三叉神经痛的磁共振弥散张量成像研究

发布时间：2018-06-02 09:48

  本文选题：三叉神经痛 + 弥散张量成像　； 参考：《昆明医科大学》2014年硕士论文

【摘要】：目的：对健康志愿者和TN患者行3.OT磁共振弥散张量成像(diffusion tensor imaging, DTI)序列检查,通过对正常对照组(control subjects)双侧三叉神经(trigeminal nerve, TGN)脑池段(cisternal segment)、三叉神经痛(trigeminal neuralgia, TN)组责任血管(Responsible Vessel, RV)压迫点以及TN组健侧对应位置三叉神经的表观扩散系数(apparent diffusion coefficient, ADC)值和部分各向异性(Fractional Anisotrop, FA)值测量,比较三组ADC值及FA值的差异,并研究ADC值的变化与FA值的变化是否存在相关性；测量TN组患侧责任血管压迫点及相应位置健侧TGN的横断面面积(cross-sectional area, CSA),观察CSA的变化与ADC值、FA值是否存在相关性。尝试通过测量DTI的相关参数FA值、ADC值以及形态学参数CSA,并了解各参数与TN的相关性,尝试建立一种无创性的对TN病理微结构变化的磁共振诊断模式。 材料与方法： 1.一般资料 1.1健康对照组 对40例正常志愿者(检查前均取得志愿者同意并签订知情同意书)行MRI的DTI序列扫描,所有志愿者临床均无与三叉神经相关的症状和体征。男性20例,女性20例,年龄20-83岁,平均51.2岁。 1.2TN组 收集2012年9月--2013年12月本院神经外科诊断为原发性TN患者40例,其中男性16例,女性24例,年龄21-74岁,平均年龄53.3岁,病程范围从3年-20年不等,平均为5.7年,均为单侧面部疼痛,右侧19例,左侧21例。TN组按照疼痛与否分为患侧(ipsilateral TN)与健侧(contralateral TN)组。 2.设备与检查方法 运用PHILIPS Achieve3.0T MR超导扫描仪,选用8通道相阵头颅专用线圈,成像序列分别为：①对正常对照组及TN组首先行常规序列扫描：横断面T2WI(TR/TE=3300ms/100ms)、T1WI (TR/TE=550ms/15ms)及T2FLAIR序列(TR/TE=6000ms/120ms)。②对TN组行形态学序列：3D-FIESTA (TR=5.0ms, TE=1.9ms);3D-TOF-MRA平扫及增强序列(TR=16.0ms,TE=3.5ms)③对正常对照组及TN组行T1WI-3D-TFE序列(TR/TE=7.5ms/3.5ms)及DTI序列(TR/TE=7687ms/76.6ms). 3.病例分组及图像分析 全部数据在EWS(Extended MR WorkSpace)工作站内应用Fibertrack和Diffusion软件进行后处理。在所得图像上选择感兴趣区(region of interest,ROI),ROI为圆形或点状,分别测量其FA值和ADC值；另外对TN组患者分别测量患侧责任血管压迫点及相应位置健侧TGN的CSA。 3.1正常对照组 在FA彩图与T1WI-3D-TFE解剖像的融合图上,将正常对照组双侧TGN的脑池段按照距离分成四个点,分别在TGN脑干发出点起点、出Meckel's腔的终点以及这两个点(桥池段起点到终点)之间的1/3处、2/3处,对这四个点的ADC值和FA值进行采集,进行双侧对比。再将正常志愿者按照年龄分成六组,30岁以下7例,30-40岁8例,40-50岁12例,50-60岁6例,60岁以上5例,分别对这四个点测量的ADC值及FA值进行双侧对比。最后再分别将单侧的四个点两两进行纵向对比。 3.2TN组 利用Diffusion软件生成的ADC图及FA图,分别在患侧责任血管压迫点测量FA值及ADC值,并且测量相应对侧无症状侧的值。将TN组患侧、TN组健侧分别与正常对照组双侧TGN的FA值及ADC值进行对比分析,研究三组上述测量值是否存在差异性,对TN组患侧分析ADC值的变化与FA值的变化是否具有相关性；另外,对比分析TN患者双侧TGN的CSA是否存在差异性,以及患侧CSA的变化与FA值、ADC值的相关性。 4.统计方法 采用SPSS18.0进行统计学分析,以P0.05(双侧)为差异有统计学意义。计量资料用x±s表示。 ①首先对各组统计量进行正态性检验,如为正态分布,选用t检验(t-test)或单因素方差分析(1-way analysis of variance,ANOVA)；不符合正态分布选用非参数检验法(non-parametric test)。②对40例正常志愿者双侧三叉神经距脑干发出点不同位置点的FA及ADC值进行配对t检验(pair T test)；按照年龄分组,分别对各组年龄段的双侧TGN桥池段不同距离的FA值及ADC值进行配对t检验；最后,再将桥池段相邻距离之间的FA值及ADC值进行单因素方差分析,并且分别对四个点之间的任意两个点的FA值及ADC值差异性进行统计分析。③先将TN组患侧与健侧TGN的FA值及ADC值进行配对t检验,再用独立样本t检验(independent samples T test)将TN组患侧、健侧分别与正常对照组双侧的FA值和ADC值进行对比；最后,通过线性回归(Linear regression)分析,研究FA值的变化与ADC的变化是否存在相关性,并绘制散点图及线性趋势线。④通过配对t检验对TN患者双侧TGN的CSA进行对比分析,并通过线性回归分析研究CSA的变化与ADC值、FA值的变化是否有相关性。 结果： 1.各组数据均符合正态分布。 2.