3.0T MRI、扩散加权成像和扩散张量成像在早产儿脑病的应用研究
发布时间：2019-05-23 08:58
【摘要】：第一部分MRI及扩散加权成像在早产儿脑病的应用研究 研究背景：近年来，随着围产医学和NICU呼吸支持技术的发展以及早产儿管理水平的提高，早产儿的存活率尤其是极低体重儿和超低体重儿的存活率逐年升高，这一群体的神经系统发育结局也备受关注。早产儿脑发育不成熟，具有易损伤的特点。围产期缺氧缺血、感染/炎症等高危因素导致炎症因子大量激活、兴奋氨基酸堆积和氧自由基释放，容易发生早产儿脑病(encephalopathy of prematurity，EP)。这不仅引起神经系统发育障碍，并严重影响存活早产儿的生命质量，，还会造成患儿以后的脑发育障碍，给家庭和社会带来沉重负担。 目的：探讨早产儿脑病的磁共振表现和DWI表现及其分类，并比较不同胎龄早产儿脑损伤的影像学表现差异。 材料和方法：产前有胎膜早破、宫内窘迫、胎盘及脐带异常、羊水异常、多胎、母孕期患病等危险因素；产时或产后有窒息史、复苏抢救史、反复呼吸暂停、低氧血症、高碳酸血症、慢性肺疾病、感染等危险因素早期临床表现出现临床表现喂养困难、呼吸暂停、惊跳、抽动、精神反应差等，出生后1分钟、5分钟Apgar评分7分以下；排除其他脑病,如低血糖脑病、遗传代谢性脑病、胆红素脑病、先天性脑发育异常等。符合以上条件一项或一项以上者，收入病例组，行MRI及DWI检查。本项研究收录90例符合条件的孕周25～36+6周的早产儿进行MRI及DWI检查，其中男52例，女38例，平均孕周30.6周；检查时平均日龄22.3天。扫描序列主要有FSE的T1、T2和T2FLAIR及SE/EPI序列DWI。分析EP的早期MRI及DWI表现，并与复查结果进行对照研究。 结果：常规MRI及DWI可以早期显示并区分早产儿脑病的不同类型的缺血性损伤和出血性损伤；孕周32周以上和孕周32周以下的早产儿脑损伤类型不同，孕周32周以下的早产儿弥漫性白质损伤占所有损伤类型的比例较孕周32周以上的大，合并出血性损伤的比例也较大，且弥漫性损伤后期形成PVL的比例也大于孕周32周以上的早产儿。复查的41例早产儿脑病患儿出现脑室周围白质软化（periventricular leukomalacia, PVL）形成，部分伴胶质增生、髓鞘化延迟、胼胝体薄、脑外间隙增宽、脑室扩大、脑容量减小等影像表现。结论：MRI及DWI可以客观反映早产儿脑病脑损伤的严重程度，且可对不同孕周的早产儿脑损伤类型进行分组比较其差异，并可早期评估EP预后。 第二部分扩散张量成像在早产儿脑病的应用研究 目的：比较纠正足月的EP患儿与正常足月儿的ADC值、FA值，以评估早产儿脑病后期脑损伤及神经纤维发育程度。 材料与方法：以12例无窒息史的正常足月儿为对照（平均胎龄39.8周，平均日龄10.8天），对20例纠正胎龄≥37周的EP患儿（平均纠正胎龄39.7周，平均日龄32.5天）行MRI及DTI检查，在双侧基底节、丘脑、内囊后肢、额叶、顶枕叶白质等敏感易损区取感兴趣区（ROI），并比较两组间ADC、FA值差异。 结果：豆状核外侧、丘脑腹外侧、内囊后肢、额叶白质、顶叶白质、枕叶白质的ADC值两组间对比差异均具有统计学意义（P＜0.05）。双侧豆状核外侧FA值对比两组间差异不显著（P＞0.05），其余部位丘脑腹外侧、内囊后肢、额叶白质、顶叶白质、枕叶白质的FA值两组间对比差异均具有统计学意义（P＜0.05）。 结论：DTI序列可以无创性监测早产儿脑病后脑发育情况，并评估临床预后。
[Abstract]:The application of the first part of MRI and diffusion-weighted imaging in the prematurity of encephalopathy Background of the study: In recent years, with the development of the respiratory support technology of the perinatal medicine and the NICU and the raising of the management level of the premature infants The survival rate of the high and premature infants, especially the very low birth weight and the low birth weight, is increasing year by year, and the development outcome of the nervous system of this group is also well-known. Note: The premature infant brain is immature and has a very easy to be damaged. The high-risk factors, such as perinatal hypoxic-ischemia, infection/ inflammation, lead to a large number of activation of inflammatory factors, the accumulation of excitatory amino acids and the release of oxygen free radicals, which are prone to prematurity of encephalopathy (EP). ). This not only causes the development barrier of the nervous system, but also seriously affects the quality of life of the surviving premature infants, and also causes the development of the brain in the later period of the child, which brings heavy negative to the family and the society The purpose of this study was to investigate the MRI findings and the classification of DWI in prematurity, and to compare the imaging table of the brain injury of premature infants with different gestational age. Current differences. Materials and methods: pre-natal, premature rupture of the membrane, intrauterine distress, placental and umbilical cord abnormalities, abnormal amniotic fluid, multiple births, and illness in the mother's pregnancy, etc.; the history of asphyxia, the history of resuscitation, repeated apnea, hypoxemia, hypercapnia, The early clinical manifestation of the risk factors such as chronic lung disease, infection and the like has the clinical manifestation, the feeding difficulty, the apnea, the shock, the movement, the mental reaction