新生儿脑发育和脑损伤的磁共振功能成像的应用研究

发布时间：2018-04-20 08:00

本文选题：新生儿 + 弥散张量成像　；参考：《南京医科大学》2016年博士论文

【摘要】：第一部分磁共振弥散张量成像在新生儿脑髓鞘发育的初步研究目的:应用磁共振弥散张量成像(diffusion tensor imaging,DTI)定量测定分数各向异性(fractional anisotropy,FA)值,各向异性值可反映脑白质微结构,对照研究足月儿和早产儿在脑内不同部位白质FA值的差异,探讨DTI在脑白质髓鞘发育中的应用价值。材料和方法:将100例围产史正常,无器质性神经系统疾病的足月儿和早产儿分为两组:足月儿39例,胎龄37周～42周,早产儿61例,均纠正胎龄到40周。入组新生儿均行常规MRI和DTI扫描,测量双侧内囊前后肢、胼胝体膝部和压部、侧脑室前角旁白质、侧脑室后角旁白质、半卵圆中心中央部、室管膜下区以及外囊和小脑中脚区这些兴趣区的FA值,分析脑内各部位白质的FA值在足月儿和早产儿的差异以及足月儿和早产儿脑内不同部位FA值的差异。结果:①左右半球相同部位的FA值的差异无统计学意义(P0.05)。胼胝体膝部和压部FA值比较,早产儿和足月儿组内比较均有统计学意义(P0.05)。②早产儿和足月儿不同部位FA值比较,早产儿FA值较足月儿低。内囊前后肢、胼胝体压部、半卵圆中心b区及外囊和小脑中脚区FA值早产儿和足月儿两组比较差异有统计学意义(P0.05)。胼胝体膝部、侧脑室前角旁白质、侧脑室后角旁白质、半卵圆中心a区、室管膜下区的FA值早产儿和足月儿两组比较无显著差异(P0.05)。③早产儿和足月儿组内各白质区FA值不同,两两比较均发现内囊后肢高于前肢,侧脑室后角旁白质高于侧脑室前角旁白质,胼胝体压部高于膝部,各差异均有统计学意义(P0.05)。半卵圆中心中央部a和b平面比较没有统计学意义(P0.05)。各ROI其中侧脑室前角旁白质FA值最低,胼胝体压部和内囊后肢FA值最高,两者比较侧脑室前角旁白质与胼胝体压部和内囊后肢均有显著性差异(P0.05)。结论:所选兴趣区FA值早产儿较足月儿降低,内囊前后肢、胼胝体压部、半卵圆中心b区及外囊和小脑中脚区FA值早产儿和足月儿两组比较差异有统计学意义,提示这些区域早产儿髓鞘成熟较足月儿晚。脑内不同部位的FA值也有所差异,反映了髓鞘化时间、白质纤维排列方式和髓鞘本身结构特点的差异。FA值能定量的分析髓鞘化进程,评估脑白质发育情况。第二部分磁敏感加权成像在新生儿高胆红素血症中的应用研究目的:探讨磁敏感加权成像(susceptibility weighted imaging,SWI)在新生儿高胆红素血症脑内出血中的应用价值。材料和方法:对120例新生儿(出生28天内的足月儿和纠正胎龄42周内的早产儿)吸纳入组进行前瞻性SWI检查,受试者分为4组,每组30例。第1组健康查体的早产儿;第2组健康查体的足月儿;第3组临床诊断高胆红素血症的早产儿;第4组临床诊断高胆红素血症的足月儿。对120例新生儿进行常规MRI和SWI扫描,2名不知被检者病史的放射科医师采用双盲法分析MRI和SWI图像。记录常规MRI和SWI检测的出血病例数和出血灶数目;分析不同部位颅内出血在SWI上的表现。结果:①MRI和SWI对新生儿颅内出血的检出阳性率比较有统计学意义,SWI优于常规MRI(P0.001)。在高胆红素血症组常规MRI和SWI对出血灶的检出阳性率有统计学意义(P0.05),而在正常对照组常规MRI和SWI对出血灶的检出阳性率比较没有统计学意义(P0.05)。②常规MRI和/或SWI上诊断为脑出血的病例共43例,其中早产儿27例,足月儿16例;高胆红素患儿29例,正常对照新生儿14例。在发生率上早产儿和足月儿差异有统计学意义(P0.05)。比较高胆红素血症和健康新生儿,发生率差异是显著性的(P0.05),包括足月儿和早产儿。③43例中14例新生儿显示颅内脑外出血(5例为硬膜下出血,1例为硬膜下出血合并小脑出血,8例为蛛网膜下腔出血),14例均在MRI和SWI图像中显示。对脑外出血的检出阳性病例数上,MRI和SWI两者之间的差异无统计学意义(P0.05)。④29例新生儿在SWI图像上显示存在脑内出血,其中10例常规MRI未显示。新生儿颅内出血(包括生发基质-脑室内出血、大脑和小脑实质出血)其中大脑和小脑实质出血以微出血(直径小于10mm)为表现形式,检出阳性病例数SWI明显优于常规MRI,两者之间的差异有统计学意义(P0.05)。SWI对生发基质-脑室内出血检出阳性病例数与常规MRI比较无明显统计学意义(P0.05)。⑤43例颅内出血病例检出数目122个,包括室管膜下-脑室内出血19个(15.6%)、大脑实质内出血43个(35.2%)、小脑出血46个(37.7%)、硬膜下出血6个(4.9%)和蛛网膜下腔出血8个(6.6%)。常规MRI检出数目78个,两者比较有统计学意义(P0.05)。⑥本研究中早产儿生发基质-脑室出血较足月儿多见,大脑实质出血和小脑出血早产儿和足月儿均可发生,硬膜下出血足月儿多见,蛛网膜下腔出血早产儿多见。结论:早产儿高胆红素血症患儿颅内出血发病率较正常新生儿高,SWI较常规MRI在新生儿高胆红素血症大脑和小脑实质出血检出的阳性率、病灶数目方面有着明显的优势,可作为常规MRI的有力的补充。第三部分常规磁共振及磁共振波谱在新生儿缺氧缺血性脑病中的研究目的:围产期缺氧缺血性损伤后脑病(HIE)可以通过不同的诊断技术评价,本研究的目的是结合常规磁共振与氢质子波谱成像诊断HIE和评估它们的应用价值。材料和方法:前瞻性观察研究2012年2月到2013年2月入组的84名足月新生HIE患儿(轻至中度组StageⅠ-Ⅱ和严重组StageⅢ),10名正常的新生儿作为对照组。两位放射学医生采用双盲法给MRI征象评分,对比分析两组间常规磁共振成像(MRI)信号差异及1H-MRS脑代谢物胆碱复合物(Cho)/肌酸(Cr)、N-乙酰天门冬氨酸(NAA)/Cr、乳酸(Lac)/Cr结果的差异。结果:①征象分析:StageⅠ-II组(n = 53)和StageⅢ组(n = 31)在T1加权成像(T1WI)上点状高信号损伤灶(punctate white matter lesions,PWML)和T2加权成像(T2WI)上脑水肿信号表现相似;基底节、丘脑、胼胝体或脑干的MRI和DWI信号异常发生在StageⅢ组,与StageⅠ-Ⅱ组比较其有显著性差异(P=0.001)。②StageⅠ-Ⅱ组脑内斑点状白质病变(PWML)平均值是5.38±4.68(数目1～43),StageⅢ组PWML平均值是16.82±17.66(数目4-59),两组数目比较有显著性差异(P=0.035);PWML多位于大脑髓静脉附近,在DWI序列上多呈高信号。③StageⅠ-Ⅱ组MRI评分平均值是6.20±1.75,StageⅢ组MRI评分平均值是9.78±3.64,两组MRI的分数评估有显著性差异(P=0.009)。④基底节和丘脑区波谱分析 NAA/Cr、Cho/Cr 和 Lac/Cr 比值在 HIE 组、StageⅠ-Ⅱ组和 StageⅢ组与对照组之间比较均有统计学意义(P0.05);而NAA/Cr、Cho/Cr.比值StageⅠ-Ⅱ组和StageⅢ组两者比较无统计学意义(P0.05);Lac/Cr比值StageⅢ组较StageⅠ-Ⅱ组明显升高,Lac/Cr比值两组比较有显著性差异(P0.05)。结论:常规MRI与1H-MRS相结合可客观反映HIE患儿脑形态及代谢物变化,更为准确判断HIE患儿脑损伤严重程度。
