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目的探讨扩散张量成像(DTI)技术联合扩散张量纤维示踪(DTT)技术在外伤致胫神经损伤中的价值。方法回顾性分析15例经手术证实不同程度胫神经损伤患者(损伤组)及15名健康志愿者(对照组)的膝关节DTI资料,定量分析两组膝关节胫神经各向异性(FA)值及表观扩散系数(ADC)值。采用独立样本t检验分析两组间FA值、ADC值差异;进一步分析FA值及ADC值的受试者工作特征(ROC)曲线,评价其对胫神经损伤诊断的准确性,并采用DTT对胫神经进行纤维示踪,评估神经纤维走向、形态。结果损伤组FA值为0.51±0.05,对照组FA值为0.58±0.05,两组差别具有统计学意义(t=-4.509,P<0.05);损伤组ADC值为(1.43±0.07)×10~(-3)mm~2/s,对照组ADC值为(1.35±0.10)×10~(-3)mm~2/s,两组差别具有统计学意义(t=2.725,P<0.05);FA值的ROC曲线下面积(AUC)为0.884,ADC值的ROC曲线AUC为0.724。结论 DTI技术可以定量分析胫神经损伤的损伤程度,并且在对中等以及重度神经损伤的诊断上FA值较ADC值具有较高诊断效能,但其不能从形态学上对胫神经予以显示。DTT技术则可清晰显示胫神经损伤后不同损伤程度的神经纤维形态变化。两者联合可大大提高对胫神经损伤诊断的正确率,并且能够对胫神经损伤后修复等进行随访和评估。
Objective To investigate the value of diffusion tensor imaging (DTI) combined with diffusion tensor fiber tracing (DTT) in traumatic tibial nerve injury. Methods The knee joint DTI data of 15 cases of tibial nerve injury (injury group) and 15 healthy volunteers (control group) confirmed by operation were retrospectively analyzed. The anisotropy of the tibial nerve of the two groups was quantitatively analyzed And apparent diffusion coefficient (ADC) values. The independent sample t-test was used to analyze the differences of FA and ADC between the two groups. The ROC curves of FA and ADC values were further analyzed to evaluate the diagnostic accuracy of tibial nerve injury. Nerve fibers were traced to assess the nerve fiber orientation, morphology. Results The FA value in the injury group was 0.51 ± 0.05, the FA value in the control group was 0.58 ± 0.05, the difference between the two groups was statistically significant (t = -4.509, P <0.05); the ADC value in the injury group was (1.43 ± 0.07) × 10 ~ The ADC value of control group was (1.35 ± 0.10) × 10 ~ (-3) mm ~ 2 / s, the difference was statistically significant (t = 2.725, P <0.05). The area under the ROC curve (AUC) of the FA value was 0.884, and the AUC of the ADC value of the ROC curve was 0.724. Conclusion The DTI technique can quantitatively analyze the damage degree of the tibial nerve injury. And the diagnostic value of FA in diagnosis of moderate and severe nerve injury is higher than that of ADC value, but it can not be morphologically displayed on the tibial nerve. DTT technology can clearly show the tibial nerve injury after different degrees of nerve fiber morphological changes. The combination of the two can greatly improve the diagnostic accuracy of the tibial nerve injury, and can be followed up and evaluation of tibial nerve injury repair and so on.