difference and the like, the Apgar score of 5 minutes after the birth is below 7 points, and the other encephalopathy, such as the hypoglycaemic encephalopathy, the genetic metabolic encephalopathy, Bilirubin encephalopathy, congenital brain Abnormal development, etc. In accordance with one or more of the above conditions, the income case group, the line MRI, and the DWI was examined by DWI. In this study,90 cases of prematurity with 25-36 + 6 weeks of gestational age were examined by MRI and DWI. Among them,52 were male,38 were female, 30.6 weeks in average, and average age at the time of examination. 22.3 days. The scan sequence has mainly FSE T1, T2 and T2FLAIR and SE/ EPI Sequence DWI. The early MRI and DWI performance of EP were analyzed and compared with the results of the review. Line-control studies. Results: Conventional MRI and DWI can identify and differentiate between different types of ischemic and hemorrhagic injury in prematurity with early-term MRI and DWI. Preterm infants below 32 weeks of gestation and below 32 weeks of gestation The type of brain injury was different. The proportion of diffuse white matter lesions in the premature infants under the age of 32 weeks was greater than that of the gestational period of 32 weeks, the proportion of the combined hemorrhagic injury was also large, and the proportion of the late-stage formation of PVL in the late stage of the diffuse injury was also greater than that of the gestational week 32. The periventricular leukomalacia (PVL) was found in 41 of the 41 premature infants with prematurity. Conclusion: MRI and DWI can objectively reflect the severity of brain injury in prematurity, and can compare the types of brain injury of premature infants with different gestational weeks. The second part of the diffusion tensor imaging The purpose of this study is to compare the value of the ADC and FA of the normal term infants with the value of the normal term and the value of the FA to assess the post-term brain of the prematurity. Injury and nerve fiber development degree. Materials and Methods:12 cases of normal foot-term infants with no asphyxia history were used as control (mean age of 39.8 weeks, average age of 10.8 days), and 20 cases of EP (mean corrected gestational age, 39.7 weeks, mean age of 32.5 days) were performed with MRI and DT. I examined the region of interest (ROI) in sensitive and vulnerable areas, such as the bilateral basal ganglia, the thalamus, the hindlimb of the inner capsule, the frontal lobe, the top occipital white matter, and the like, and Results: The difference between the two groups of ADC and FA values in the outside of the pea-like nucleus, the outside of the ventral thalamus, the hindlimb of the inner capsule, the white matter of the frontal lobe, the white matter of the parietal white matter and the white matter of the occipital lobe There was no significant difference between the two groups (P> 0.05), the difference between the two groups was not significant (P> 0.05), and the difference between the two groups of the FA values of the white matter and the white matter of the occipital lobe, the white matter of the frontal lobe, the white matter of the occipital lobe, the white matter of the occipital lobe and the white matter of the frontal lobe, the white matter of the frontal lobe and the white matter of the occipital lobe were all significant (P <0.05). Conclusion: DTI can be used for non-invasive monitoring of premature delivery.
