脊髓圆锥弥散张量成像扫描在下尿路功能障碍中的应用

doi:10.3969/j.issn.1006-9771.2024.03.011

《中国康复理论与实践》 ›› 2024, Vol. 30 ›› Issue (3): 333-338.doi: 10.3969/j.issn.1006-9771.2024.03.011

脊髓圆锥弥散张量成像扫描在下尿路功能障碍中的应用

孙浩瑜¹^,²^,³^,⁴, 高轶¹^,², 吴娟¹^,²(), 廖利民¹^,²^,³^,⁴(), 靖华芳¹^,², 张思雨¹^,², 李东¹^,², 韩春生¹^,²

1.首都医科大学康复医学院，北京市 100068
2.中国康复研究中心北京博爱医院，北京市 100068
3.中国康复科学所，北京市 100068
4.北京市神经损伤与康复重点实验室，北京市 100068

收稿日期:2023-09-11 修回日期:2024-01-10 出版日期:2024-03-25 发布日期:2024-04-01
通讯作者: 吴娟，E-mail： juanwu7070@126.com；廖利民，E-mail： lmliao@263.net
作者简介:孙浩瑜(1996-)，男，汉族，山东临沂市人，博士研究生，主要研究方向：神经泌尿与尿动力学；
高轶(1982-)，女，汉族，湖北十堰市人，博士，主要研究方向：神经泌尿与尿动力学；
吴娟(1969-)，女，汉族，云南昆明市人，硕士，副主任医师，主要研究方向：神经泌尿与尿动力学，泌尿与盆底康复。
廖利民(1964-)，男，汉族，四川高县人，博士，教授、主任医师，博士研究生导师，主要研究方向：神经泌尿与尿动力学。
第一联系人：
孙浩瑜和高轶对本论文的贡献相同。
基金资助:
1.北京市自然科学基金项目重点项目(7202236);2.中国康复研究中心科研基金项目(2020-12);3.中央级公益性科研院所基本科研业务费专项资金项目(2023CZ-1)

Application of diffusion tensor imaging scanning of conus medullaris in lower urinary tract dysfunction

SUN Haoyu¹^,²^,³^,⁴, GAO Yi¹^,², WU Juan¹^,²(), LIAO Limin¹^,²^,³^,⁴(), JING Huafang¹^,², ZHANG Siyu¹^,², LI Dong¹^,², HAN Chunsheng¹^,²

1. Capital Medical University School of Rehabilitation Medicine, Beijing 100068, China
2. Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing 100068, China
3. China Rehabilitation Science Institute, Beijing 100068, China
4. Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing 100068, China

Received:2023-09-11 Revised:2024-01-10 Published:2024-03-25 Online:2024-04-01
Contact: WU Juan, E-mail: juanwu7070@126.com;LIAO Limin, E-mail: lmliao@263.net
Supported by:
Key Project of Beijing Natural Science Foundation(7202236);Research Fund Project of China Rehabilitation Research Center(2020-12);Fundamental Research Funds for Central Public Welfare Research Institutes(2023CZ-1)

摘要/Abstract

摘要：

目的利用MRI弥散张量成像(DTI)技术寻找膀胱过度活动症(OAB)和膀胱活动低下(UAB)患者脊髓圆锥信号的异常。

方法 2021年5月至2023年4月，从北京博爱医院招募下尿路功能障碍患者23例(病例组)。所有患者行盆底电生理检查和影像尿动力检查，根据患者尿动力灌注期膀胱收缩情况，将病例组分为UAB组和OAB组。同时招募健康受试者8例(对照组)。所有受试者行T₁₀~L₅脊髓MRI平扫+DTI序列扫描。通过DTI序列对比MRI平扫节段确定脊髓圆锥位置，提取圆锥中段的各向异性分数(FA)、表观弥散系数(ADC)和相对各项异性(RA)。

