隐匿性脑瘫的VBM、DTI和静息态脑功能成像研究

发布时间：2018-02-01 23:53

本文关键词： 脑瘫磁共振成像基于体素的形态测量学基于纤维束示踪的空间统计分析静息态脑功能成像　出处：《中国人民解放军医学院》2014年博士论文　论文类型：学位论文

【摘要】：目的：通过基于体素的形态测量学（voxel-based morphometry, VBM）、纤维束示踪的空间统计分析（tract-based spatial statistics，TBSS）和静息态脑功能成像（restingstate functional magnetic resonance imaging, resting state fMRI）分析隐匿性痉挛双瘫(spastic diplegic cerebral palsy, SDCP)的全脑结构和功能的改变，探讨隐匿性SDCP的脑损伤模式。方法：我们选用16例隐匿性SDCP患者和16例年龄、性别与之相匹配的正常对照组，磁共振常规扫描均未见异常。所有患者均行粗大运动功能评分（Gross MotorFunction Classification System, GMFCS）。所有受试者进行磁共振扫描,获取三维磁化准备快速梯度回波（3D magnetization prepared rapid gradient echo,3D MP-RAGE）T1加权像（T1weighted imanging, T1WI）、弥散张量成像（diffusion tensor imaging,DTI）数据，其中12例隐匿性SDCP患者和14例正常对照组行静息态脑功能成像扫描，扫描范围包括全部大脑。采用VBM技术比较隐匿性SDCP与健康志愿者脑灰白质体积差异，采用两独立样本t检验进行统计学分析。采用TBSS技术比较隐匿性SDCP与健康志愿者脑各向异性分数(fractional anisotropy, FA)值变化，寻找有显著性差异的脑白质纤维。并对隐匿性SDCP患者的灰白质差异点与GMFCS进行相关性分析。评估隐匿性SDCP患者静息状态下脑局部一致性（regionalhomogeneity, ReHo）、低频振幅（amplitude of low frequency fluctuation，ALFF）以及关键脑区包括中央前回和丘脑的功能连接（functional connectivity, FC）改变。结果：与正常对照组相比，隐匿性SDCP双侧基底节区、丘脑、岛叶和左侧中脑灰质体积减少，胼胝体后部和右侧放射冠白质体积减少，全脑灰白质未见体积增加。隐匿性SDCP脑灰质与白质的体积减少与患者的GMFCS均无显著相关性。隐匿性SDCP的多个纤维束FA值显著低于正常对照组，主要包括双侧皮质脊髓束、中央前后回及旁中央小叶、前额叶、颞叶、内囊和外囊、胼胝体、扣带回、丘脑、脑干和小脑等部位的纤维束。其中双侧前额叶、丘脑、内囊、胼胝体和脑干的纤维束与GMFCS呈显著负相关。相对于正常对照组，隐匿性SDCP患者脑ReHo值减低区域主要包括双侧额顶颞叶、小脑、右侧扣带回和右侧豆状核，增加区域包括左侧楔前叶、距状回、梭状回和右侧楔前叶。隐匿性SDCP组全脑ALFF未见明显增高或减低区域。功能连接分析显示与双侧中央前回功能连接减低区域主要位于左侧的颞叶和双侧的颞枕叶，包括双侧梭状回和舌回；功能连接增强区域主要位于对侧中央前后回和运动辅助区以及同侧的中央后回。双侧丘脑功能连接减低的区域主要包括双侧基底节区、扣带回和前额叶；连接增强的区域主要包括双侧的中央前回、对侧小脑。结论：隐匿性SDCP的脑结构和功能改变存在特定的空间分布模式，，其特定的分布可能与该病的病理基础有关。这些异常有助于理解隐匿性SDCP的发病机制，从而提供早期诊断的潜在影像学指标。
[Abstract]:Objective: through voxel based morphometry (voxel-based morphometry, VBM), spatial statistical analysis tractography (tract-based spatial statistics, TBSS) and resting state functional brain imaging (restingstate functional magnetic resonance imaging, resting state fMRI) analysis of occult spastic diplegia (spastic diplegic cerebral palsy, SDCP) - the change of structure and function of brain, brain injury model of occult SDCP.
Methods: We selected 16 cases of occult SDCP patients and 16 age, gender matched normal control group with the routine MRI scan were normal. All patients underwent gross motor function score (Gross MotorFunction, Classification System, GMFCS). MRI scans of all subjects, obtaining three-dimensional magnetization prepared rapid gradient echo (3D magnetization prepared rapid gradient echo, 3D MP-RAGE T1 (T1weighted) Imanging, T1WI weighted imaging, diffusion tensor imaging (diffusion), tensor imaging, DTI) data, including 12 cases of occult SDCP patients and 14 cases of normal control group underwent resting state fMRI scanning, the scanning range includes all the brain. VBM technology of SDCP compared with healthy volunteers gray matter volume differences in hiding, using two independent sample t test was used for statistical analysis. Using TBSS technology is the occult SDCP and health Kang volunteers (fractional anisotropy, fractional anisotropy value change, FA) for cerebral white matter fiber had significant difference. And the difference of gray matter in patients with occult SDCP and GMFCS correlation analysis. The assessment of occult SDCP patients in resting state brain regional homogeneity (regionalhomogeneity, ReHo), low frequency (amplitude amplitude of low frequency fluctuation, ALFF) and the key brain regions including the precentral gyrus and thalamus functional connectivity (functional connectivity, FC).
Results: compared with normal control group, thalamus occult SDCP in bilateral basal ganglia, and insula and left midbrain decreased gray matter volume, corpus callosum and right coronaradiata posterior white matter volume decreased, whole brain gray matter volume was increased. The occult SDCP of brain gray matter and white matter volume reduction had no significant correlation with patients GMFCS. A plurality of fiber bundle FA occult SDCP was significantly lower than that of the normal control group, including bilateral corticospinal tract, and posterior central gyrus and paracentral lobule, prefrontal cortex, temporal lobe, internal capsule and external capsule, corpus callosum, cingulate gyrus, thalamus, cerebellum and brainstem fibers and other parts of the prefrontal cortex. Among them, the internal capsule, thalamus, corpus callosum and brainstem fiber bundle was negatively correlated with GMFCS.
Compared with the normal control group, the areas of ReHo decrease in patients with occult SDCP mainly include bilateral fronto fronto temporal lobe, cerebellum, right cingulate gyrus and right lenticular nucleus, and the increased areas include the left anterior cingulate lobe, the distance like gyrus, the fusiform gyrus and the right anterior cingulate lobe.
In the occult SDCP group, the whole brain ALFF did not significantly increase or decrease.
The functional connectivity analysis showed temporal and occipital lobe and bilateral precentral gyrus decreased functional connectivity areas were mainly located in the left temporal lobe and bilateral, bilateral fusiform gyrus and lingual gyrus; functional connectivity areas were mainly located in the contralateral supplementary motor area and posterior central gyrus and ipsilateral postcentral gyrus and bilateral thalamus decreased functional connectivity. Regions including bilateral basal ganglia, cingulate and prefrontal cortex; link enhancement region mainly include bilateral precentral gyrus, contralateral cerebellum.
Conclusion: there is a specific spatial distribution pattern of occult SDCP in brain structure and function. Its specific distribution may be related to the pathological basis of the disease. These abnormalities help to understand the pathogenesis of occult SDCP and provide potential imaging indicators for early diagnosis.

【学位授予单位】：中国人民解放军医学院
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R445.2;R742.3

【参考文献】