复发缓解型多发性硬化丘脑损伤的多模态定量MRI检测

发布时间：2018-03-23 18:55

本文选题：多发性硬化　切入点：丘脑　出处：《贵州医科大学》2017年硕士论文

【摘要】：目的:利用DTI、MRS、3D-T1WI技术评价复发缓解型多发性硬化丘脑微观结构及体积变化,并探讨DTI参数、MRS参数及体积与临床神经功能障碍之间的相关性。方法:依据McDonald2010诊断标准纳入本院2015年1月-2016年5月临床确诊复发缓解型多发性硬化(relapsing remitting multiple sclerosis,RRMS)患者33例组成RRMS组,对照组为健康志愿者33例,其性别、年龄与RRMS组相匹配。在RRMS患者进行MRI扫描前,由两名神经内科医生对其进行扩展残疾量表(expanded disability status scale,EDSS)评分。患者组及对照组均使用PHILIPS Achieva 3.0T X-Series超导型磁共振成像系统扫描获取DTI数据、左侧丘脑单体素MRS数据、右侧丘脑单体素MRS数据、3D-T1WI数据。将DTI数据经过dcm2niigui软件转换,使用PANDA软件处理DTI图像,包括涡流及头动校正等步骤,利用最小二乘法拟合张量模型对所处理的数据进行计算,从而获得FA、MD、AD、RD值,以双侧丘脑为模板提取FA、MD、AD、RD值,使用独立样本t检验分析RRMS患者左侧丘脑及右侧丘脑的DTI参数与对照组的差异,将RRMS患者双侧丘脑DTI参数与EDSS评分进行Person相关分析。使用LC-model软件对左侧丘脑及右侧丘脑单体素MRS数据进行分析得出NAA、Ins、Glu定量浓度值,使用独立样本t检验分析RRMS患者左侧丘脑及右侧丘脑NAA、Ins、Glu定量浓度值与对照组的差异,将RRMS患者左侧丘脑及右侧丘脑NAA、Ins、Glu浓度与EDSS评分进行Person相关分析。对3D-T1WI全脑结构图像进行预处理(包括标准化、分割、平滑等),所得图像的数据利用SPM自带的统计软件包进行统计分析,使用双侧丘脑模板再次提取得出丘脑体积,计算出左、右丘脑体积与脑实质体积的比值Vl、Vr,使用独立t检验分析RRMS患者Vl、Vr与对照组的差异,将RRMS患者Vl、Vr与EDSS评分进行Person相关分析。结果:1、与对照组比较,RRMS患者左侧丘脑及右侧丘脑的FA值均降低(p0.05),RRMS患者左侧丘脑及右侧丘脑MD、AD、RD值升高(p0.05);RRMS患者左侧丘脑及右侧丘脑FA、MD、AD、RD值与EDSS评分之间均无相关性(p0.05)。2、与对照组比较,RRMS患者左侧丘脑及右侧丘脑的NAA定量浓度值降低(p0.05),RRMS患者左侧丘脑Ins定量浓度值升高(p0.05),RRMS患者右侧丘脑Ins定量浓度值差异无统计学意义(p0.05),RRMS患者左侧丘脑及右侧丘脑Glu定量浓度值差异无统计学意义(p0.05);RRMS患者左侧丘脑及右侧丘脑NAA定量浓度值与EDSS评分呈负相关(左侧丘脑r=-0.669,p0.05;右侧丘脑r=-708,p0.05),RRMS患者左侧丘脑Ins定量浓度值与EDSS评分之间呈负相关(r=-0.708,p0.05),RRMS患者右侧丘脑Ins、双侧丘脑Glu定量浓度值与EDSS评分无相关性(p0.05)。3、与对照组比较,RRMS患者左侧丘脑体积、右侧丘脑体积差异无统计学意义(p0.05),RRMS患者左侧丘脑及右侧丘脑体积与EDSS评分无相关性(p0.05)结论:1、RRMS患者丘脑存在微观结构的改变。2、RRMS患者丘脑NAA浓度值的降低和Ins浓度值的升高可能是监测RRMS患者神经功能状况的指标。3、RRMS患者丘脑体积不能作为监测RRMS患者神经功能状况的指标。
[Abstract]:Objective: using DTI, MRS, 3D-T1WI evaluation of relapsing remitting multiple sclerosis thalamic microstructure and volume changes, and to explore the correlation between DTI parameters, MRS parameters and volume and neurological dysfunction. Methods: according to the diagnostic criteria of McDonald2010 in our hospital in January 2015 -2016 year in May the clinical diagnosis of relapsing remitting multiple sclerosis (relapsing remitting multiple sclerosis, RRMS) in 33 cases of group RRMS, control group of 33 healthy volunteers, their gender, age matched with RRMS group. MRI scan was performed in two RRMS patients before, by God by physicians to be expanded disability scale (expanded disability status scale, EDSS) score group. And the control group of patients using the PHILIPS Achieva 3.0T X-Series superconducting magnetic resonance imaging scanning system to obtain DTI data, the left thalamus single voxel MRS data, right thalamus, single voxel MRS data, 3 D-T1WI data. DTI data by dcm2niigui software, using PANDA software DTI image processing, including eddy current and head correction steps of the data was calculated by using the least squares fitting tensor model, obtained FA, MD, AD, RD value in bilateral thalamus as template extracted from FA, MD, AD. The value of RD, using independent samples t test analysis of RRMS patients with left thalamus and right thalamus DTI parameters and control