磁共振IVIM技术在活体心脏成像的初步研究

发布时间：2018-01-13 06:36

本文关键词：磁共振IVIM技术在活体心脏成像的初步研究　出处：《大连医科大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:探讨磁共振体素内不相干运动(intravoxel incoherent motion,IVIM)技术在人活体心脏成像中的可行性,以及相关参数定量测量的可重复性及一致性情况,并且初步分析磁共振IVIM成像技术在心脏损害相关疾病中的临床应用价值。材料与方法:收录2015年5月-2016年1月在大连医科大学附属第一医院行3.0T心脏磁共振IVIM成像技术检查的志愿者及临床患者,共计64例,包括34例正常人(男19例,女15例,年龄8-76岁)和30例患有心脏损害相关疾病的患者(男15例,女15例,年龄37-77岁),其中包含10例肥厚型心肌病患者及20例糖尿病、高血压患者。采用多个b值(0、20、50、80、100、120、200、300、500s/mm~2),在左室短轴层面分别对左室心尖部、中间部及基底部进行心脏磁共振IVIM成像扫描。由两名心血管影像诊断医师采用双盲法对图像质量进行等级评估,对符合要求的图像定量测量IVIM成像各参数值,包括ADCslow,ADCfast及f(fraction of ADCfast)值。再由一名经验较丰富的心血管影像诊断医师间隔1个月以上对相关参数进行第2次重复测量。所得数据采用GraphPad Prism 5软件及SPSS 17.0统计包进行分析。对图像质量等级一致性评估采用Kappa检验。对心脏IVIM成像成功率差异使用卡方检验。成像各影响因素之间采用独立样本t检验或Wilcoxon检验。对心脏IVIM成像各参数值定量测量可重复性及一致性检验使用组内相关系数分析(intraclass correlation coefficient)。对正常组三个不同层面的IVIM各参数值,正常组与不同疾病组之间的各参数值,采用独立样本t检验、Wilcoxon秩和检验、单因素方差分析及Kruskal-Wallis H秩和检验分析。P0.05认为有统计学差异。结果:1、在64例受试者中,最后有51例受试者,共计131层心脏IVIM图像成功,符合II级、III级评估标准,满足能够进行IVIM成像参数的定量测量要求。以心肌成像层面为基准,IVIM心脏成像的总成功率为68.23%(131/192);其中,正常组成功率为74.51%(76/102),疾病组成功率为61.11%(55/90),正常组图像成功率高于疾病组的成功率(P0.05);心尖部、中间部、基底部三个层面心脏IVIM成功率无统计学差异(P0.05);心脏IVIM成像失败组的心率明显高于成功组(P0.05)。2、两名医师对心脏IVIM成像的图像质量等级评估一致性好(Kappa=0.80)。对于正常组及疾病组左心室心肌IVIM各参数ADCslow,ADCfast和f值的重复性测量,同一名医师重复2次测量及两名医师分别2次进行IVIM各参数测量均具有较好的重复性及一致性(ICC0.80)。3、正常人心尖部、中间部及基底部三层心脏IVIM各参数值无明显统计学差异(P0.05);肥厚型心肌病患者组以及糖尿病、高血压患者组的ADCfast值均显著低于正常人组(83.12±22.33×10-3mm~2/s,103.02±21.10×10-3mm~2/s vs132.43±20.23×10-3 mm~2/s,P0.05);糖尿病、高血压患者组与肥厚型心肌病患者组之间ADCfast值无统计学差异(P0.05);ADCslow及f值在正常人组,糖尿病、高血压患者组以及肥厚型心肌病患者组之间均没有统计学差异(P0.05)。结论:本研究初步验证了人活体心脏磁共振IVIM成像技术的可行性并且具有一定的临床意义。其中,ADCfast值可以良好的反映心脏损害相关疾病的心肌微循环灌注变化情况,也许可以用于心肌微循环灌注状态的监测及预测。但是,心脏磁共振IVIM成像仍然具有挑战性。
[Abstract]:Objective: To investigate the magnetic resonance intravoxel incoherent motion (intravoxel incoherent, motion, IVIM) technical feasibility in human cardiac imaging, and the relative parameters of quantitative measurement repeatability and consistency, and preliminary analysis of magnetic resonance imaging IVIM damage related diseases in clinical application in heart. Materials and methods included: May 2015 -2016 year in January in the First Affiliated Hospital of Dalian Medical University 3.0T cardiac magnetic resonance imaging examination of IVIM volunteers and patients, a total of 64 cases, including 34 cases of normal people (male 19 cases, female 15 cases, aged 8-76 years) and 30 patients with heart damage related diseases (15 cases of male, female in 15 cases, aged 37-77 years), including 10 cases of patients with hypertrophic cardiomyopathy and 20 cases of diabetes mellitus, hypertension patients. Using multiple b values (0,20,50,80100120200300500s/mm~2), left ventricular short axis level respectively The left ventricular apex, cardiac magnetic resonance imaging scans IVIM middle part and the base. By two cardiovascular diagnostic imaging physician by double blind method evaluation on image quality of the image, numerical, quantitative measurement of IVIM imaging to meet the requirements of various parameters including ADCslow, ADCfast and f (fraction of ADCfast) by value. A more experienced cardiovascular diagnostic imaging physician interval for 1 months or more of the relevant parameters were repeated second