功能磁共振对运动性失语预后评估作用的研究

发布时间：2018-01-13 21:10

本文关键词：功能磁共振对运动性失语预后评估作用的研究　出处：《大连医科大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的运用功能磁共成像3D T1.T2 FLAIR结构序列以及静息态功能磁共振ALFF分析对颅脑外伤及出血性脑卒中导致的运动性失语(Motor aphasia)的认知、神经机制进行较为系统的研究,并将探索影响其预后的fMRI上的评估指标。为广大神经外科医师在面对患者家属询问其是否能康复时,提供影像学依据,更好更有效的评估患者预后,进而指导后期康复治疗,提高诊疗水平。方法对2014年至2015年12月于杭州师范大学附属医院神经外科收治的20例颅脑外伤及出血性脑卒中(其中急性硬膜下血肿5人,左侧基底节脑出血11人,动静脉畸形4人)导致的运动性失语的患者进行3.0T功能磁共振检查,主要包括以下磁功能序列:1.静息态功能磁共振(resting-state functional magnetic resonance imaging,RS-fMRI)扫描,采集时间8分钟,在扫描开始前,告知患者放松心情,缓解压力,均匀呼吸,切勿紧张,胡思乱想,给予患者安全警报遥控器,使患者在碰到紧急情况能及时通知。在扫描时,把磁共振室内的灯光关闭,避免产生干扰。对完成的静息态功能磁共振数据行低频振幅(amplitude of low frequency fluctuation,ALFF)分析;先对采集到的静息态数据进行预处理,主要包括以下步骤:(1)去除静息态fMRI图像前10个时间点的数据;(2)时间层矫正;(3)头动矫正;(4)空间标准化;(5)平滑处理;(6)去线性飘移(7)滤波(8)去协变量。2.扰相梯度双回波T1加权成像(spoiled gradient recalled echo T1-weighted imaging,SPGR-T1 WI):全脑T1加权分析;扫描时间5分5秒,主要用于观察结构象以及利用采集3D-T1图像制作全脑灰质模板,获取全脑低频振幅图。3.液体衰减反转恢复(fluidattenuated inversion recovery,FLAIR)序列:T2像。其主要用于更好地观察结构象。跟踪随访患者3个月后患者的失语恢复情况以及磁共振测量结果,探寻出具有指导其预后意义的功能磁共振评估指标。结果在本研究收集的20例颅脑外伤及出血性脑卒中导致的运动性失语中,所有例患者其ALFF分析均提示语言功能脑区活动异常,进一步证实了运动性失语产生的原因,为左侧额下回后部及其邻近区的病变所引起。同时我们发现,不仅仅左侧额下回后部脑区活动出现异常,颅内多个脑区出现不同程度的增高及减弱。本研究中16例患者预后不佳,但均较有所好转,遗留一定程度的失语情况.对比失语后恢复较好的病人和恢复较差的病人,我们发现,恢复较好的病人,其后扣带回区ALFF值减低程度小于恢复较差的病人,其右侧镜像区(mirror region)出现不同程度活动增强。结论运动功能磁共振技术,结合3D T1.T2 FLAIR结构序列以及静息态功能磁共振ALFF分析,从一定程度可以评估运动性失语患者的预后,其后扣带回脑区ALFF值的大小以及右侧镜像区是否出现活动增强,与该患者预后有着紧密的关系。
[Abstract]:Objective to analysis using functional MRI imaging 3D T1.T2 FLAIR sequence and resting state functional magnetic resonance ALFF on traumatic brain injury and motor aphasia caused by cerebral hemorrhagic stroke (Motor aphasia) cognition, systematically studies the neural mechanisms, and explore the effect of the pre evaluation index after fMRI. For the majority of neurosurgeons in the face of the families of patients asked whether can rehabilitation, provide imaging basis, prognosis is better and more effective evaluation of patients, and then guide the late rehabilitation treatment, improve the treatment level. Methods from 2014 to December 2015 at Hangzhou Normal University Affiliated Hospital Department of Neurosurgery treated 20 cases of traumatic brain injury and hemorrhagic stroke (including acute subdural hematoma in 5 who left basal ganglia hemorrhage in 11, AVM 4) motor aphasia caused by patients with 3.0T functional magnetic resonance imaging, mainly including Under the magnetic function sequence: 1. resting state functional magnetic resonance (resting-state functional magnetic resonance imaging, RS-fMRI) scanning, acquisition time of 8 minutes before the start of the scan, inform the patient to relax and relieve stress, even breathing, not nervous, to make blind and disorderly conjectures of patient safety alerts, remote control, so that patients in an emergency can timely notice in the scan, the magnetic resonance indoor lights off, to avoid interference. On the completion of the resting state fMRI data for low-frequency amplitude (amplitude of low frequency fluctuation, ALFF) analysis on the collected first; resting state data preprocessing, mainly includes the following steps: (1) the removal of the resting 10 former state fMRI image time point data; (2) time correction; (3) head motion correction; (4) spatial normalization; (5) smoothing; (6) to the linear drift (7) filter (8) to the covariate spoiled gradient echo double.2. T1 (spoiled gradient recalled echo weighted imaging, T1-weighted imaging, SPGR-T1 WI): analysis of whole brain T1 weighted scan; time of 5 minutes and 5 seconds, mainly used to observe the structure and production of whole brain gray matter template using 3D-T1 image acquisition, acquisition of whole brain low-frequency amplitude figure.3. liquid attenuation inversion recovery (fluidattenuated inversion, recovery, FLAIR) sequence T2: like. It is mainly used for better observation of the structure. And like magnetic resonance measurement results of the recovery of the patients with aphasia after 3 months of follow-up were explored with functional magnetic resonance guidance the prognostic significance of the evaluation index. Results in 20 cases of craniocerebral trauma were collected for this study and hemorrhagic stroke Anandia in all cases, the ALFF analysis indicated that language function abnormal brain activity, further confirmed the cause of motor aphasia caused by left inferior frontal gyrus and adjacent posterior part The lesions caused by. We also found that not only the left posterior inferior frontal gyrus brain activity is abnormal, intracranial multiple brain regions increase and decrease in varying degrees. The poor prognosis of 16 patients in the study, but were improved, aphasia legacy to a certain extent. The ratio of patients recovered well after aphasia and the poor recovery of patients, we found that patients with good recovery, the cingulate cortex decreased ALFF level is less than the poor recovery of patients, the right side of the mirror (mirror region) with varying degrees of activity. Conclusion the motor functional magnetic resonance technology, combined with 3D T1.T2 FLAIR structure sequence and resting state functional magnetic resonance ALFF analysis. Can predict the prognosis of the patients with motor aphasia in a certain degree, then the cingulate regions of the brain ALFF value and the right image area is enhanced, and the prognosis is closely The relationship.

【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

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