摘要
目的将MRI T2WI信号量化分类，同时探讨其与术前临床表现、预后三者之间的关系。方法2005年4月至2007年7月共计73例患者，均行前路、后路或后前路联合手术。术前所有患者均行高分辨率1．5T MRI成像。于矢状面T2WI脊髓受压信号增高最明显部位计算机测量信号强度值，取兴趣区面积为0．05cm^2，再于颈7胸1椎体水平脊髓信号正常部位测量信号强度值，取兴趣区面积为0．3cm^2，计算得出两者比值（0．05cm^2面积信号强度值／0．3cm^2面积信号强度值）。如T2WI脊髓信号无明显改变，则取脊髓受压最严重部位0．05cm^2为兴趣区测量信号强度值。比值数据经对数转换、系统聚类后分为3组。结合临床表现分析相互之间的关系。结果各组间改善率、年龄、术前JOA评分经方差分析F值、P值分别为F=22．009、P〈0．001，F=6．371、P=0．003，F=5．561、P=0．006。此3项指标各组之间差异有统计学意义。各组间Babinski征及性别经卡方检验，值及P值分别为r=15．719、P〈0．001，r=1．898、P=0．387，Babinski征各组之间差异有统计学意义，性别差异在组间无统计学意义。各组间信号比值对数、术后JOA评分及病程经秩和检验3项指标各组之间差异均有统计学意义,x^2值及P值分别为x^2=62．616、P〈0．001,x^2=25．946、P〈0．001，x^2=13．952、P=0．001。结论低信号比值组即无明显T2WI高信号和轻度存在T2WI高信号患者，往往年龄相对较小，病程相对较短，减压术后效果较好。反之如果T2WI高信号逐步增高且伴随锥体束征出现，则提示预后较前者欠佳。
Objective To investigate whether the signal intensity ratio in magnetic resonance imaging （MRI） and clinical manifestations can reflect prognosis in patients with cervical compressive myelopathy. Methods Seventy-three patients with cervical compressive myelopathy treated with anterior, posterior, or posterior-anterior united decompression underwent 1.5-T MRI before surgery. T2-weighted images （T2WI） of the sagittal signal intensity on the cervical severe compression cord were obtained, and the regions of interest （ROIs） were taken by 0. 05 cm^2. T2-weighted MR images of sagittal normal cord signal on the cervical between C7-T1 disc levels were obtained, and the ROIs were taken by 0. 3 cm^2. Signal value is measured by computer and the signal ratio between the regions of the 0. 05 cm^2 and 0. 3 cm^2 was calculated. If no intramedullary high signal intensity was noted on T2-weighted MR images, the ROIs were taken by 0. 05 cm^2 of the severe compression cord. The 73 patients were divided into 3 groups ： low, medium, and high signal ratio groups （ Group 1,2, and 3, n = 18, 32, and 23 respectively）. Results The recovery rate and JOA score of Group 1 were significantly higher, the age and Babinski sign positive rate were significantly lower, and disease duration was shorter in Group 1 than in Groups 2 and 3 （ F = 22. 009, P 〈 0. 001,F = 5. 561,P =0. 006,F =6. 371,P =0. 003,x^2 = 15. 719,P 〈0. 001,and x^2 = 13. 952,P=0.001）. There was no significant differences in sex among these 3 groups （x^2 = 1. 898,P = 0. 387）. Conclusion The patients with light or without intramedullary signal change on T2WI experience a good surgical outcome. However, the patients with increase of signal intensity ratio and the occurrence of pyramidal sign show a poor prognosis after surgery.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2008年第43期3072-3076,共5页
National Medical Journal of China
关键词
颈椎病
脊髓
磁共振成像
Cervical spondylosis
Spinal cord
Magnetic resonance imaging
