【摘要】 目的 探讨高分辨MRI结合扩散张量成像（diffusion tensor imaging, DTI）技术在肘管综合征尺神经微结构定量评估中的应用价值，分析DTI参数与临床严重程度及电生理指标的相关性。材料与方法 前瞻性纳入42例肘管综合征患者（McGowan Ⅰ级14例、Ⅱ级18例、Ⅲ级10例）和40例健康对照。采用3.0 T MRI行常规序列和DTI扫描，测量肘管入口、中段、出口三个位点的尺神经横截面积（cross-sectional area, CSA）、信号强度比、各向异性分数（fractional anisotropy, FA）、表观扩散系数（apparent diffusion coefficient, ADC）、径向扩散系数（radial diffusivity, RD）等参数。分析影像学参数与McGowan分级、电生理指标的相关性，评价诊断效能。结果 病例组肘管中段CSA[（19.85±5.32） vs.（8.24±1.86） mm²)]、RD值[（1.45±0.26）vs.（0.82±0.10）×10^-3 mm²/s]高于对照组，FA值[（0.42±0.09）vs.（0.61±0.04）]降低（均P<0.001）。FA值与运动神经传导速度呈正相关（r=0.682）,RD值呈负相关（r=-0.712）。随McGowan分级增加，FA值进行性降低[Ⅰ级（0.49±0.06）、Ⅱ级（0.41±0.05）、Ⅲ级（0.32±0.04）],RD值逐渐升高。RD值诊断效能最高[曲线下面积（area under the curve, AUC）=0.918，敏感度88.10%，特异度87.50%],FA+RD联合模型AUC达0.943。结论 DTI技术能够定量评估肘管综合征尺神经微结构改变，DTI参数与临床严重程度和电生理指标密切相关，FA值和RD值联合应用具有优异的诊断效能，为肘管综合征的早期诊断和病情评估提供了客观的影像学依据。更多还原

【Abstract】 Objective: To investigate the value of high-resolution MRI combined with diffusion tensor imaging（DTI） in the quantitative assessment of ulnar nerve microstructure in cubital tunnel syndrome（CTS） and to analyze the correlation between DTI parameters and clinical severity and electrophysiological parameters. Materials and Methods: Forty-two patients with CTS（14 McGowan grade Ⅰ, 18 grade Ⅱ, and 10 grade Ⅲ） and 40 healthy controls were prospectively enrolled. Conventional 3.0 T MRI and DTI were used to measure the ulnar nerve cross-sectional area（CSA）, signal intensity ratio, fractional anisotropy（FA）, apparent diffusion coefficient（ADC）, and radial diffusion coefficient（RD） at the entrance, midsection, and exit of the cubital tunnel. The correlation between imaging parameters and McGowan grade and electrophysiological parameters was analyzed, and the diagnostic performance was evaluated. Results: The case group had higher CSA [（19.85 ± 5.32） vs.（8.24 ± 1.86） mm²] and RD [（1.45 ± 0.26） vs.（0.82 ± 0.10） × 10^-3 mm²/s] in the mid-cubital tunnel than the control group, while the FA [（0.42 ± 0.09） vs.（0.61 ± 0.04）] was lower（all P < 0.001）. FA was positively correlated with motor nerve conduction velocity（r = 0.682）, while RD was negatively correlated（r =-0.712）. With increasing McGowan grade, FA progressively decreased [grade Ⅰ（0.49 ± 0.06）, grade Ⅱ（0.41 ± 0.05）, grade Ⅲ（0.32 ± 0.04）], while RD gradually increased. The RD value had the highest diagnostic efficacy [area under the curve（AUC） = 0.918, sensitivity 88.10%, specificity 87.50%], and the AUC of the FA+RD combined model reached 0.943. Conclusions: DTI technology can quantitatively assess the microstructural changes of the ulnar nerve in cubital tunnel syndrome. DTI parameters are closely correlated with clinical severity and electrophysiological indices. The combined application of FA and RD values has excellent diagnostic efficacy and provides an objective imaging basis for the early diagnosis and assessment of cubital tunnel syndrome.更多还原