[Abstract]:The first part of the first part of the study of magnetic resonance diffusion tensor imaging in the development of the brain sheath of the newborn: diffusion tensor imaging (DTI) was used to quantify the fractional anisotropy (fractional anisotropy, FA). The anisotropy value can reflect the white texture of the brain. The difference in the value of white matter FA in the same part of the value of DTI in the development of cerebral white matter myelin. Materials and methods: 100 cases of normal perinatal history, no organic nervous system disease of foot and preterm infants were divided into two groups: 39 cases of foot moon, fetal age 37 to 42 weeks, 61 premature infants to 40 weeks. All neonates in the group were routinely MRI and DT I scan was used to measure the FA values of the anterior and posterior limbs of the corpus callosum, the knee and pressure of the corpus callosum, the side of the lateral ventricle, the paraventricular accessory white matter, the posterior horn of the lateral ventricle, the central central part of the oval circle, the subependymal region, the outer capsule and the cerebellar middle foot. The difference in the FA value of the white matter in the brain at the foot and the preterm infants and the term and preterm birth were analyzed. The difference of FA values in different parts of the brain. Results: (1) there was no significant difference in the FA value of the same parts of the left and right hemispheres (P0.05). Compared with the FA value of the genu and the pressure part of the corpus callosum, the comparison between the premature and the foot month group was statistically significant (P0.05). (2) the FA value of preterm infants and the FA in the different parts of the foot moon was lower than that of the full moon. The hind limbs, the pressure of the corpus callosum, the central B area of the semi oval circle and the FA value of the outer capsule and the middle cerebellum in the two groups were statistically significant (P0.05). The corpus callosum, the lateral ventricle anterior corner of the white matter, the lateral ventricle corner of the white matter, the center of the semi oval center a, the FA value in the subependymal region and the two groups of the foot months were not significantly different (P0 .05). (3) the FA values in the white matter area of the preterm and foot moon group were different. 22 the posterior limb of the inner capsule was higher than the forelimb. The accessory white matter in the posterior horn of the lateral ventricle was higher than the side of the lateral ventricle, and the pressure of the corpus callosum was higher than the knee. The difference was statistically significant (P0.05). There was no statistical significance (P0.05) in the central central part of the central part of the center of the oval center and in the B plane. ROI of the anterior horn of the lateral ventricle was the lowest in the lateral ventricle, with the highest value of the corpus callosum and the posterior limb of the inner capsule. There were significant differences between the anterior horn of the ventricle and the posterior limb of the corpus callosum (P0.05). Conclusion: the FA value of the selected region of interest was lower than that of the foot, the anterior hind limbs of the internal capsule, the pressure of the corpus callosum, the center of the corpus callosum, the center of the corpus callosum, and the center of the B and the outside of the center of the oval circle. The difference between the FA value of the preterm and the two groups of the cerebellar and cerebellar feet was statistically significant, suggesting that the myelin maturation of the premature infants in these areas was later than that of the foot. The FA values in different