轻度创伤性脑损伤的扩散峰度成像及动脉自旋标记技术研究

发布时间：2018-05-17 02:19

本文选题：轻度创伤性脑损伤 + 基于纤维束示踪空间统计分析　；参考：《天津医科大学》2017年硕士论文

【摘要】：目的采用扩散峰度成像技术(Diffusion Kurtosis Imaging,DKI)及脉冲式动脉自旋标记技术(Pulsed Arterial Spin Labeling,PASL)对轻度创伤性脑损伤(Mild Traumatic Brain Injury,m TBI)患者的脑组织结构及脑血流量的变化进行分析,并研究影像学上这些变化与脑震荡后综合症严重程度的相关关系。对象和方法本研究纳入m TBI组患者20例(男性11例、女性9例,年龄23-45岁,平均年龄为30.5±7.4岁),格拉斯哥昏迷指数(Glasgow Coma Scale,GCS)评分均为15分;对照组(Normal Control,NC)正常志愿者15例(男性7例、女性8例,年龄22-50岁,平均年龄为32.7±9.9岁)。另外,本研究根据磁敏感加权成像(Susceptibility Weighted Imaging,SWI)的图像上有无轴索损伤对m TBI组患者进一步分组,分为有轴索损伤组[SWI(+)]8例和无轴索损伤组[SWI(-)]12例。所有图像均懫用Siemens公司Magnetom Trio Tim 3.0T MR扫描仪进行采集,采用8通道头线圈。所有受试者进行T1 MPRAGE序列、T2WI序列、SWI序列、DKI序列及PASL序列扫描。在进行扫描前对m TBI组患者进行Rivermead脑震荡后综合征问卷调查表(Rivermead Postconcussion Symptom Questionnaire,RPSQ)评分。DKI数据分析:(1)脑白质纤维束分析:通过Diffusional Kurtosis Estimator(DKE)软件得到各参数图(FA、MD、MK、AK、RK);采用FSL软件对NC组、SWI(-)组、SWI(+)组3组进行基于纤维束示踪空间统计(Tract Based Spatial Statistics,TBSS)分析和FA、MD、MK、AK、RK各参数与RPSQ评分的相关性分析。以年龄作为协变量。p0.05时认为结果存在统计学差异。(2)双侧丘脑分析:应用(1)中TBSS分析过程中已进行涡流校正、标准空间配准的各参数(FA、MD、MK、AK、RK)数据,对双侧丘脑进行感兴趣区(Region of interest,ROI)分析。统计分析应用SPSS21.0软件包进行,对NC组、SWI(-)组及SWI(+)组3组间左、右侧丘脑的FA、MD、MK、AK、RK值进行方差分析,两两组比较检验应用Bonferroni法;对各参数值与RPSQ量表评分进行Spearman相关性分析。以年龄作为协变量。p0.05时认为结果存在统计学差异。PASL数据分析:r CBF参数图通过MRI扫描仪自动得到,对脑组织的r CBF值进行ROI分析,感兴趣区域取双侧额叶、双侧顶叶、双侧枕叶、双侧颞叶及双侧丘脑。统计分析应用SPSS21.0软件包进行,对NC组、SWI(-)组及SWI(+)组3组间各个ROI区域的r CBF值进行方差分析,两两组比较检验应用Bonferroni法;对r CBF参数值与RPSQ量表评分进行Spearman相关性分析。年龄作为协变量。p0.05时认为结果存在统计学差异。结果DKI数据结果:(1)脑白质纤维束各参数值分析结果:SWI(-)组与NC组相比:SWI(-)组多个脑白质区域FA值升高、MD值降低、MK值升高、AK值升高及RK值升高;且DKI参数(AK)显示异常区域较DTI(FA、MD)广泛。SWI(+)组与NC组相比:SWI(+)组多个脑白质区域FA值降低、MD值升高、MK值降低、AK值降低及RK值降低。SWI(+)组与SWI(-)组相比:SWI(+)组多个脑白质区域FA值降低,、MD值升高、MK值降低、AK值降低及RK值降低。本研究未发现与RPSQ评分相关的白质区域。(2)双侧丘脑各参数值分析结果:SWI(+)组右侧丘脑MK值明显升高(两两组比较非Bonferroni法检验,p=0.043),余参数值均未出现明显变化。丘脑各参数值与RPSQ评分无明显相关性。PASL数据结果:SWI(-)组与NC组相比:SWI(-)组左侧枕叶r CBF值明显降低(p=0.021)。SWI(+)组与NC组相比:SWI(+)组左侧额叶、右侧顶叶、右侧枕叶、右侧颞叶的r CBF值均明显降低(左侧额叶:p=0.047,右侧顶叶:p=0.020,右侧枕叶:p=0.011,右侧颞叶:p=0.033)。SWI(+)组与SWI(-)组相比:SWI(+)组右侧颞叶的r CBF值明显降低(p=0.028)。左侧额叶r CBF值与RPSQ评分存在明显负相关(r=-0.598,p=0.007)。结论1.利用DKI技术对急性期轻度创伤性脑损伤患者进行研究,发现急性m TBI患者脑白质MK、AK、RK各参数值发生了异常变化,且参数AK在SWI(-)组发现的脑白质微结构异常范围较DTI参数(FA、MD)广泛,提示对于m TBI所致的脑白质的损伤,DKI对m TBI患者脑白质微结构损伤的评估较DTI敏感,同时提供了与DTI不同的微观变化信息,使我们能够更好地理解m TBI所致的脑白质的病理生理变化。2.利用DKI技术对急性期轻度创伤性脑损伤患者进行研究,发现急性m TBI患者丘脑的MK值发生变化,而DTI参数(FA、MD)未发生明显变化,说明DKI较DTI能敏感地发现m TBI患者脑灰质的异常,丘脑损伤也可能参与到m TBI患者神经功能障碍的发生发展过程中。3.利用PASL技术对急性期轻度创伤性脑损伤患者进行研究,发现急性m TBI患者脑组织血流量减低,而且一些区域的脑血流量与脑震荡后综合征的严重程度存在相关性,提示m TBI患者脑组织血流动力学的异常可能参与了临床症状产生。
[Abstract]:Objective to analyze the changes of brain tissue structure and cerebral blood flow in patients with mild traumatic brain injury (Mild Traumatic Brain) (Pulsed Arterial Spin Labeling, PASL) by Diffusion Kurtosis Imaging (DKI) and pulse arterial spin labeling (PASL), and to study these changes in imaging and imaging. The correlation of the severity of post concussion syndrome. Subjects and methods included 20 patients in group M TBI (male 11, female 9, age 23-45, average age 30.5 + 7.4 years old), and Glasgow coma index (Glasgow Coma Scale, GCS) scores were 15; Normal Control, NC (Normal Control, NC) normal volunteers were 15 cases (male 7 cases, female 8). For example, the age of 22-50 years, the average age of 32.7 + 9.9 years old. In addition, the study based on the Susceptibility Weighted Imaging (SWI) image without axonal injury to the m TBI group patients further divided into [SWI (+)]8 cases and the non axonal injury group [SWI (-)]12 cases. All images are Siemens company Mag. The netom Trio Tim 3.0T MR scanner was collected with 8 channel head coils. All subjects performed T1 MPRAGE sequence, T2WI sequence, SWI sequence, DKI sequence and PASL sequence scan. (1) the analysis of white matter fiber bundle: through Diffusional Kurtosis Estimator (DKE) software, each parameter diagram (FA, MD, MK, AK, RK) is obtained. Correlation analysis. There was a statistical difference between the results of age as a covariate.P0.05. (2) bilateral thalamus analysis: application (1) in the process of TBSS analysis in the process of eddy current correction, the parameters of the standard space registration (FA, MD, MK, AK, RK), the region of interest (Region of interest, ROI) analysis of