正常对照组 ①双侧三叉神经的平均ADC值为(1.431±0.308)×10-3mm2/s,其中左侧为(1.493±0.341)×10-3mm2/s,右侧为(1.369±0.258)×10-3mm2/s;平均FA值为0.423±0.057,其中左侧为0.416±0.058,右侧为0.431±0.055。②按照年龄分组,在40-50岁组,桥池段的2/3处FA值及ADC值出现了左右不对称的特点。 ③FA值及ADC值在单侧任意两点水平间均无显著统计学差异。 3.TN组 ①TN组患侧的平均FA值(0.330±0.056)显著低于TN组健侧(0.408±0.054)(t=-8.448,P0.05)以及正常对照组双侧(0.423±0.057)(t=8.432,P0.05)；TN组健侧和正常对照组双侧FA值并没有差异性(t=1.433,P0.05)。TN组患侧的AI)C值(2.052±0.473)×10-3mm2/s则显著高于TN组健侧(1.541±0.266)×10-3mm2/s(t=8.830,P0.05)以及正常对照组双侧(1.431±0.308)×10-3mm2/s(t=8.432,P0.05)；TN组健侧和正常对照组双侧ADC值并没有明显差异性(t=1.433,P0.05)。进一步研究发现FA值的降低与ADC的增高呈负相关(r=-0.613,P0.001)。 TN组患侧的CSA(3.75±0.35)mm2显著低于(t=-27.313,P0.001)TN组健侧(5.21±0.33)m2,进一步将CSA分别与FA值及ADC值做相关分析,选用通过线性回归(Linear regression)分析,发现其存在线性关系,进一步做相关分析,Pearson相关系数显示：FA值的下降与CSA的减小呈正相关(r=0.526,P0.001):ADC的增加与CSA的减小呈负相关(r=-0.867,P0.001)。 结论： 正常对照组 1.DT I图像能够清晰分辨双侧三又神经脑池段,可实现各项导出量的测量。 2.三叉神经脑池段左右侧各导出量的差异与年龄有着一定的关系。 3.随着距脑干发出点距离水平的不同,TGN的FA值及ADC值存在相关变化,这种变化与三叉神经脑池段的解剖有一定关系。TN组 1.DTI技术显示,TN患者患侧较其健侧及正常人双侧平均FA值显著性减低,ADC值显著性增高,并且TN患者患侧FA值的降低和ADC的增高呈负相关,提示TN患者患侧由于血管压迫导致明显脱髓鞘改变,为诊断三叉神经痛提供了非常有价值的信息。 2.TN患者患侧较健侧CSA显著性减小,且CSA的减小与FA值的降低呈正相关,与ADC值的增高呈负相关,提示TN组患侧血管神经压迫点有明显萎缩(横断面面积减小),且这种形态学改变与脱髓鞘改变有相关性,脱髓鞘程度越重神经萎缩越严重。 3.DTI技术可以显示血管压迫性三叉神经痛的神经萎缩及脱髓鞘改变,可以进一步指导TN的诊断和治疗。
[Abstract]:Objective: to examine the 3.OT magnetic resonance diffusion tensor imaging (diffusion tensor imaging, DTI) sequence of healthy volunteers and TN patients, and to pass to the normal control group (control subjects) of the bilateral trigeminal nerve (trigeminal nerve, TGN) brain pool, and the three fork neuralgia group. Ssel, RV) the apparent diffusion coefficient (apparent diffusion coefficient, ADC) values and the partial anisotropy (Fractional Anisotrop, FA) values of the contralateral trigeminal nerve of the TN group were measured to compare the difference between the ADC values and the FA values of the three groups, and to investigate whether there was a correlation between the variation of the values and the changes of the values. The cross-sectional area (cross-sectional area, CSA) of the vascular compression point and the corresponding position TGN was observed. The correlation between the changes of CSA and the value of ADC and the value of FA was observed. By measuring the FA value, ADC value and the CSA of the morphological parameters of DTI, the correlation between the parameters and the TN was investigated, and a noninvasive pathological micro knot was established. A diagnostic model of magnetic resonance (MRI).
