与对侧正常神经根各观察项目测量值。绘制受压神经根D值和ADC值的ROC曲线,评价诊断效果。结果对照组L₄、L₅、S₁神经根的D值分别为(0.603±0.064)×10^-3 mm²/s、(0.624±0.079)×10^-3 mm²/s、(0.628±0.088) ×10^-3 mm²/s, D*值分别为(3.815±0.541) ×10^-3 mm²/s、(3.862±0.414)×10^-3 mm²/s、(3.915±0.611) ×10^-3 mm²/s; f值分别为0.454%±0.076%、0.484%±0.101%、0.445%±0.094%; ADC值分别为(0.934±0.085)×10^-3 mm²/s、(0.945±0.051)×10^-3 mm²/s、(0.953±0.064)×10^-3 mm²/s。观察组神经根受压侧D、D*、f、ADC值分别为(0.669±0.081)×10^-3 mm²/s、(3.852±0.776)×10^-3 mm²/s、0.528%±0.115%、(1.096±0.087)×10^-3 mm²/s,健侧D、D*、f、ADC值分别为(0.617±0.080)×10^-3 mm²/s、(3.961±0.684)×10^-3 mm²/s、0.479%±0.083%、(0.938±0.074)×10^-3 mm²/s。对照组同节段左右两侧神经节和不同节段神经节所测D、D*、f、ADC值,差异均无统计学意义(P值均＞0.05)。观察组受压侧神经根与对侧正常神经根比较:D和ADC值均升高,差异均有统计学意义(P值均＜0.01);D*、f值差异均无统计学意义(P值均＞0.05)。绘制并分析ROC曲线,D值对诊断神经根受压具有较高效能,其次是ADC值,D值的AUC为0.923(95%CI 0.803~0.987),ADC值的 AUC为0.895(95%CI 0.865~0.999)。结论 IVIM模型的MR DWI技术可用于腰骶神经根检查,且与单指数模型的MR DWI相比能更详细、准确地反映神经根受压后的病理改变。

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	李强
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关键词 ：磁共振成像, 神经根病, 腰骶神经根, 体素内不相干运动, 弥散加权成像

Abstract：Objective To explore the feasibility of diffusion weighted imaging(DWI) based on intravoxel incoherent motion(IVIM) in the diagnosis of compressed lumbosacral nerve roots.Methods The prospective study was conducted. A total of 60 images were collected and analyzed in this study, 30 of which were from the observation group. Routine lumbar MR sequences, 3D-fiesta sequences and IVIM-DWI sequences of patients with lumbar disc herniation caused nerve root compression in Affiliated Hospital of Taishan Medical College from April 2017 to October 2017. Thirty healthy volunteers were selected as the control group, their ages and sexes matched with those of observation group. At GE ADW 4.6 workstation, MADC software package was used to measure the slow diffusion coefficient(D), fast diffusion coefficient(D*), apparent diffusion coefficient(ADC), fraction of fast ADC(f) values of bilateral L₄, L₅ and S₁ ganglia of control group, and the D, D*, f and ADC values of compressed side and opposite nerve roots of observation group were measured. The measured values of left and right ganglion and different ganglion of the same segment in control group were compared. The measured values of the compressed side nerve roots in the observation group were compared with the measured values of the normal nerve roots in the opposite side, to see whether the differences between the values were statistically significant.Results The D values of nerve roots of L₄, L₅ and S₁ in control group were (0.603±0.064)×10^-3 mm²/s, (0.624±0.079)×10^-3 mm²/s, (0.628±0.088) ×10^-3 mm²/s, respectively. The D* values were (3.815±0.541) ×10^-3, (3.862±0.414) ×10^-3, (3.915±0.611) ×10^-3, respectively, in mm²/s. The f values were 0.454%±0.076%, 0.484%±0.101% and 0.445%±0.094%, respectively. The ADC values were (0.934±0.085) ×10^-3, (0.945±0.051) ×10^-3, (0.953±0.064) ×10^-3, respectively, in mm²/s.The values of D, D*, f and ADC on the compression side of nerve root in observation group were (0.669±0.081) ×10^-3 mm²/s, (3.852±0.776)×10^-3 mm²/s, 0.528%±0.115%, (1.096±0.087) ×10^-3 mm²/s, and the values of D, D*, f and ADC on the healthy side were (0.617±0.080) ×10^-3 mm²/s, (3.961±0.684) ×10^-3 mm²/s, 0.479%±0.083%, (0.938±0.074)×10^-3 mm²/s, respectively. The values of D, D*, f and ADC measured by the left and right ganglion of the same segment and the ganglion of different segments were not statistically significant(all P values＞0.05). Compared with the normal nerve roots on the opposite side, the values of D and ADC were both increased, the difference was statistically significant(all P values＜0.01). D*, f the difference was not statistically significant(all P values＞0.05). ROC curve was drawn and analyzed, and D value was highly effective in diagnosing nerve root compression, followed by ADC value, The AUC of D value was 0.923(95%CI 0.803-0.987), and the AUC of ADC value was 0.895 (95%CI 0.865-0.999).Conclusions The diffusion-weighted imaging technique of IVIM model can be used for lumbosacral nerve root examination.Compared with the diffusion-weighted imaging technique of single exponential model, it can reflect the pathological changes after nerve root compression in more details and accurately.

Key words： Magnetic resonance imaging Radiculopathy Lumbosacral nerve root Intravoxel incoherent motion Diffusion weighted imaging

收稿日期: 2019-03-09

通讯作者: 赵红金,Email:278160739@qq.com

引用本文:

李强, 孙文文, 韩龙, 赵红金. 体素内不相干运动弥散加权成像在受压腰骶神经根诊断中的应用[J]. 中华解剖与临床杂志, 2019, 24(6): 537-542.
Li Qiang, Sun Wenwen, Han Long, Zhao Hongjin. Application of diffusion weighted imaging based on intravoxel incoherent motion model in diagnosis of compressed lumbosacral nerve roots. Chinese Journal of Anatomy and Clinics, 2019, 24(6): 537-542.

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http://www.cjac.com.cn/CN/10.3760/cma.j.issn.2095-7041.2019.06.004 或 http://www.cjac.com.cn/CN/Y2019/V24/I6/537

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