正常与生长发育迟缓儿童垂体MRI测量对照研究

发布时间：2018-06-25 23:15

本文选题：垂体 + 发育迟缓　；参考：《泰山医学院》2012年硕士论文

【摘要】：目的应用高分辨率磁共振（Magnetic Resonance Imaging，MRI）成像，获取生长发育迟缓与健康儿童垂体体积及各径线的测量数据，并对测量数据进行统计学分析，为临床诊断儿童生长发育迟缓提供更丰富的诊断依据与信息。材料和方法 1.研究对象选择：从山东省省立医院内分泌科就诊的儿童中，自2010年9月至2011年12月间选择符合生长发育迟缓条件的儿童90例，其中男性50例，女性49例，平均年龄8.19±3.53岁，年龄范围3～15岁，并按3岁～6岁、6岁～10岁、10岁～15岁3个年龄段分为A1、B1、C1组；同时在健康查体者中随机选择年龄、性别相匹配的健康儿童99例作为对照组，其中男性53例，女性46例，平均年龄7.10±3.04岁，年龄范围3～15岁，同样按3岁～6岁、6岁～10岁、10岁～15岁3个年龄段分为A2、B2、C2组。正常及生长发育迟缓儿童两组间性别及年龄均无统计学差异。 2.仪器和设备采用3.0T GE（SIGNA HD x GEMSGEMS）超导型磁共振扫描仪（美国GeneralElectric Company），头部八通道相控阵线圈，扫描序列包括常规序列和冠状位3D T1WIFSPGR序列。所有受试对象均进行冠状T2WI（TR3200ms，TE118.1ms）、T1WI（TR580ms，TE9.4ms）、矢状位T1W（ITR580ms，TE14.1ms）以及3D T1WI FSPGR扫描，其具体参数为：TR7.6ms，TE3.3ms，FOV240mm×240mm，层厚1.4mm，矢状位和冠状位扫描线分别垂直垂体左右径线及垂直鞍底。常规所有的序列扫描完，利用Reformat后处理软件对冠状3D T1WI FSPGR原始图像进行矢状位和冠状位重建，矢状位和冠状位扫描线分别垂直垂直鞍底及垂体左右径线。重建参数如下：FOV240mm，层厚1.4mm，层间距0.5mm，使定位准确，图像统一、一致，然后在冠状位及矢状位分别对垂体进行测量；利用3D T1WI FSPGR原始图像通过MIP技术从矢状、冠状及轴位三方位辨认垂体结构边界，并勾绘出垂体结构的轮廓图像，然后保留勾绘出的垂体，利用自动体积测量软件进行垂体的体积测量。统计分析采用SPSS17.0进行统计学分析，所有数据资料均使用s显示。同性别年龄不同垂体测量值的比较用单因素方差分析，相同组别不同性别垂体测量值及生长发育迟缓与健康对照组之间的比较采用独立样本t检验分析，垂体分型数据采用χ~2分析。选取P0.05为有差异，P0.01为有显著性差异。结果 1.正常儿童垂体体积及径线测量：三个不同年龄段（A2、B2、C2）男性垂体体积分别为A2：（224.55±71.21）mm~3、B2：（320.20±64.80）mm~3、C2：（358.32±81.57）mm~3，女性垂体体积分别为A2：（271.69±87.51）mm~3、B2：（365.90±83.52）mm~3、C2：（496.69±128.93）mm~3；垂体正中矢状位高径：男性分别为A2：（4.24±0.563）mm、B2：（4.91±0.82）mm、C2：（5.87±1.29）mm，女性分别为A2：（4.51±0.83）mm、B2：(5.04±1.00) mm、C2：(6.26±1.41) mm，垂体前后径男性各组分别为A2：（7.09±1.44）mm、B2：（7.67±1.56）mm、C2：(7.67±1.17) mm，女性分别为A2：(7.38±1.23) mm、B2：(8.02±1.01) mm、C2：(9.30±1.42) mm，垂体冠状位正中高径三个不同年龄段男性各组分别为A2：（3.17±0.48）、B2：（3.79±.57）mm、C2：(4.45±1.00)mm，垂体冠状位正中高径女性分别为A2：（3.94±0.82）mm、B2：（4.80±0.71）mm、C2：（5.76±0.90）mm，垂体冠状位宽径男性各组别为A2：（10.11±1.18）mm、B2：(11.35±1.58) mm、C2：(11.20±3.19) mm，女性各组分别为A2：(11.12±1.28) mm、B2：(12.06±1.26) mm、C2：(13.91±1.01) mm。 2.生长发育迟缓儿童垂体体积及径线测量：三个不同年龄段（A1、B1、C1）男性垂体体积分别为A1：（226.67±30.49）mm~3、B1：（304.04±67.56）mm~3、C1：（308.31±104.64）mm~3，女性垂体体积分别分别为A1：（210.10±58.54）mm~3、B1：（307.30±82.01）mm~3、C1：（359.00±135.27）mm~3，，垂体正中矢状位高径男性各组分别为A1：（4.00±1.00）mm、B1：（4.53±1.28）mm、C1：（4.31±1.08）mm，女性分别为A1：（4.36±0.63）mm、B1：(4.56±0.97) mm、C1：(4.92±1.41) mm，垂体前后径男性各组分别为A1：（7.55±1.30）mm、B1：（8.72±1.04）mm、C1：(9.37±1.46) mm，女性分别为A1：(6.92±0.91) mm、B1：(7.81±1.08) mm、C1：(8.14±1.31) mm，垂体正中冠状位高径男性各组分别为A1：（3.91±0.74）、B1：（4.59±0.70）mm、C1：(5.73±0.81)mm，女性分别为A1：（3.51±0.54）mm、B1：（4.23±0.57）mm、C1：（4.48±1.00）mm，垂体冠状位宽径男性各组别为A1：（11.06±1.05）mm、B1：(11.91±1.92) mm、C1：(13.25±1.72) mm，女性各组分别为A1：(11.13±1.61) mm、B1：(11.48±1.60) mm、C1：(12.32±2.59) mm。