bilateral thalamus (Region of interest, ROI). Statistical analysis applied SPSS21 .0 software package was carried out to analyze the FA, MD, MK, AK, RK values of the 3 groups between groups NC, SWI (-) and SWI (+) group. The 22 groups of comparison tests were applied to the Bonferroni method, and the Spearman correlation analysis was carried out for the values of the parameters and the RPSQ scale. R CBF parameters were automatically obtained by MRI scanner, ROI analysis of R CBF value of brain tissue, bilateral frontal lobe, bilateral parietal lobe, bilateral occipital lobe, bilateral temporal lobe and bilateral thalamus in the region of interest. Statistical analysis and analysis were carried out with SPSS21.0 software package, and the variance analysis of R values of each ROI region between the 3 groups of SWI (-) group and SWI (+) group was analyzed in NC group, 22 Group comparative test using Bonferroni method; Spearman correlation analysis of R CBF parameter value and RPSQ scale score. Age as a covariate.P0.05, the results were statistically different. Results DKI data results: (1) the results of each parameter value analysis of white matter fiber bundle: SWI (-) group compared with the NC group: SWI (-) group of multiple brain white matter region FA value increased, The MD value decreased, the MK value increased, the AK value increased and the RK value increased, and the DKI parameter (AK) showed that the abnormal region was more than DTI (FA, MD) and the broad.SWI (+) group was lower than the NC group. High MK value decreased, AK value decreased and RK value decreased. The study did not find the white matter area related to the RPSQ score. (2) the analysis of the values of each parameter in the bilateral thalamus: the MK value of the right thalamus in the SWI (+) group was significantly higher (22 groups compared with non Bonferroni test, p=0.043), and the values of the residual ginseng were not obviously changed. The parameters of the thalamus and the RPSQ score were not obvious. Compared with the NC group, the SWI (-) group compared with the NC group: the R CBF value of the left occipital lobe in the SWI (-) group was significantly lower (p=0.021).SWI (+) group compared with the NC group: the left frontal lobe of the SWI (+) group, the right parietal lobe, the right occipital lobe and the right temporal lobe decreased significantly (left frontal lobe: right parietal lobe: right right occipital lobe: right temporal lobe) The WI (+) group was compared with the SWI (-) group: the R CBF value of the right temporal lobe in the SWI (+) group was significantly lower (p=0.028). The left frontal lobe R CBF value was negatively correlated with the RPSQ score (r=-0.598, p=0.007). Conclusion 1., the DKI technique was used to study the patients with mild traumatic brain injury. Changes, and the parameters AK found in the SWI (-) group are more extensive than the DTI parameters (FA, MD). It is suggested that DKI is more sensitive to the damage of white matter in the cerebral white matter caused by M TBI than that in M TBI, and provides a different microview change information that is different from that of DTI, so that we can better understand the brain of the brain. The pathophysiological changes of white matter.2. used DKI technique to study the patients with mild traumatic brain injury in acute stage. It was found that the MK value of the thalamus in the acute m TBI patients changed, and the DTI parameter (FA, MD) did not change obviously. It shows that DKI is more sensitive than DTI to find the abnormality of the gray matter in the m TBI patients. The thalamic injury may also be involved in the patient God. In the process of dysfunctional development,.3. used PASL technology to study the patients with mild traumatic brain injury in acute phase, and found that the blood flow of brain tissue in acute m TBI patients decreased, and the cerebral blood flow in some regions was correlated with the severity of postconcussion syndrome, suggesting the abnormal hemodynamics of brain tissue in M TBI patients. It may be involved in the emergence of clinical symptoms.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.2;R651.15

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