【学位授予单位】：华中科技大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R445.2;R722.6
本文编号：2483763
[Abstract]:The application of the first part of MRI and diffusion-weighted imaging in the prematurity of encephalopathy Background of the study: In recent years, with the development of the respiratory support technology of the perinatal medicine and the NICU and the raising of the management level of the premature infants The survival rate of the high and premature infants, especially the very low birth weight and the low birth weight, is increasing year by year, and the development outcome of the nervous system of this group is also well-known. Note: The premature infant brain is immature and has a very easy to be damaged. The high-risk factors, such as perinatal hypoxic-ischemia, infection/ inflammation, lead to a large number of activation of inflammatory factors, the accumulation of excitatory amino acids and the release of oxygen free radicals, which are prone to prematurity of encephalopathy (EP). ). This not only causes the development barrier of the nervous system, but also seriously affects the quality of life of the surviving premature infants, and also causes the development of the brain in the later period of the child, which brings heavy negative to the family and the society The purpose of this study was to investigate the MRI findings and the classification of DWI in prematurity, and to compare the imaging table of the brain injury of premature infants with different gestational age. Current differences. Materials and methods: pre-natal, premature rupture of the membrane, intrauterine distress, placental and umbilical cord abnormalities, abnormal amniotic fluid, multiple births, and illness in the mother's pregnancy, etc.; the history of asphyxia, the history of resuscitation, repeated apnea, hypoxemia, hypercapnia, The early clinical manifestation of the risk factors such as chronic lung disease, infection and the like has the clinical manifestation, the feeding difficulty, the apnea, the shock, the movement, the mental reaction difference and the like, the Apgar score of 5 minutes after the birth is below 7 points, and the other encephalopathy, such as the hypoglycaemic encephalopathy, the genetic metabolic encephalopathy, Bilirubin encephalopathy, congenital brain Abnormal development, etc. In accordance with one or more of the above conditions, the income case group, the line MRI, and the DWI was examined by DWI. In this study,90 cases of prematurity with 25-36 + 6 weeks of gestational age were examined by MRI and DWI. Among them,52 were male,38 were female, 30.6 weeks in average, and average age at the time of examination. 22.3 days. The scan sequence has mainly FSE T1, T2 and T2FLAIR and SE/ EPI Sequence DWI. The early MRI and DWI performance of EP were analyzed and compared with the results of the review. Line-control studies. Results: Conventional MRI and DWI can identify and differentiate between different types of ischemic and hemorrhagic injury in prematurity with early-term MRI and DWI. Preterm infants below 32 weeks of gestation and below 32 weeks of gestation The type of brain injury was different. The proportion of diffuse white matter lesions in the premature infants under the age of 32 weeks was greater than that of the gestational period of 32 weeks, the proportion of the combined hemorrhagic injury was also large, and the proportion of the late-stage formation of PVL in the late stage of the diffuse injury was also greater than that of the gestational week 32. The periventricular leukomalacia (PVL) was found in 41 of the 41 premature infants with prematurity. Conclusion: MRI and DWI can objectively reflect the severity of brain injury in prematurity, and can compare the types of brain injury of premature infants with different gestational weeks. The second part of the diffusion tensor imaging The purpose of this study is to compare the value of the ADC and FA of the normal term infants with the value of the normal term and the value of the FA to assess the post-term brain of the prematurity. Injury and nerve fiber development degree. Materials and Methods:12 cases of normal foot-term infants with no asphyxia history were used as control (mean age of 39.8 weeks, average age of 10.8 days), and 20 cases of EP (mean corrected gestational age, 39.7 weeks, mean age of 32.5 days) were performed with MRI and DT. I examined the region of interest (ROI) in sensitive and vulnerable areas, such as the bilateral basal ganglia, the thalamus, the hindlimb of the inner capsule, the frontal lobe, the top occipital white matter, and the like, and Results: The difference between the two groups of ADC and FA values in the outside of the pea-like nucleus, the outside of the ventral thalamus, the hindlimb of the inner capsule, the white matter of the frontal lobe, the white matter of the parietal white matter and the white matter of the occipital lobe There was no significant difference between the two groups (P> 0.05), the difference between the two groups was not significant (P> 0.05), and the difference between the two groups of the FA values of the white matter and the white matter of the occipital lobe, the white matter of the frontal lobe, the white matter of the occipital lobe, the white matter of the occipital lobe and the white matter of the frontal lobe, the white matter of the frontal lobe and the white matter of the occipital lobe were all significant (P <0.05). Conclusion: DTI can be used for non-invasive monitoring of premature delivery.
【学位授予单位】：华中科技大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R445.2;R722.6
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