parts of the brain were also different, reflecting the time of myelination, the difference between the arrangement of white matter fibers and the characteristics of the myelin itself, the.FA value can be used to quantify the myelination. Process, evaluation of brain white matter development. Second application of magnetic sensitive weighted imaging in neonatal hyperbilirubinemia Objective: To explore the value of susceptibility weighted imaging (SWI) in neonatal hyperbilirubinemia intracerebral hemorrhage. Materials and methods: 120 cases of newborn (28 days of birth) The full-term infants and the preterm infants who corrected the gestational age for 42 weeks were divided into 4 groups, 30 cases in each group, 30 in each group, first in the early birth of healthy body examination, second in the full term for healthy body examination, third in the prematurity in the diagnosis of hyperbilirubinemia, and in the fourth groups in the foot for the diagnosis of hyperbilirubinemia in the fourth groups, and 120 neonates. With routine MRI and SWI scans, 2 radiologists who did not know the history of the subjects were used to analyze the MRI and SWI images by double blind method. The number of bleeding cases and the number of hemorrhagic foci were recorded by the routine MRI and SWI tests, and the expression of intracranial hemorrhage in different sites on SWI. Results: (1) the positive rates of MRI and SWI on neonatal intracranial hemorrhage were statistically compared. SWI was better than conventional MRI (P0.001). In the high bilirubinemia group, the positive rate of MRI and SWI was statistically significant (P0.05), but the positive rate of MRI and SWI in normal control group was not statistically significant (P0.05). (2) 43 cases of normal MRI and / or SWI were diagnosed as cerebral hemorrhage. 27 preterm infants, 16 foot months, 29 cases of high bilirubin and 14 normal newborns. There were significant differences in the incidence of premature and foot months (P0.05). The difference in the incidence of hyperbilirubinemia and healthy newborns was significant (P0.05), including the full moon and preterm infants. 14 of the 43 cases of newborns showed intracranial Extradural hemorrhage (5 cases of subdural hemorrhage, 1 cases of subdural hemorrhage with cerebellar hemorrhage, 8 cases of subarachnoid hemorrhage), 14 cases were shown in MRI and SWI images. There was no statistical difference between MRI and SWI (P0.05) in the positive cases of extradural hemorrhage (P0.05). (4) 29 cases of newborn infants showed intracerebral hemorrhage in SWI images. 10 cases of conventional MRI were not shown. Intracranial hemorrhage (including germinal matrix - intraventricular hemorrhage, cerebral and cerebellar parenchyma hemorrhage) in which cerebral and cerebellar parenchyma hemorrhage was characterized by micro bleeding (diameter less than 10mm), the number of positive cases SWI was significantly better than that of conventional MRI, and the difference between the two was statistically significant (P0.05).SWI for birth. The number of positive cases in matrix intracerebroventricular hemorrhage was not statistically significant (P0.05). (5) 43 cases of intracranial hemorrhage were detected in 122 cases, including 19 (15.6%) intraventricular intraventricular hemorrhage, 43 cerebral hemorrhage (35.2%), 46 cerebellar hemorrhage (37.7%), 6 subdural hemorrhage (4.9%) and 8 subarachnoid hemorrhage (6) (6). .6%). The number of normal MRI was 78, and there was a significant difference between them (P0.05). 