局灶性癫痫的静息态功能磁共振成像研究

发布时间：2018-02-16 16:21

本文关键词： 静息态磁共振脑功能成像局部一致性低频振幅低频振幅分数颞叶内侧癫痫　出处：《天津医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：探讨基于ReHo、ALFF及fALFF的静息态功能磁共振成像技术对于局灶性癫痫致痫灶检查的可行性,并比较与其他技术(MRI、VEEG和FDG-PET)的诊断效能。对象与方法：选择经临床综合诊断局灶性癫痫52例,采用SIEMENS TRIO3.0T MR扫描仪对所有患者行常规MRI、海马高分辨成像以及静息态fMRI扫描。采用Matlab7.1和SPM8对静息态数据进行预处理。预处理后的数据采用REST1.4软件行ReHo、ALFF和fALFF三种不同分析方法处理获取激活图,然后对三种分析方法的处理结果分别进行组水平和个体水平两部分研究。第一部分：采用REST1.4软件对20例单侧颞叶内侧癫痫患者(13例左侧,7例右侧,对7例右侧颞叶癫痫患者的图像进行翻转)和与之年龄、性别相匹配的正常志愿者20例行静息态fMRI扫描。经ReHo, ALFF和fALFF分析获得的静息态数据分别进行全脑水平和双侧颞叶内侧水平两样本t检验分析；第二部分：对52例诊断为局灶性癫痫患者行常规MRI、VEEG、FDG-PET和RS-fMRI检查的结果分别进行比较,统计分析这些技术定位致痫灶的敏感性、特异性、阳性预测值和阴性预测值差异,并对ReHo、ALFF及fALFF三种不同分析方法定位致痫灶的敏感性、特异性、阳性预测值和阴性预测值的差异进行统计分析。结果： 1、ReHo、ALFF、fALFF三种分析方法均可以显示左侧颞叶内侧癫痫患者组局部异常的脑功能活动；患者组增加的异常脑活动区域主要位于左侧颞叶内侧结构和致痫灶同侧脑区域。 2、经卡方检验分析,分别比较MRI、VEEG、FDG-PET与RS-fMRI定位致痫灶敏感性、特异性、阳性预测值和阴性预测值的统计学差异。①MRI与RS-fMRI的诊断敏感性差异具有统计学意义,RS-fMRI敏感性高于MRI(x2值为8.60,P值为0.0034)。而VEEG、FDG-PET与RS-fMRI的诊断敏感性差异不具有统计学意义(P值均大于0.05)。②MRI、VEEG、FDG-PET与RS-fMRI的诊断特异性、阳性预测值和阴性预测值之间均无统计学意义(P值均大于0.05)。 3、经卡方检验分析,比较ReHo、ALFF和fALFF三种分析方法定位致痫灶敏感性、特异性、阳性预测值和阴性预测值的统计学差异。①ReHo与ALFF和fALFF诊断敏感性差异具有统计学意义,ReHo的诊断敏感性高于ALFF和fALFF(x2值分别为4.63和8.82,P值分别为0.0314和0.0030),但ALFF和fALFF诊断敏感性差异不具有统计学意义(P值均大于0.05)。②ReHo、ALFF和fALFF三者之间的诊断特异性、阳性预测值和阴性预测值差异比较均无统计学意义(P值均大于0.05)。结论： 1、基于ReHo、ALFF、fALFF分析方法的RS-fMRI具有较好的可行性,具有定位局灶性癫痫致痫灶和网络的潜在能力。 2、基于ReHo、ALFF、fALFF的RS-fMRI具有相对高的敏感性和特异性定位致痫灶,与目前临床领域常用的定位技术比较,其效能高于常规MRI,与VEEG和FDG-PET有相似的诊断效能,可用于临床病例的研究。
[Abstract]:Objective: to investigate the feasibility of resting functional magnetic resonance imaging (Mr) based on Rehoff ALFF and fALFF in the diagnosis of epileptogenic foci caused by focal epilepsy, and to compare the diagnostic efficacy of MRIVEEG and FDG-PET with other techniques. Participants and methods: 52 cases of focal epilepsy diagnosed by clinical comprehensive diagnosis were selected. SIEMENS TRIO3.0T Mr scanner was used for routine MRI, hippocampal high-resolution imaging and resting fMRI scanning in all patients. The rest data were preprocessed by Matlab7.1 and SPM8. The data were preprocessed by REST1.4 software, ReHohaliff and fALFF. The analysis method processes to obtain the activation map, Then the results of the three methods were studied in two parts: group level and individual level. The first part: using REST1.4 software, 13 patients with unilateral medial temporal lobe epilepsy were treated with left side and 7 patients with right side. The images of 7 patients with right temporal lobe epilepsy were flipped) and aged. The rest state data obtained by Reho, ALFF and fALFF analysis were analyzed by t-test at global brain level and bilateral medial temporal lobe level, respectively. Part two: 52 patients with focal epilepsy were examined by conventional MRII-VEEGG-PET and RS-fMRI respectively. The sensitivity, specificity, positive predictive value and negative predictive value of the epileptogenic foci were statistically analyzed. The sensitivity, specificity, positive predictive value and negative predictive value of epileptogenic foci were analyzed statistically. Results:. 1ReHoFFFFfALFF could show abnormal brain function in patients with left medial temporal lobe epilepsy, and the increased abnormal brain activity was mainly located in the medial structure of left temporal lobe and the ipsilateral brain region of epileptogenic foci. 2. The sensitivity and specificity of MRI VEEGG PET and RS-fMRI localization for epileptogenic foci were compared by chi-square test. The difference of diagnostic sensitivity between positive predictive value and negative predictive value was statistically significant. The sensitivity of RS-fMRI was higher than that of MRI(x2 (8.60% P = 0.0034), but there was no significant difference in diagnostic sensitivity between VEEGFDG-PET and RS-fMRI. The diagnostic specificity of VEEGG-PET and RS-fMRI was higher than 0.05%. There was no significant difference between the positive predictive value and the negative predictive value (P > 0.05). 3. The sensitivity and specificity of the three methods for localization of epileptogenic foci were compared between Rehoff and fALFF by chi-square test. The diagnostic sensitivity of ReHo was higher than that of ALFF and fALFF(x2 (4.63 and 8.82 P = 0.0314 and 0.0030, respectively), but the diagnostic sensitivity of ALFF and fALFF was higher than that of ALFF and fALFF. The difference between positive predictive value and negative predictive value was statistically significant. The diagnostic sensitivity of ReHo was higher than that of ALFF and fALFF(x2, respectively. The sex difference was not statistically significant (P > 0.05) and the diagnostic specificity between ReHoALFF and fALFF was significant. The difference between positive predictive value and negative predictive value was not statistically significant (P > 0.05). Conclusion:. 1. The RS-fMRI based on ReHoFFFfALFF analysis method is feasible and has the potential ability to locate focal epileptogenic foci and networks. 2. The RS-fMRI based on ReHoFFFfALFF has relatively high sensitivity and specificity in localization of epileptogenic foci. Compared with conventional localization techniques in clinical field, its efficacy is higher than that of conventional MRIs. It has similar diagnostic efficacy to VEEG and FDG-PET, and can be used in clinical case studies.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.2;R742.1

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