| Objective:To explore the clinical value of magnetic resonance diffusion tensor imaging in the early diagnosis and prognosis evaluation of traumatic cervical spinal cord injury.Methods:30 inpatients with acute SCI who came to our hospital for neck trauma were selected,including 18 males and 12 females.The age range was 17-65 and the average age was 40.1±11.7.The selected subjects were divided into positive group and negative group according to the regular T2WI and STIR sequences for high signal,and 16 cases were found to have a high signal positive group?A group?in the regular T2WI and STIR sequences in the acute phase of cervical cord injury.In the acute phase of spinal cord injury,there were 14 cases with no obvious abnormal signals on the conventional T2WI and STIR sequences in the negative group?group B?.Routine MR sequence and DTI examinations were performed at three time points in the acute phase?<72h?,subacute phase?72h-5W?,and chronic phase?5-12W?respectively in group A and B.including 16 cases at acute stage,15 at subacute stage and 15 at chronic stage were performed in group A;14 at acute stage and 14 at subacute stage and at chronic stage 11 cases were performed in group B.30 healthy volunteers were selected to the control group,including 16 males and 14 females,aged 20-60 years old with an average age of 38.3±11.5.Using a superconducting GE SignaHDxt 3.0T MR scanner,an 8-channel head-and-neck phased-array coil,applying a gradient field in 15 directions,with a diffusion sensitivity coefficient b of1000 s/mm2,followed by conventional MR and DTI sequence scans,after the DTI scan Send all the original DTI data to the workstation and use the DTI post-processing software to first correct the geometric distortion of the image and DTI misregistration caused by the slight movement of the examinee,set the FA value with a lower limit of 0.18,and obtain each layer separately.Corresponding FA maps and ADC maps and then reconstruct the DTT maps.Manually set the region of interest?ROI?to maintain the area of about 1015mm2.Select the middle of the spinal cord as far as possible to avoid the influence of volume and magnetic sensitivity and motion artifacts near the cerebrospinal fluid and bone.In the control group,11 equally spaced ROIs were selected on the C2-C7 plane.The FA and ADC values of each acquired slice were recorded,and the mean value of each plane was compared with the injury group;the ROI of the injured group A were performed on spinal cord with the T2WI and STIR sequences hyperintensity;ROI of group B were performed on the most severe level of vertebral and accessory fractures or paravertebral soft tissue injury,the FA value and ADC value of each ROI were recorded,and each value was measured 35 times and averaged.In the subacute and chronic phase of the patient's review,the measured levels were as consistent as possible with the first sequence level.All the values were measurement data.Normality tests were in accordance with the normal distribution and expressed as x±s.Two independent sample t-tests were performed using SPSS 17.0 statistical software to compare the FA values between the A and B groups and the control group.The ADC value,with a P<0.05 difference,is of universal significance.Image analysis and data measurement were performed completely independent between 3 high-grade attending physician of radiology department.Results:1.Control group:The measured FA value is the largest at the C2/3 level,the FA value is 0.69,the minimum is at the C5 level,the FA value is 0.63,and the measured ADC value is the largest at the C5 level,which is 1.12×10-3mm2/s.The C2/3 level was the smallest,which was 0.96×10-3mm2/s;however,the difference between the FA value and the ADC value at the C1-7 level was not statistically significant.2.The FA values in group A:The FA values in group A were 0.42±0.27 in acute stage,0.51±0.25 in subacute stage,and 0.57±0.18 in chronic stage;FA values in group B were 0.55±0.28 in acute stage and 0.56±0.26 in subacute stage.The chronic phase was 0.62±0.14.Comparison between groups:The FA values of group A and B were lower than those of the group C.At the mean time,the FA value of group A was always lower than that of group B,and the differences were statistically significant?P<0.001?.Intragroup comparison:The FA values of group A and B at different time points showed a gradually increasing trend,and the differences were statistically significant?P<0.001?.3.ADC values in group A:1.30±0.35×10-3mm2/s in acute phase,1.25±0.24×10-3mm2/s in subacute phase,and 1.11±0.18×10-3mm2/s in chronic phase;group B The ADC values were 1.18±0.37×10-3mm2/s in the acute phase,1.06±0.19×10-3mm2/s in the subacute phase,and 1.06±0.17×10-3mm2/s in the chronic phase.Comparison between groups:The ADC values of group A and group B were higher than those of the group C;at the same time point,the ADC value of injury group A was always higher than that of injury group B,and the difference was statistically significant?all P<0.001?.Intragroup comparisons:ADC values of groups A and B gradually decreased at different time points,and the difference was statistically significant?P<0.001 for both??Conclusion:1.DTI is used to detect SCI earlier than routine MR sequence to detect occult SCI;2.FA value and ADC value can quantitatively analyze the severity of white matter injury in patients with SCI and predict the recovery of cervical spinal cord function. |
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