目的：应用磁共振弥散张量成像（DTI）观察脊髓型颈椎病（CSM）患者皮质脊髓束（CST）逆行性Wallerian变性的特征，并分析其损伤程度与肢体运动功能障碍的关系。资料与方法：对28例CSM患者及28例性别和年龄相匹配的健康志愿者行常规MRI及DTI检查，分别测量位于双侧脑桥、大脑脚、内囊后肢、侧脑室体旁白质、半卵圆中心及中央前回皮层下白质的ROI的各向异性分数（FA）值和表观扩散系数（ADC）值。所有被试者均采用JOA运动评分法进行临床运动功能评分。研究各ROI的FA值及ADC值的变化，并分析其与临床运动功能评分的相关性。结果：CSM组各ROI左右两侧对称部位的FA、ADC值差异均无统计学意义（P>0.05）。与健康对照组相比，CSM患者的各平面的FA值均减低（P<0.05），半卵圆中心、内囊后肢及脑桥的ADC值升高（P<0.05）。CSM组的JOA评分较对照组减低（P<0.05），且与内囊后肢、大脑脚、脑桥处的FA值以及内囊后肢的ADC值相关。结论：DTI可以检测出CSM患者CST的继发性逆行性Wallerian变性，而且这种逆行性的神经纤维继发性变性可能与患者的运动功能受损有关。
Abstract
Objective: To observe the characteristics of retrograde Wallerian degeneration of corticospinal tract(CST) in patients with cervical spondylotic myelopathy by diffusion tensor imaging(DTI), and to analyze the relationship between the degree of damage of corticospinal tract and limb motor dysfunction. Materials and Methods: A total of 28 CSM patients and 28 sex-, age- and education-matched healthy controls underwent conventional MRI and DTI examinations. The fractional anisotropy(FA) values and apparent diffusion coefficient(ADC) values of ROI in the bilateral pons, cerebral peduncle, posterior limb of internal capsule, periventricular, centrum semiovale, and subcortical white matter were measured. All subjects were scored for clinical motor function. To analyze the changes of FA and ADC values in each ROI area, and to explore the correlation between these changes and clinical scores. Results: There was no significant difference in FA values and ADC values between the left and right ROI of the CSM group(P>0.05). Compared with the healthy control group, the FA values of the various levels of CSM were reduced(P<0.05), and the ADC values of the centrum semioval, the posterior limb of the internal capsule and the pons were increased(P<0.05). The JOA score of the CSM group was lower than that of the control group(P<0.05), and correlated with the FA values of the pons, cerebral peduncle, posterior limb of internal capsule, and the ADC value of the posterior limb of internal capsule. Conclusion: DTI can detect secondary retrograde Wallerian degeneration of CST in patients with CSM, and this retrograde secondary degeneration of CST is associated with the impairment of motor function.
关键词
颈椎病 /
椎体束 /
磁共振成像
Key words
Cervical spondylosis /
Pyramidal tracts /
Magnetic resonance imaging
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基金
国家自然科学基金地区科学基金项目（编号81460329）；江西省研究生创新专项基金资助项目（编号YC2018-S109）；江西省自然科学基金项目（编号20192ACBL20039、20181BAB205063）。