结果 UAB组12例，OAB组11例。病例组盆底电生理检查均存在异常。盆底电生理检查结果显示，UAB组与OAB组间骶反射弧神经传导有显著性差异(P = 0.036)。DTI扫描结果显示，与对照组比较，病例组ADC升高(t = 2.185, P = 0.037)；UAB组FA降低(t = 3.439, P = 0.005)，ADC显著升高(t = 4.582, P < 0.001)。

结论对于下尿路功能障碍患者，DTI有助于寻找脊髓是否存在潜在的病变。FA和ADC是很有价值的脊髓圆锥损伤的诊断指标。

关键词: 膀胱过度活动症, 膀胱活动低下, 脊髓圆锥, 弥散张量成像

Abstract:

Objective To investigate the signal abnormality of conus medullaris in patients with overactive bladder (OAB) and underactive bladder (UAB) by MRI diffusion tensor imaging (DTI).

Methods From May, 2021 to April, 2023, 23 patients with lower urinary tract dysfunction without trauma and supraspinal lesions were enrolled (case group). All patients underwent imaging urodynamics and pelvic floor electromyography. Based on the bladder contraction during the filling phase of urodynamics, the patients were divided into UAB group and OAB group. Eight healthy subjects were included as the control group. All participants underwent T₁₀ to L₅ spinal segment MRI scans and DTI scans. The position of conus medullaris was determined by comparing the DTI sequences with the MRI scans. The fractional anisotropy (FA), apparent diffusion coefficient (ADC), and relative anisotropy (RA) of the conus medullaris intermediate segment were compared.

Results Twelve cases were in UAB group, and eleven in OAB goup. Abnormalities were found in the pelvic floor electromyography in the case group. There was significant difference in sacral reflex arc nerve conduction testing between UAB and OAB groups (P = 0.036). Compared with the control group, ADC increased (t = 2.185, P = 0.037) in the case group; FA decreased (t = 3.439, P = 0.005) and ADC increased (t = 4.582, P < 0.001) in UAB group.

Conclusion DTI is helpful to find the potential lesion of spinal cord in patients with lower urinary tract dysfunction. FA and ADC are valuable indicators for the diagnosis of conus medullaris injury.

Key words: overactive bladder, underactive bladder, conus medullaris, diffusion tensor imaging

中图分类号:

R695

孙浩瑜, 高轶, 吴娟, 廖利民, 靖华芳, 张思雨, 李东, 韩春生. 脊髓圆锥弥散张量成像扫描在下尿路功能障碍中的应用[J]. 《中国康复理论与实践》, 2024, 30(3): 333-338.

SUN Haoyu, GAO Yi, WU Juan, LIAO Limin, JING Huafang, ZHANG Siyu, LI Dong, HAN Chunsheng. Application of diffusion tensor imaging scanning of conus medullaris in lower urinary tract dysfunction[J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(3): 333-338.

图/表 3

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参考文献 42

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项目	UAB组(n = 12)		OAB组(n = 11)		P值^a
项目	正常	异常	正常	异常	P值^a
皮质运动传导	4	8	5	6	0.680
阴部神经皮质感觉诱发电位	3	9	4	7	0.667
骶反射弧神经传导	2	10	7	4	0.036
阴部神经运动传导	3	9	2	9	1.000
鞍区皮肤交感反应	8	4	6	5	0.680
肛门括约肌自主收缩	6	6	4	7	0.680

项目	FA	ADC	RA
对照组	0.446±0.699	2.564±0.303	0.363±0.114
病例组	0.397±0.129	3.317±0.949	0.355±0.114
OAB组	0.447±0.147	2.743±0.823	0.370±0.138
UAB组	0.350±0.094	3.843±0.744	0.342±0.091
t值^a	1.081	2.185	0.324
P值^a	0.084	0.037	0.749
t值^b	0.008	0.567	0.128
P值^b	0.994	0.584	0.900
t值^c	3.439	4.582	0.652
P值^c	0.005	< 0.001	0.523

脊髓圆锥弥散张量成像扫描在下尿路功能障碍中的应用

Application of diffusion tensor imaging scanning of conus medullaris in lower urinary tract dysfunction

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