随着年龄的增长垂体生长缓慢，以C1组最为显著。 3.垂体分型:正常儿童A2、B2、C2组垂体分型：凹陷型30例，平坦型40例，隆凸型29例。相同性别不同年龄组间分型差异有统计学意义(χ~2值分别为19.92、5.66，P值均0.05)。生长发育迟缓儿童A1、B1、C1组垂体分型：凹陷型35例，平坦型41例，隆凸型14例。相同性别不同年龄组间分型差异无统计学意义(χ~2值分别为（10.07、1.41，P值均0.05)。正常儿童垂体随年龄增加，隆起型逐渐增加，凹陷型逐渐减少，在儿童期生长发育迟缓和正常对照组三个年龄阶段垂体分型均以平坦型最为多见。结论本研究通过3D磁化强度预备梯度回波序列T1WI（3D T1WI FSPGR），应用3DMIP体积分析后处理软件勾绘垂体及应用Reformat后处理软件重建，测量垂体体积及各径线并进行统计学分析。结果表明，生长发育迟缓儿童垂体体积均较正常儿童垂体体积小，以第三年龄阶段为著，差异有统计学意义；正常及生长发育迟缓儿童垂体体积在不同年龄组（A2、B2、C2和A1、B1、C1）间差异有统计学意义(F值分别为18.63、19.23，和5.42、6.39P 0．05)；此研究为各种垂体疾病及生长发育迟缓儿童的临床诊断和科学研究提供客观依据。
[Abstract]:objective
Magnetic Resonance Imaging (MRI) imaging was used to obtain the measurement data of growth retardation and healthy children's pituitary volume and each diameter line, and the measured data were statistically analyzed to provide more diagnostic basis and information for the clinical diagnosis of children's growth retardation.
Materials and methods
1. the selection of research objects:
Among the children from the Department of endocrinology in the provincial hospital of Shandong Province, 90 children were selected from September 2010 to December 2011, including 50 males and 49 females, with an average age of 8.19 + 3.53 years and 3~15 years old, and divided into A1, B1, and C1 groups at the age of 3 to 6, 6 to 10 years and 15 years. Among the healthy subjects, 99 healthy children were randomly selected as the control group, including 53 males and 46 females, the average age was 7.10 + 3.04 years, the age range was 3~15 years old, the same according to 3 years to 6 years, 6 to 10 years, 10 years to 15 years, group C2. Normal and growth retarded children between groups of sex and sex between groups. There was no statistical difference in age.
2. instruments and equipment
Using the 3.0T GE (SIGNA HD x GEMSGEMS) superconducting magnetic resonance scanner (American GeneralElectric Company), the eight channel phased array coils in the head, the scanning sequence includes the conventional sequence and the coronal 3D T1WIFSPGR sequence. And 3D T1WI FSPGR scan, the specific parameters are: TR7.6ms, TE3.3ms, FOV240mm x 240mm, layer thickness 1.4mm, sagittal and coronal scan lines perpendicular to the vertical pituitary diameter and vertical saddle bottom respectively.