group differences, RRMS patients with bilateral thalamus DTI parameters and EDSS score Person correlation analysis was conducted using LC-model software. On the left thalamus and right thalamus, single voxel MRS data analysis of NAA, Ins, Glu quantitative the concentration value, using independent samples t test analysis of RRMS patients with left thalamus and right thalamus, NAA, Ins, Glu concentration and quantitative differences in the control group, RRMS patients left thalamus and right thalamus, NAA, Ins, Glu concentration and EDSS score for P Erson analysis of whole brain structural images of 3D-T1WI pretreatment (including standardization, segmentation, smoothing, etc.) the image data were analyzed using statistical software SPM with the use of template to extract the bilateral thalamus thalamus, calculate the ratio of Vl, left, right thalamus and brain volume Vr, the independent t test was used to analysis the differences of Vr and RRMS in patients with Vl, control group, RRMS were Vl, Vr and EDSS were tested with Person correlation analysis. Results: 1, compared with the control group, RRMS patients with left thalamus and right thalamus FA values were lower in patients with RRMS (P0.05), left thalamus and right thalamus MD, AD, RD increased (P0.05); RRMS patients with left thalamus and right thalamus, FA, MD, AD, between RD and EDSS score showed no correlation (.2, P0.05) compared with the control group, NAA quantitative RRMS concentration in patients with left thalamus and right thalamus decreased (P0.05), with RRMS Who left thalamus Ins quantitative concentration increased (P0.05), RRMS patients with right thalamic Ins quantitative concentration values showed no significant difference (P0.05), RRMS patients with left thalamus and right thalamus Glu quantitative concentration showed no significant difference (P0.05); RRMS patients with left thalamus and right thalamus NAA quantitative concentration was negatively correlated with EDSS score (r=-0.669 P0.05; the left thalamus, right thalamus, r=-708, P0.05), there was a negative correlation between RRMS patients with left thalamus Ins quantitative concentration and EDSS score (r=-0.708, P0.05), RRMS patients with right thalamic Ins, bilateral thalamus Glu quantitative concentration had no correlation with EDSS score (.3, P0.05) compared with the control group, patients with RRMS the left thalamus, there was no significant difference of the volume of the right thalamus (P0.05), there was no correlation between RRMS patients with left thalamus and right thalamus and EDSS score (P0.05) conclusion: 1 RRMS patients with thalamic exist microstructure changes in.2, RR The decrease of NAA concentration and the increase of Ins concentration in MS patients may be an index to monitor the neurological function of RRMS patients..3 can not be used as an index for monitoring the neurological function of RRMS patients.

【学位授予单位】：贵州医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R744.51;R445.2

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