times. The measurement data obtained using GraphPad Prism 5 software and SPSS 17 statistical package for analysis. The image quality level of conformity assessment by Kappa test. The success rate of cardiac IVIM imaging using the chi square test. The difference between factors the effect of imaging by using independent sample t test or Wilcoxon test. Analysis of repeatability and consistency test using the intraclass correlation coefficient of each parameter of quantitative measurement of cardiac IVIM imaging (intracla SS correlation coefficient). The parameters of the normal group of three different levels of IVIM value, the parameter values between the normal group and different disease groups, using independent samples t test, Wilcoxon test, single factor analysis of variance and Kruskal-Wallis test and H test analysis of.P0.05 that there is significant difference between the results: 1, in 64. Subjects in the last 51 subjects, a total of 131 layers of cardiac IVIM image, with II grade, III grade evaluation standard, can meet the measurement requirements. IVIM imaging parameters in myocardial imaging level as the benchmark, IVIM heart total success rate is 68.23% (as 131/192) among them; the success rate is 74.51%, the normal group (76/102), the success rate of disease group was 61.11% (55/90), normal group success rate is higher than the success rate of disease group (P0.05); the middle part of the apical, basal, three levels of cardiac IVIM success rate had no significant difference (P0.05); heart IVIM imaging failed group of heart rate was significantly higher than that of group.2 (P0.05), image quality level of two doctors on cardiac IVIM imaging assessment of consistency (Kappa=0.80). The parameters of the normal group and disease group left ventricular myocardial IVIM ADCslow, repeated measurements of ADCfast and F value, the same physician repeated 2 times measurement and two physicians were 2 times for each parameter of IVIM measurement has good repeatability and consistency (ICC0.80).3, normal heart apex, there were no significant differences between the middle and basal layer of three cardiac IVIM parameters (P0.05); hypertrophic heart myopathy group and diabetes mellitus, hypertension group the ADCfast values were significantly lower than those in normal group (83.12 + 22.33 * 10-3mm~2/s, 103.02 * 10-3mm~2/s + 21.10 vs132.43 + 20.23 * 10-3 mm~2/s, P0.05); diabetes mellitus, ADCfast between hypertensive patients with hypertrophic cardiomyopathy patients with no statistical difference value ISO (P0.05); ADCslow and F value of diabetes in the normal group, there were no statistical differences between hypertensive patients and patients with hypertrophic cardiomyopathy group (P0.05). Conclusion: This study demonstrates the feasibility of in vivo cardiac magnetic resonance imaging and IVIM has clinical significance. The ADCfast value of myocardium microcirculation change can be a good reflection of the heart damage related diseases, perhaps can be used for monitoring and predicting myocardial microcirculation perfusion status. However, cardiac magnetic resonance imaging IVIM remains challenging.

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R445.2;R54

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