高清晰弥散张量成像在鞍区肿瘤的应用研究

发布时间：2018-05-13 00:33

本文选题：MRI + 弥散张量成像　；参考：《福建中医药大学》2017年硕士论文

【摘要】：目的:检测健康成人前视路DTI指标的正常值范围,分析其分布特点及影响因素。探讨鞍区肿瘤患者前视路DTI指标、DTT图形态结构的变化特征,并分析其与手术后视觉功能改变和预后的关系。方法:选取健康成年志愿者38例,女20例,男18例,年龄18～80岁,平均(38.2± 15.9)岁。既往无眼科、糖尿病等病史,现无阳性视觉传导系统症状和体征,并能配合完成视力、视野检查及MRI扫描。使用3.0TMRSkyra扫描仪(Siemens公司,柏林,德国),对检查者除常规序列扫描外,还采用分段读出平面回波成像序列(RS-EPI)进行前视路轴位DTI扫描(薄层扫描找到适宜定位片的倾斜角,以能清晰看到前视路形态结构为准),9个分段数,30个弥散梯度方向。由同一名影像科高年资技师进行图像扫描,采用3.0T MR Skyra扫描仪自带的后处理工作站软件,由两名高年资的影像科医生进行DTI指标采集和DTT影像重建。轴位上检测双侧视神经中点、视交叉正中点及双侧视束中点的FA、ADC值,以其代表前视路各部位的FA值和ADC值。经后处理在DTT图上重建出前视路纤维束,观察其形态结构情况。选取福州总医院诊断为鞍区肿瘤并接受手术治疗的成年患者,为鞍区肿瘤组。排除标准:合并有鞍区之外的颅内肿瘤,术前接受过放疗或肿瘤复发或残留而再次手术,术后免疫组化结果为非肿瘤性疾病,有MRI扫描禁忌的,或依从性差不能完成术后检查随访的患者。鞍区肿瘤组共入选21例。同时配对选取与鞍区肿瘤组匹配的健康成人21例作为对照组。鞍区肿瘤组与健康成人对照组在鞍区肿瘤组手术前1周内同时行轴位前视路DTI扫描。鞍区肿瘤组在手术后4个月时复查前视路DTI。运用VIS(visual impairment score)评分分级表进行视觉功能的评估。将前视路分为肿瘤前方的视神经、肿瘤区的视交叉及肿瘤后方视束3个部位,测量方法同健康成人对照组。测定两组前视路中每个部位的FA值、ADC值,并据此计算以上3个部位的值。对比分析研究这些值的差异及其与VIS分级的关系。统计分析采用SPSS20.0版本软件进行,P0.05认为差异有统计学意义。结果:前视路DTI的彩色编码FA图像表现:正常前视路呈较均匀的绿色信号。ADC图像表现:正常前视路呈灰色,与正常脑组织灰度可区分,脑脊液呈白色信号。DTT图可三维显示正常前视路纤维束形态,且后处理软件界面可任意角度旋转DTT图对前视路纤维束进行观察。前视路DTI的定量指标FA与ADC值呈显著负相关,r =-0.693,P0.001。整个前视路的FA、ADC值与性别、年龄无关(P0.05)。不同前视路部位的FA值、ADC值存在显著差异(P0.05),视交叉与视神经、视束之间有显著差别(P0.05),视神经与视束之间无明显差别(P0.05),视交叉处FA值最低ADC值最高。鞍区肿瘤组,DTT图中可三维观察前视路纤维束形态结构(连续、中断、饱满或稀疏);并且可观察前视路纤维束与肿瘤之间的空间位置关系:前视路神经纤维束是受肿瘤挤压变形移位,还是被肿瘤组织包绕。鞍区肿瘤组的前视路纤维束形态与视觉功能的VIS评分分级无关(P0.05),但与预后关系显著(P0.05),依据视觉功能VIS评分预后分组,术前前视路纤维束形态结构连续型的患者,在术后4个月时,视觉功能恢复要好于中断型(P0.05)。鞍区肿瘤组在肿瘤前方的视神经、肿瘤区的视交叉及肿瘤后方的视束这3个区域的FA值均显著低于健康成人对照组(P0.05),而ADC值均显著高于健康成人对照组(P0.05)。FA、ADC值在前视路各部位之间存在显著性差异(P0.001),视神经与视束无明显差异(P0.05),视交叉FA值显著低于视神经、视束(P0.001),视交叉ADC值显著高于视神经、视束(P0.001)。对照组FA值在3个部位之间存在显著性差异(P0.001),而视神经与视束无明显差异(P=0.998);视交叉显著低于视神经、视束(P0.001);对照组ADC值在3个部位之间存在显著性差异(P0.001),而视神经与视束无明显差异(P=0.122);视交叉显著高于视神经、视束(P0.001)。鞍区肿瘤组术后4个月整个前视路FA值较术前明显上升(P0.05),ADC值明显下降(P0.05)。其中,肿瘤前方视神经、肿瘤部位的视交叉及肿瘤后视束术后4个月的FA值均较术前显著上升(P0.05),且肿瘤视交叉部位的回升程度大于视神经、视束(P0.05)。而术后4个月的ADC值也发生了类似FA值的恢复情况。鞍区肿瘤组术前FA、ADC值与VIS评分及分级无关(P0.05)。鞍区肿瘤组术后视交叉部位FA值升高组的病情改善率为92.99%,显著高于FA值下降组的28.6%(P=0.006)。由此,鞍区肿瘤术后视交叉部位FA值的变化是视觉功能预后的良好预测指标,其敏感度、特异度、阳性预测值及阴性预测值分别为 86.7%、83.3%、92.9%、71.4%。结论FA值和ADC值是DTI的敏感且可靠的指标,可用于前视路的定量分析。DTT图可三维显示前视路神经纤维束的形态结构,可将其用来判断鞍区肿瘤病人的预后,DTT图上前视路形态结构连续型的患者,其预后要好于中断型。鞍区肿瘤患者的前视路DTI指标可在整个前视路发生不同程度变化,视交叉处尤为显著。手术后这些变化在前视路不同部位出现不同程度的恢复,并与视觉功能的改善相关,鞍区肿瘤术后视交叉部位FA值上升与视觉功能预后成正相关。
[Abstract]:Objective: to detect the normal range of DTI index in healthy adults, analyze its distribution characteristics and influence factors. To explore the DTI index of the anterior vision and the morphological changes of the DTT map in the sellar tumor patients, and to analyze the relationship between the changes of the visual function and the prognosis after the operation. Methods: 38 healthy adult volunteers, 20 women, 18 men, and a year were selected. The average age of 18~80 years (38.2 + 15.9) years old. The history of non Ophthalmology, diabetes and other diseases, there is no positive visual conduction system symptoms and signs, and can cooperate with the completion of visual acuity, visual field examination and MRI scan. Using the 3.0TMRSkyra scanner (Siemens, Berlin, Germany), in addition to the routine sequence scan, the inspector also uses segmented readout plane echo. Image sequence (RS-EPI) scan the front optic axis position DTI scan (TLC scan to find the inclined angle of the suitable location plate, to clearly see the shape and structure of the forward view), 9 segments and 30 dispersion gradient directions. The image scanning of the same image technician, and the