磁共振弥散张量成像在新生儿缺氧缺血性脑病中的研究

发布时间：2018-03-15 00:01

本文选题：足月新生儿　切入点：缺氧缺血性脑病　出处：《兰州大学》2012年硕士论文　论文类型：学位论文

【摘要】：目的探讨磁共振弥散张量成像(DTI)在足月新生儿缺氧缺血性脑早期诊断和随访中的价值,基于其定量指标ADC值、FA值可敏感探测水分子跨膜运动引起的弥散量和(或)方向异常以及各向异性弥散对脑的微结构信息反映,重点研究两方面：1.探讨ADC值、FA值在评价足月新生儿缺氧缺血性脑病(HIE)早期脑损伤中的价值；2.分析FA值在HIE患儿脑白质中的变化趋势,揭示HIE脑损伤对髓鞘发育的影响。方法1.将26例足月HIE新生儿分为轻、中、重度3组进行常规MRI和DTI扫描,分别测定双侧额叶深部白质、放射冠、内囊后肢、丘脑腹外侧、豆状核及尾状核头部的ADC值和FA值,并和对照组进行比较,分析HIE患儿脑不同部位ADC值和FA值的变化规律以及跟新生儿神经行为学测定(NBNA)评分的相关性。2.对26例HIE患儿中15例跟踪随访,根据初次扫描时临床分度划分为轻、中重度2组,分别测定双侧额叶深部白质、放射冠和内囊后肢的FA值,对HIE早期和后期同一部位的FA值进行对照研究,并进行两两组间比较,分析FA值在HIE脑损伤后髓鞘化过程中的变化规律。结果1.ADC值、FA值在额叶深部白质、放射冠、内囊后肢、丘脑腹外侧的组间具有统计学意义,ADC值、FA值随病情加重而减低；豆状核和尾状核头部的FA值组间差异无统计学意义；内囊后肢的ADC值、FA值与NBNA评分的一致性最高。2.FA值在额叶深部白质、放射冠、内囊后肢从早期到后期均增加,但随病情程度不同增加的幅度不同；轻度组额叶深部白质、放射冠和内囊后肢的FA值者大于中重度组。结论1.与常规MRI比较,DTI技术可以早期、客观、定量的评价HIE脑损伤的程度和范围,尤其是脑白质损伤的评定中具有一定的应用价值；2.磁共振弥散张量成像的FA值,在HIE复查中可定量反映新生儿期不同轻重程度HIE患儿脑损伤对脑白质髓鞘发育的影响程度,提出可以作为预后评估的指标。
[Abstract]:Objective to evaluate the value of diffusion Zhang Liang DTI in early diagnosis and follow-up of hypoxic-ischemic brain in term neonates. Based on the ADC value and FA value of the quantitative index, the dispersion and / or direction anomalies caused by the transmembrane movement of water molecules can be detected sensitively, and the information of anisotropic diffusion on the microstructures of the brain can be reflected. To discuss the value of ADC value in evaluating the early brain injury of term neonates with hypoxic-ischemic encephalopathy (HIE) 2.To analyze the change trend of FA value in white matter of children with HIE, and to reveal the effect of HIE brain injury on myelin development. Methods 1. 26 cases of term HIE neonates were divided into 3 groups: mild, moderate and severe. The ADC and FA values of bilateral deep white matter of frontal lobe, corona radiata, posterior limb of internal capsule, ventrolateral thalamus, lentiform nucleus and head of caudate nucleus were measured. Compared with the control group, the changes of ADC value and FA value in different parts of brain of HIE children were analyzed, and the correlation between ADC value and neonatal neurobehavioral score was analyzed. 2. 15 cases of 26 cases of HIE were followed up. The FA values of the deep white matter of bilateral frontal lobe, the corona radiata and the hindlimb of the internal capsule were measured according to the clinical grading of the first scan. The FA values of the same site in the early and late stage of HIE were compared. The changes of FA value in the process of myelination after HIE brain injury were analyzed. Results 1. The ADC value of FA in the deep white matter of frontal lobe, corona radiata, posterior limb of internal capsule and ventrolateral thalamus was significantly lower than that in the other two groups, but there was no significant difference in FA between the lentiform nucleus and the head of caudate nucleus. The ADC value of internal capsule hind limb and NBNA score were the highest. 2. FA value increased from early to late stage in deep white matter of frontal lobe, corona radiata and hind limb of internal capsule, but the amplitude of increase was different with the degree of disease, the white matter in deep frontal lobe was increased in mild group. The FA values of the radiosurgery and internal capsule hind limbs were higher than those of the moderate and severe groups. Conclusion 1.Compared with conventional MRI, it can be used to evaluate the extent and extent of brain injury in HIE early, objectively and quantitatively, especially in the evaluation of brain white matter injury. 2.The FA value of diffusion-weighted Zhang Liang imaging. The influence of brain injury on myelin development of white matter in neonates with HIE of different severity in neonatal stage can be quantitatively reflected in HIE reexamination, and it can be used as a prognostic index.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R445.2;R722.1

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