正常人和血液透析病人脑内铁沉积的3.0T MR定量磁敏感图研究
发布时间：2018-09-14 20:28
【摘要】：目的： 评估MR定量磁敏感图(quantitative susceptibility mapping, QSM)对正常人与血液透析病人脑铁含量测量的可行性,首先利用QSM对不同年龄正常人脑铁含量进行测量,观察脑内铁含量的分布特性及其随年龄的变化趋势。然后,采用QSM成像技术测量血液透析病人脑内额叶白质及深部灰质核团的磁敏感值并与年龄、性别均匹配的正常人所测的相应磁敏感值进行对比分析,探讨磁敏感值与神经精神病学测试评分、流行病学及临床血液生化指标的相关性。 资料与方法： 采用Siemens MAGNETOM Trio Tim3.0T超导磁共振扫描仪,首先,于2012年11月至2013年7月间从天津当地居民收集健康右利手正常人63名,男24名,女39名,年龄20至63岁,平均年龄37±13岁。所有正常人均行常规磁共振成像(magnetic resonance imaging, MRI)和未滤波磁敏感加权成像(susceptibility weighted imaging, SWI)扫描,获得正常颅脑SWI未滤波相位图和幅度图,利用SMART后处理软件对未滤波相位图和幅度图进行后处理得到QSM图,利用SPIN软件手工绘出QSM图中双侧额叶白质及各灰质核团(尾状核、苍白球、壳核、背侧丘脑、红核、黑质及齿状核)的感兴趣区(region of interest, ROI),测量ROI区的磁敏感值,并与两篇文献中报道的分别对尸体脑组织染色及采用电耦合等离子体质谱成像法进行元素分析所获得的脑内各结构的铁含量进行线性相关分析,观察两者的一致性,采用秩和检验比较左右两侧额叶白质及各灰质核团间的统计学差异,利用Spearman相关分析探讨各ROI区的磁敏感值与年龄的相关性。然后,收集2012年11月至2013年12月在我院进行血液透析的病人53名(男31名,女22名),年龄21至75岁,平均年龄47.4±13.5岁,平均透析时间26.7个月(1至114个月),同时从天津当地健康居民收集45名正常人(男18名,女27名)作为对照组,年龄25至70岁,平均年龄42.3±11.7岁。所有正常人及血液透析病人均为右利手,并采用3.0T MR扫描仪进行常规MRI与未滤波SWI扫描。利用未滤波相位图像通过后处理获得QSM图,分别于QSM图像上测量血液透析病人与正常人双侧脑内额叶白质与深部灰质核团的磁敏感值,采用两独立样本t检验比较血液透析病人与正常人之间脑内额叶白质与深部灰质核团的磁敏感值、神经精神病学测试评分的差异性。采用Spearman相关分析观察血液透析病人脑内额叶白质与深部灰质核团的磁敏感值与神经精神病学测试评分间的相关性。采用多元逐步回归分析法观察血液透析病人脑内额叶白质与深部灰质核团的磁敏感值与流行病学及临床血液生化指标间的相关性。 结果： 本研究所测各ROI磁敏感值与两篇文献(Hallgren和Sourander及Langkammer)中报道的分别对尸检脑组织染色及采用电耦合等离子体质谱成像法进行元素分析所获得的脑内各结构的铁含量具有很高的正相关性(r=0.905, P=0.002; r=0.900,P=0.037): (1)正常人苍白球的磁敏感值最大,其次为黑质,额叶白质的磁敏感值最小(磁敏感值分别为95.019ppb、86.687ppb、-12.845ppb); (2)正常人尾状核、黑质、红核及齿状核左右两侧磁敏感值之间均存在统计学差异(P0.05)； (3)正常人左右两侧苍白球的磁敏感值男女性别之间均存在统计学差异,左侧苍白球P值为0.024,右侧苍白球P值为0.016； (4)正常人双侧尾状核、壳核、红核、齿状核的磁敏感值均与年龄具有止相关性(P0.05)；双侧尾状核、壳核、红核及齿状核的平均磁敏感值亦与年龄呈正相关(P0.05)； (5)血液透析病人左右两侧尾状核、壳核、黑质、红核及齿状核的磁敏感值均高于正常人左右两侧相应核团的磁敏感值(P均0.01)； (6)血液透析病人左右两侧尾状核的磁敏感值与简易精神状态评价量表(Mini-Mental State Examination, MMSE)测试评分均呈负相关(左侧r=-0.415；右侧r=-0.311,P均0.05)； (7)在血液透析病人中,脑内一些结构的磁敏感值与流行病学及临床血液生化指标间存在相关性。透析时间的长短与左右两侧壳核及右侧背侧丘脑的磁敏感值均呈正相关；胆固醇含量与左侧尾状核的磁敏感值呈正相关；未饱和铁结合力与左侧苍白球的磁敏感值呈正相关；透析后收缩压与右侧苍白球的磁敏感值呈正相关；β2微球蛋白与左侧背侧丘脑的磁敏感值呈正相关；血红蛋白与右侧齿状核的磁敏感值呈正相关；C反应蛋白与右侧额叶白质的磁敏感值呈正相关；透析后脉压与右侧黑质的磁敏感值呈负相关(P0.05)； (8)血液透析病人双侧额叶白质及脑内深部灰质核团的磁敏感值与血清铁蛋白含量均无相关性(P0.05)； 结论： 利用SWI未滤波相位图与幅度图后处理获得的QSM图能清晰显示脑内富含铁质的结构,如灰质核团,表现为高信号；QSM图能较准确评估脑内各结构的铁含量,与对尸检脑组织染色获得的各结构铁浓度结果一致；双侧尾状核、壳核、红核、齿状核的铁含量均随年龄的增长具有增加的趋势。 血液透析病人脑内一些灰质核团(双侧尾状核、壳核、黑质、红核及齿状核)的铁沉积较正常人相应灰质核团增多,并且一些核团的铁沉积与透析时间的长短呈正相关,即随透析时间的延长而增加。尾状核内磁敏感值的升高可以反映神经认知功能的损害,尤其是执行功能的损害。磁敏感值可以作为一种反映脑内铁含量变化的临床指标。