software of the post processing workstation with the 3.0T MR Skyra scanner. Two senior imaging doctors performed DTI index collection and DTT image reconstruction. On the axis, the midpoint of bilateral optic nerve, the FA, ADC value of the midpoint of the optic intersecting and bilateral optic tract were measured to represent the FA and ADC values of the various parts of the anterior vision. After the post-processing, the fibrous bundles of the anterior vision were rebuilt on the DTT map, and the morphological structure of the anterior optic pathway was observed. The State General Hospital, diagnosed as a sellar tumor and undergoing surgical treatment, is a sellar tumor group. The exclusion criteria: intracranial tumors outside the saddle area, the preoperative radiotherapy or tumor recurrence or residual reoperation, the postoperative immunohistochemical result is a non tumor disease, the MRI scan is taboo, or the compliance is not complete. 21 cases in the sellar region tumor group were selected and 21 healthy adults matched with the sellar region tumor group were selected as the control group. The saddle area tumor group and the healthy adult control group underwent DTI scan at the same time in the sellar region tumor group 1 weeks before the operation. The saddle area tumor group rechecked the DTI. transport of the preoptic route at 4 months after the operation. The VIS (visual impairment score) grading scale was used to evaluate the visual function. The anterior optic pathway was divided into the optic nerve in front of the tumor, the optic chiasma in the tumor area and the posterior optic tract of the tumor in 3 parts. The measurement method was compared with the healthy adult control group. The FA value and the value of each part of the two groups were measured, and the values of the above 3 parts were calculated. Comparative analysis and analysis of the differences in these values and the relationship with the VIS classification. Statistical analysis was carried out with the SPSS20.0 version software, and P0.05 thought the difference was statistically significant. Results: the color coded FA image of the front view road DTI: the normal front road showed a more uniform green signal.ADC image, the normal front view was gray, and the normal brain tissue was grey. The degree can be distinguished, the cerebrospinal fluid is white signal.DTT map can display the normal anterior optic tract fiber bundle form, and the post-processing software interface can rotate DTT map to observe the anterior optic tract. The quantitative index of DTI of the anterior vision FA is negatively correlated with the ADC value, R =-0.693, P0.001. the whole anterior vision FA, ADC value is independent of sex and age. P0.05). There was a significant difference (P0.05) in the value of ADC in different preoptic pathways. There was a significant difference between optic and optic nerve (P0.05), there was no significant difference between optic and optic tract (P0.05), and the lowest ADC value at the optic intersection (P0.05). In the sellar tumor group, the morphological structure of the fibrous bundle of the anterior vision was observed in the DTT map (continuous, interruption, satiety). The spatial relationship between the anterior optic fiber bundle and the tumor can be observed: the anterior optic nerve fiber bundle is shifted by the tumor and is wrapped around the tumor tissue. The VIS score of the anterior optic tract of the sellar tumor group has no correlation with the visual function (P0.05), but it has a significant relationship with the prognosis (P0.05), depending on the view. The visual function recovery was better than that of interruption (P0.05) at 4 months after operation. The FA values in the 3 regions of the sellar tumor group in front of the tumor were significantly lower than those in the healthy control group (P0. 