After routine scanning, the sagittal and coronal reconstruction of the original image of coronary 3D T1WI FSPGR was reconstructed with Reformat post-processing software. The sagittal and coronal scan lines were vertically perpendicular to the saddle bottom and the left and right hypophysis lines. The reconstruction parameters were as follows: FOV240mm, the thickness 1.4mm, the interval spacing 0.5mm, making the positioning accurate, the image unifying, and the same. Then the hypophysis was measured in the coronal and sagittal positions, and the pituitary structure boundary was identified from the sagittal, coronal and axial three directions by using the 3D T1WI FSPGR original image, and the outline image of the pituitary structure was plotted. Then the pituitary gland was retained and the volume measurement of the pituitary gland was measured by the auto volume measurement software.
statistical analysis
SPSS17.0 was used for statistical analysis. All data were displayed by s. Single factor variance analysis was used to compare the measured values of hypophysis in the same sex age. The comparison of pituitary measurement values and growth retardation with healthy control groups was analyzed by independent sample t test, and the pituitary classification data were analyzed by X ~2 score. P0.05 was selected as the difference. P0.01 showed significant difference.
Result
1. the measurement of pituitary volume and diameter in normal children: three different age groups (A2, B2, C2) were A2: (224.55 + 71.21) mm~3, B2: (320.20 + 64.80) mm~3, C2: (358.32 + 81.57) mm~3, A2: (271.69 + 87.51) mm~3, B2: 365.90 + 83.52); pituitary median sagittal Height diameter: the male was A2: (4.24 + 0.563) mm, B2: (4.91 + 0.82) mm, C2: (5.87 + 1.29) mm, A2: (4.51 + 0.83) mm, B2: (5.04 + 1) mm, C2: (6.26 + 1.41) mm. M, B2: (8.02 + 1.01) mm, C2: (9.30 + 1.42) mm, A2: (3.17 + 0.48), B2: (3.79 +.57) mm, C2: (4.45 + 1) mm, B2: (3.79 +.57) mm, and C2: (4.45 + 1) mm in the pituitary coronal median height, respectively. The groups were A2: (10.11 + 1.18) mm, B2: (11.35 + 1.58) mm, C2: (11.20 + 3.19) mm, A2: (11.12 + 1.28) mm, B2: (12.06 + 1.26) mm, C2: (13.91 + 1.01) mm.) in female groups.
2. the measurements of pituitary volume and diameter in children with growth retardation: three different age groups (A1, B1, C1) were A1: (226.67 + 30.49) mm~3, B1: (304.04 + 67.56) mm~3, C1: (308.31 + 104.64) mm~3, and A1: (210.10 + 58.54) mm~3, respectively, B1: (307.30 + 82.01), respectively. The median sagittal height of the pituitary was A1: (4 + 1) mm, B1: (4.53 + 1.28) mm, C1: (4.31 + 1.08) mm, A1: (4.36 + 0.63) mm, B1: (4.56 + 0.97) mm, C1: (4.92 + 1.41) mm. (6.92 + 0.91) mm, B1: (7.81 + 1.08) mm, C1: (8.14 + 1.31) mm, A1: (3.91 + 0.74), B1: (4.59 + 0.70) mm, C1: (5.73 + 0.81) mm, and A1: (3.51 + 0.81) mm respectively. Mm, B1: (11.91 + 1.92) mm, C1: (13.25 + 1.72) mm, the female groups were A1: (11.13 + 1.61) mm, B1: (11.48 + 1.60) mm, C1: (12.32 + 2.59) mm., with the increase of age, the growth of the pituitary was slow, which was the most significant in the C1 group.
3. pituitary classification: normal children's A2, B2, C2 group hypophysis: 30 cases of depression, 40 flat type, 29 cases of protuberance. The difference between the same sex and different age groups is statistically significant (19.92,5.66, P, 0.05). The A1, B1, and C1 group of children with growth retardation: 35 cases, 41 flat type, and 14 cases of protruding. There was no statistical difference between the different age groups of the same sex (~2 value (10.07,1.41, P value, respectively 0.05). The pituitary gland of normal children increased with age, the protruding type increased gradually, and the depression type decreased gradually. In children, the three stages of growth retardation and normal control group were most common in flat type.
conclusion
In this study, the gradient echo sequence T1WI (3D T1WI FSPGR) was prepared by the 3D magnetization. After 3DMIP volume analysis, the pituitary volume and the Reformat post-processing software were rebuilt, and the pituitary volume and the diameter lines were measured and analyzed statistically. The results showed that the pituitary volume of children with slow growth and development was smaller than that of normal children. The difference between normal and growth retarded children was statistically significant in different age groups (A2, B2, C2 and A1, B1, C1) in normal and growth retarded children (F value was 18.63,19.23, and 5.42,6.39P 0.05) in normal and growth retarded children (F value was 18.63,19.23, and 5.42,6.39P 0.05). The study was the clinical diagnosis and science of various pituitary diseases and growth retarded children. The research provides an objective basis.
【学位授予单位】：泰山医学院
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R723;R445.2

【参考文献】