扩散峰度成像对视神经脊髓炎脑实质微观组织的研究

发布时间：2018-03-21 20:37

  本文选题：视神经脊髓炎　切入点：磁共振成像　出处：《大连医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:本研究运用扩散峰度成像技术(diffusionkurtosis imaging,DKI)对视神经脊髓炎(Neuromyelitisoptica,NMO)患者及健康对照人群的脑实质进行检测,比较分析视神经脊髓炎患者颅内细微组织结构的变化情况,探讨扩散峰度成像技术对视神经脊髓炎的临床诊断及预后评价的应用价值。材料与方法:收集从2014年11月到2016年12月之间于大连医科大学附属第一医院神经内科住院的NMO患者10名作为病例组。病例组中包括男患者1人,女患者9人,年龄28～53岁,平均年龄(41.1±8.49)岁,并由研究脱髓鞘病的神经内科医师根据其临床症状对其进行EDSS评分。收集本市同期10名健康志愿者作为健康对照组,要求其年龄性别与病例组相匹配。在所有参与人员知情同意的情况下,采用3.0TMRI进行常规及DKI序列的检测。将扫描后获得图像利用ADW4.4工作站中Functool软件进行分析,然后即可获得本研究应用的相关参数,包括径向峰度(radial kurtosis,RK)、轴向峰度(axial kurtosis,AK)、平均扩散峰度(mean kurtosis,MK)、径向弥散率(radial diffusion ratio,RD)、轴向弥散率(axial diffusion ratio,AD)、平均弥散率(medial diffusion ratio,MD)对应图像,分别对常规MRI表现正常的顶叶、枕叶、颞叶、额叶区白质,内囊(前肢、后肢)、胼胝体(压部、膝部)白质纤维束的感兴趣区进行RK、AK、MK、RD、AD、MD的测量。因为灰质具有高度各向同性,方向性参数在灰质具有明显误差,因此对壳核、苍白球、尾状核、丘脑脑深部灰质核团仅测量MD及MK值。每一部位的感兴趣区在同一层面左右两侧各测量3次,取平均值作为最后结果。采用SPSS 21.0统计学应用软件对所有检测区获得的数据进行分析。对视神经脊髓炎组与健康对照组各检测区所获得的DKI参数均值进行两独立样本t检验,比较两组数据间是否存在差异;应用Spearmans相关分析视神经脊髓炎组各部位DKI参数与EDSS评分量表之间的相关性。将P0.05作为具有统计学差异的标准。结果:1.视神经脊髓炎患者所有检测的白质及纤维束区AK、MK值均升高,但只有颞叶的AK值明显升高(P0.05)。额叶、顶叶、枕叶区白质,内囊(前肢、后肢)、肼胝体部(压部、膝部)白质纤维束的RK值略上升,颞叶RK值略降低(P0.05)。2.视神经脊髓炎患者颞叶、枕叶区白质及内囊后肢RD值明显下降,顶叶、枕叶、颞叶、额叶区白质,内囊(前肢、后肢)、胼胝体压部的白质纤维束的MD值明显下降,顶叶、颞叶、额叶区、内囊部(前肢、后肢)、胼胝体部(压部、膝部)的AD值下降明显(P0.05)。3.视神经脊髓炎患者苍白球部MK值升高明显,所检测的灰质核团MD值均明显下降(P0.05)。4.NMO患者壳核、额叶的MK值,顶叶和胼胝体压部的AK值与EDSS评分成负相关(P0.05)。结论:1.DKI是一项能够量化人体内水分子非高斯分布方式扩散的MRI新技术,能够更加真实、敏锐发现组织细微结构改变。2.与常规MRI相比,DKI可早期发现NMO颅内组织的细微损伤,有助于疾病的早期诊断。3.DKI的MK及AK值可以评估NMO患者的预后情况。
[Abstract]:Objective: in this study, diffusion kurtosis imaging (DKI) was used to detect the brain parenchyma in patients with neuromyelitis optica NMOA (NMOA) and healthy controls, and to compare and analyze the changes of intracranial fine tissue structure in patients with optic neuromyelitis. To explore the value of diffusion kurtosis imaging in the clinical diagnosis and prognosis evaluation of optic neuromyelitis. Materials and methods: collected from November 2014 to December 2016, Department of Neurology, first affiliated Hospital, Dalian Medical University. Ten hospitalized NMO patients as case groups. The case group included a male patient. Nine female patients, aged 28 to 53 years, with an average age of 41.1 卤8.49 years, were assessed by neurologists for demyelinating disease according to their clinical symptoms. Ten healthy volunteers in the same period were collected as healthy control group. With the informed consent of all the participants, the routine and DKI sequences were detected by 3.0TMRI. The images were scanned and analyzed by Functool software in ADW4.4 workstation. Then the relevant parameters used in this study were obtained, including radial kurtosis, axial kurtosis, mean diffusion kurtosism, radial diffusion diffusion, axial kurtosiskurtosis, radial diffusion rate, axial diffusion rate and medial diffusion diffusion. The area of interest in the white matter of the parietal lobe, occipital lobe, temporal lobe, frontal lobe, internal capsule (forelimb, hind limb, corpus callosum (bulbar, knee)) of the normal parietal lobe, occipital lobe, temporal lobe, frontal lobe, and internal capsule (forelimb, hind limb, corpus callosum) was measured respectively by MRI. The directional parameters have obvious errors in gray matter, so the MD and MK values of putamen nucleus, globus pallidus, caudate nucleus and thalamic deep gray nucleus were measured only. The average value was taken as the final result. The data obtained from all the test areas were analyzed by SPSS 21.0 statistical software. Two independent sample t tests were performed on the mean DKI parameters obtained from each test area of the optic neuromyelitis group and the healthy control group. To compare the differences between the two groups of data; Spearmans correlation analysis was used to analyze the correlation between DKI parameters and EDSS score scale in optic neuritis group. P05 was taken as the standard of statistical difference. Results: 1. AK MK values in white matter and fibrous bundles were all increased in all patients with optic neuromyelitis. However, only the AK value of temporal lobe increased significantly (P 0.05). The RK value of white matter in frontal lobe, parietal lobe, occipital area, internal capsule (forelimb, hind limb, hydrazine callus, knee) increased slightly, and the RK value of temporal lobe decreased slightly (P 0.05. 2) in patients with optic neuromyelitis. The Rd value of white matter in occipital lobe and posterior limb of internal capsule decreased significantly, the MD value of white matter fiber bundle in parietal lobe, occipital lobe, temporal lobe, frontal lobe, temporal lobe, frontal lobe, internal capsule (forelimb, posterior limb, corpus callosum) decreased significantly, parietal lobe, temporal lobe, frontal lobe, internal capsule (forelimb). The AD value of the posterior limb, corpus callosum (bulbar, knee) decreased significantly (P0.050.3.The MK value of the globus pallidus increased significantly in the optic neuromyelitis patients, and the MD values of the gray matter nuclei decreased significantly in the putamen and frontal lobes of the patients with NMO, and the MK values in the frontal lobe and the putamen nucleus of the patients with NMO were significantly decreased. The AK value of parietal lobe and corpus callosum was negatively correlated with EDSS score (P 0.05). Conclusion: 1. DKI is a new MRI technique which can quantify the diffusion of water molecules in human body by non-#china_person0# distribution, and can be more realistic. Compared with routine MRI, DKI can detect the slight injury of NMO early, which is helpful to the early diagnosis of disease. 3. The MK and AK values of DKI can evaluate the prognosis of NMO patients.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.2;R744.52
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