05), the value of ADC was significantly higher than that of the healthy adult control group (P0.05).FA, and the value of ADC was significantly different between the various parts of the anterior vision (P0.001). There was no significant difference between the optic nerve and the optic tract (P0.05). The optic cross FA value was significantly lower than the optic nerve, the optic tract (P0.001), and the optic intersecting ADC was significantly higher than the optic nerve and the optic tract (P0.001). The FA value of the control group was in the 3 parts. There was significant difference (P0.001) between the optic nerve and the optic tract (P=0.998); the optic chiasma was significantly lower than the optic nerve and the optic tract (P0.001); the ADC value of the control group was significantly different between the 3 sites (P0.001), but the optic nerve was not significantly different from the optic tract (P =0.122); the optic chiasm was significantly higher than the optic nerve, the optic tract (P0.001) and the sellar tumor group operation. The FA value of the whole anterior approach increased significantly (P0.05) in the first 4 months (P0.05), and the ADC value decreased significantly (P0.05). Among them, the FA value of the optic nerve in front of the tumor, the optic chiasma at the tumor site and the postoperative posterior optic tract of the tumor were significantly higher than that before the operation (P0.05), and the recovery of the optic intersections of the tumor was greater than that of the optic nerve and the optic tract (P0.05). And the AD of the 4 months after the operation. The C value also occurred similar to the recovery of the FA value. The preoperative FA, ADC value of the sellar tumor group was not related to the VIS score and classification (P0.05). The improvement rate of the FA value group in the optic cross section of the sellar tumor group was 92.99%, significantly higher than the 28.6% (P=0.006) in the FA value reduction group. Thus, the change of the FA value of the optic cross site after the sellar tumor operation was the visual function. A good predictor of prognosis, its sensitivity, specificity, positive predictive value and negative predictive value were 86.7%, 83.3%, and 92.9%, respectively. 71.4%. conclusion FA and ADC values are sensitive and reliable indicators of DTI, which can be used in the quantitative analysis of the anterior optic pathway for the three-dimensional display of the morphological structure of the anterior optic nerve fiber bundle, which can be used to judge the sella swollen. The prognosis of the patients with tumor is better than that of interruption. The DTI index of the anterior vision of the patients with sellar region tumor can be changed to varying degrees in the whole anterior vision, especially in the optic intersection. These changes have been recovered at different levels in the anterior vision and the visual function after the operation. Correlation between the FA value of the optic cross area and the prognosis of visual function after sellar tumor operation was positively correlated.

【学位授予单位】：福建中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.2;R739.41

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