6. In this study, the primary matrix hemorrhage of premature infants in this study is more common than that of the full moon, the cerebral parenchymal hemorrhage and cerebellar hemorrhage may occur in premature infants and foot moon infants. Subdural hemorrhage is more common and subarachnoid hemorrhage is common in premature infants. Conclusion: preterm infant Gao Danhong The incidence of intracranial hemorrhage in children with hyperbilirubinemia is higher than that of normal newborns. SWI is more effective than conventional MRI in the positive rate of brain and cerebellar parenchymal hemorrhage in neonates with hyperbilirubinemia and the number of lesions, which can be used as a powerful supplement to conventional MRI. Third parts of the conventional magnetic resonance and magnetic resonance spectroscopy are in the hypoxic and ischemic neonates. The purpose of the study in encephalopathy: perinatal hypoxic ischemic encephalopathy (HIE) can be evaluated by different diagnostic techniques. The purpose of this study was to combine conventional magnetic resonance and proton spectroscopy in the diagnosis of HIE and evaluate their application value. Materials and methods: a prospective study of 84 full months from February 2012 to 2 2013. New HIE children (mild to moderate group Stage I - II and severe group Stage III) and 10 normal newborns were used as control group. Two radiologists used double blind method to score the MRI signs, compared and analyzed the difference between the two groups of conventional magnetic resonance imaging (MRI) signal and 1H-MRS brain metabolite (Cho) / creatine (Cr), N- acetyl aspartate (NAA). /Cr, lactate (Lac) /Cr results. Results: (1) analysis of signs: Stage I -II group (n = 53) and Stage III (n = 31) were similar to the signal of brain edema on T1 weighted imaging (T1WI) on the point like high signal lesion (punctate white) and weighted imaging, and the basal ganglia, thalamus, corpus callosum or brain stem and signal differentiation It often occurred in group Stage III and compared with Stage I - II Group (P=0.001). The average value of intramedullary white matter lesions (PWML) in group Stage I - II was 5.38 + 4.68 (number 1~43), and the average value of PWML in group Stage III was 16.82 + 17.66 (4-59). The number of two groups was significantly different (P=0.035), and PWML was located near the medullary vein of the brain. The average value of MRI score in group Stage I - II group was 6.20 + 1.75, and the average value of MRI score in group Stage III was 9.78 + 3.64. The scores of two groups of MRI were significantly different (P=0.009). (4) basal ganglia and thalamic region spectrum analysis NAA/Cr, Cho/Cr and Lac/Cr ratio in HIE group, Stage I group and group III and control group There were statistical significance (P0.05), while NAA/Cr, Cho/Cr. ratio Stage I - II group and Stage III group had no statistical significance (P0.05), Lac/Cr ratio Stage III group was significantly higher than Stage I - II group, and Lac/Cr ratio two groups had significant difference (P0.05). Conclusion: the combination of conventional MRI and conventional MRI can objectively reflect the brain shape of children. Changes in state and metabolites are more accurate in judging the severity of brain injury in children with HIE.

【学位授予单位】：南京医科大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R445.2;R742

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