Materials and methods:
1. general information
1.1 healthy control group
40 normal volunteers (all volunteers who received consent before the examination and signed informed consent) were scanned with DTI sequence of MRI. All the volunteers had no symptoms and signs related to trigeminal nerve. 20 men, 20 women, 20-83 years old and 51.2 years old.
1.2TN group
40 cases of primary TN diagnosed in the Department of Neurosurgery of our hospital in September 2012 --2013 year were collected, including 16 male and 24 female, 21-74 years old and 53.3 years old. The range of course ranged from 3 years -20 years, averaging 5.7 years. All were unilateral facial pain, the right 19 cases, and the 21.TN group on the left side were divided into the affected side (ipsilateral TN). The contralateral TN group.
2. equipment and inspection methods
Using the PHILIPS Achieve3.0T MR superconducting scanner, the 8 channel phase array head special coils were selected, and the imaging sequences were: first, the normal control group and the TN group were first performed routine sequence scanning: cross section T2WI (TR/TE=3300ms/100ms), T1WI (TR/TE=550ms/15ms) and T2FLAIR sequence (TR/TE=6000ms/120ms). A (TR=5.0ms, TE=1.9ms); 3D-TOF-MRA plain scavenging and enhanced sequence (TR=16.0ms, TE=3.5ms) (TR=16.0ms, TE=3.5ms) (TR=16.0ms, TE=3.5ms) were used for T1WI-3D-TFE sequence (TR/TE=7.5ms/3.5ms) and DTI sequence (TR/TE=7687ms/76.6ms) in the normal control group and the TN group.
3. case grouping and image analysis
All data were processed in the EWS (Extended MR WorkSpace) workstation with Fibertrack and Diffusion software. The region of interest (region of interest, ROI) was selected and the FA value and the value were measured respectively in the region of interest (ROI). CSA. of GN
3.1 normal control group
On the fusion map of FA color map and T1WI-3D-TFE anatomy image, the brain pool section of bilateral TGN in normal control group is divided into four points according to distance, respectively, at the starting point of the TGN brainstem, the end point of the Meckel's cavity and the 1/3 between the two points (the starting point of the bridge section to the end point), and 2/3, to collect the ADC and FA values of the four points, and carry out both sides. The normal volunteers were divided into six groups, 7 cases under 30 years of age, 8 cases of 30-40 years old, 40-50 years and 12 cases, 50-60 years old and 6 cases, and 5 cases over 60 years old, respectively. The ADC and FA values of these six points were compared respectively.
3.2TN group
The values of FA and ADC were measured on the affected vascular compression points of the affected side, and the values of the corresponding contralateral asymptomatic side were measured by the ADC and FA maps generated by the Diffusion software. The FA values and ADC values of the TN group affected side, the healthy side of the TN group and the normal control group were compared with those of the normal control group, and the difference between the three groups was studied and the TN group was found. Whether the changes in the ADC value of the patient's side analysis were related to the changes in the FA value. In addition, the difference in the CSA of the bilateral TGN in TN patients and the correlation between the changes of the CSA and the FA value and the ADC value of the affected side of the affected side were compared.
4. statistical methods
SPSS18.0 was used for statistical analysis, and P0.05 (bilateral) was statistically significant. The measurement data were expressed by X + s.
First, a normal test was carried out for all statistics, such as normal distribution, t test (t-test) or single factor variance analysis (1-way analysis of variance, ANOVA); nonparametric test (non-parametric test) was not conformed to normal distribution (non-parametric test). (2) 40 cases of normal volunteers had different positions of the trigeminal nerve from the brainstem of the bilateral trigeminal nerve. And the ADC value of the paired t test (pair T test). According to age group, the FA value and ADC value of the different distances of the bilateral TGN bridge pool segments of each group are paired t test. Finally, the FA value and ADC value of the adjacent distance between the bridge pool section are analyzed by single factor variance, and the FA between the four points at any two points is respectively. The difference of value and ADC value was statistically analyzed. Third, the FA value and ADC value of the affected side and the healthy side of the TN group were paired t test, and the independent sample t test (independent samples T test) was used to compare the affected side of the TN group with the normal control group. Finally, the linear regression analysis was used to analyze and study the TGN. Whether there is a correlation between the change of FA value and the change of ADC, and draw a scatter plot and linear trend line. (4) a paired t test was used to compare the CSA of the bilateral TGN in TN patients, and the change of CSA and the value of ADC were studied by linear regression analysis, and whether the change of FA value was related.
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