| BackgroundLow back pain as a common chronic symptom has an increasingly impacton people’s daily lives. Some agencies found that more than80%of people in theirlifetime have experienced low back pain problems. With the development of modernmedicine, the causes and mechanisms of low back pain is deepening. Studies suggestthat many damages can cause low back pain, mostly due to a variety of oppression.Therefore, the exactly definition of the lumbosacral nerve lesions is very importantfor the diagnosis and treatmentIn the entire radiological technology, lumbosacral nerve imaging has beenplagued many images doctors. The main reason is the complex structure of thelumbosacral nerve and traveling changeable, anatomical differences caused bycongenital variation. All of these reasons make imaging difficulty and development oflumbosacral nerve imaging relatively backward. Defects and shortcomings oftraditional imaging techniques also restricted the diagnosis and he treatment oflumbosacral nerve lesions.Dffusion weighted whole body imaging with background body signalsuppression,(DWIBS) is a diffusion technology based on the EPI, STIR, SENSE threetechnologies.It can inhibit the signal of the small vessels and surrounding tissue inorder to highlight nerve signal. This sequence was invented by Japanese scanning formalignant tumors. In the early applications, noise ratio is very low, and the fatsuppression is very non-uniform. DWIBS was more used in multiple metastases ofmalignant tumors or assessment of lymphoma general condition. With theimprovement of MRI technology,3T high field MRI applications in clinical made aincreasingly development in nerve imaging. Many new parallel acquisition techniquesand coil were invented. Quality of DWIBS images has improved significantly.Peripheral nerve imaging is also achieved. Domestic scholars who discussed DWIBSmostly in applications of brachial plexus and lower extremity peripheral nerve, theyconfirmed the feasibility of the evaluation of peripheral neuropathy. In this study wefocus on normal lumbosacral plexus nerve imaging and diagnostic evaluation oflesions in DWIBS, assess value of the lumbosacral plexus imaging, and comparedwith existing magnetic resonance neuroimaging techniques to analyze differencesbetween different neuroimaging techniques to providing choice for clinical diagnosis.Analysis of neural multi-faceted by use of advanced post-processing software approach combining multiple imaging multiple sequence and by measuring the ADCvalue, initially evaluate qualitative and quantitative of this sequence in diagnosticlumbosacral plexus neuropathyPart I.3.0T MR DWIBS Image Features in the normal lumbosacral spinalnerveObjects1、 Assess the evaluation of imaging technology in normal lumbosacral plexus,compare DWIBS and PROSET,3D STIR imaging with the lumbosacral plexus.Discuss the feasibility of used in the lumbosacral plexus.2、 Measuring signal of ganglia、preganglionic root sheath and adjacent musclein DWIBS and PROSET sequence. Calculated contrast to noise ratio on each of thetwo imaging techniques Analysis DWIBS imaging characteristics.3、 Measurements of volunteers’ lumbosacral spinal nerve as followings: angleof nerve root sheath， cross section area of nerve root sheath and ganglion; length andwidth of nerve root sheath and ganglion，Materials and MethodsHealthy Volunteers:29healthy volunteers without lumbosacral disease and backleg pain symptoms.Equipment: Pilips Achieva3.0T TX dual source superconducting magneticresonance imaging system, the gradient field switching rate200mT/m·s, thegradient field strength80mT/m.DWIBS: undirected MPGs TR:9000ms, TE:69mm, THK3.5mm,FOV:300×300mm, Matrix:112×109, NEX:2, Bandwidth:36.8Hz.coronal PROSET: TR:8.6ms, TE:4.6ms, FOV:270×270mm, excitationangle8, motivate6, thickness0.7mm, matrix216×216.coronal3D STIR: TR:3000ms, TE:90ms, FOV:236×227mm motivate4times, thickness3mm, layer distance:1mm, scan matri216×216. Data Measurement and AnalysisAnalysis of L1-S1nerve root sheath, ganglion and proximal anterior branchdisplay rate. Grade the imaging of L2-L5level nerve root following the definition.Contrast the Nerve-muscle CNR and measurements angle of nerve root sheath，cross section area of nerve root sheath and ganglion; length and width of nerve rootsheath and ganglion.Using SPSS18.0software package for statistical analysis, P <0.05wasconsidered statistically significance.ResultDWIBS show a high rate in nerve root sheath and proximal anteriorbranch.DWIBS、PROSET and3D STIR have different in showing nerve.DWIBS display nerve much better than other two sequence.ConclusionDWIBS as conventional methods lumbosacral spinal nerve imaging, intuitivedisplay overall shape lumbosacral spinal nerves, and lay the foundation for the studyof neurological diseases clinically relevant changes. Part II. The clinical applications of3T DWIBS in lumbosacral spinalnerve correlated diseasesObjects1、 Explore characteristics of MR imagines in lumbosacral spinal nervecorrelated diseases.2、Compared display of lesions graded in DWIBS, PROSET,3D STIR sequenceto discussing the clinical value of three lumbosacral nerve imaging.3、the post-processing software will be used in fusion PROSET and DWIBSimage, analyze the feasibility of fusion image displayed on the lumbosacralneuropathy.4、measuring normal and compression lumbar ganglion with ADC in disease,analysis the evaluation of ADC in neuropathy feasibility study.Materials and MethodsCollected107cases of low back pain patients.61males and47females, aged13to74years, with a median age of52years old.73cases of disc herniation, neoplasticlesions in23cases (4cases of secondary tumors, neurogenic tumors8,8cases ofprimary bone tumors, nerve root sheath cyst three cases) two cases of scoliosis,5cases of tethered cord syndrome, lumbosacral plexus nerve injury in4cases,1case ofnon-specific inflammation.Equipment and Parameter：the same as part I.Data Measurement and AnalysisAnalysis of the case group spinal nerve morphology of the lesion image displaycase.Observe and analy the relationship of lesions and nerve in DWIBS, PROSET,3D STIR and grade. Using Friedman test in three sequence. Pairwise comparisonsusing Nemenyi test, when P <0.05, the difference was statistically significant.DWIBS with PROSET and CT fusion images were observed and analyzed forlumbosacral neuropathy performance.Measuring value of in normal ganglion and compression nerve node with discherniation and recorded. To investigate the correlation between ADC values and agein order to find whether exist the statistical significance. Analysis and comparison ofnormal and abnormal ADC value provide a method for assessing neuropathy inquantity. ResultIn107patients,14cases with0,1stage type disc herniation patients displaypoorly. On the two disc showed nerve compression rate of9/21, for23cases tumorlesions,7cases of dysplastic lesions and four exceptions injuries change the displayrate of23/23,7/7,4/4.DWIBS can clearly show the characteristics and extent of nervedamage caused by various types of lesions, and do precise positioningthe fused image can be fully reflected two image features in one image and makeup for deficienciesADC and age correlation coefficient of0.069. p：0.635, there is no statisticallysignificant correlation.ROC curve analysis was done, suggesting ADC values greater than1.3801×10-9(mm2/s) can be considered as the optimal predictive value for the diagnosis ofneuropathy.ConclusionDWIBS can display lumbosacral plexus lesions than other sequence, lesions canbe displayed visually as a whole, to help define the extent of disease and conductingclinical degree of injury analysis. Image fusion technology is a new post-processingbase, it can make up for the disadvantage of the two imaging sequences, but the needstudy deeply in further research. ADC value as a quantitative index neuropathy playan important role in the diagnosis of the disease in the future. |
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