[Abstract]:Objective:
To evaluate the feasibility of quantitative susceptibility mapping (QSM) in measuring brain iron content in normal subjects and hemodialysis patients, the distribution characteristics of brain iron content and its changing trend with age were observed by using QSM. The magnetic susceptibility values of frontal white matter and deep gray matter nuclei in hemodialysis patients were compared with those of normal subjects matched with age and sex. The correlation between magnetic susceptibility values and neuropsychiatric test scores, epidemiology and clinical blood biochemical indexes were discussed.
Materials and methods:
Siemens MAGNETOM Trio Tim 3.0T superconducting magnetic resonance scanner was used. Firstly, 63 healthy right-handed normal persons, 24 males and 39 females, aged 20 to 63 years, with an average age of 37 13, were collected from Tianjin residents between November 2012 and July 2013. All normal subjects underwent conventional magnetic resonance imaging (MRI) and unfiltered MRI. The unfiltered phase and amplitude maps of normal brain SWI were obtained by susceptibility weighted imaging (SWI). The unfiltered phase and amplitude maps were processed by SMART post-processing software to obtain QSM maps. The bilateral frontal white matter and gray matter nuclei (caudate nucleus, pale) in QSM maps were manually drawn by SPIN software. The region of interest (ROI) of the sphere, putamen, dorsal thalamus, red nucleus, substantia nigra and dentate nucleus was measured. The magnetic susceptibility values of the ROI were linearly correlated with the iron contents of the brain structures obtained by elemental analysis using electro-coupled plasma mass spectrometry (ECP-MS) and staining of cadaveric brain tissues, respectively, as reported in the two literatures. Then, 53 patients (31 males and 22 females) undergoing hemodialysis in our hospital from November 2012 to December 2013 were collected. Mean dialysis time was 26.7 months (1 to 114 months). Forty-five normal subjects (18 males and 27 females) aged 25 to 70 years old, with an average age of 42.3 to 11.7 years, were collected from Tianjin local healthy residents as control group. All normal subjects and hemodialysis patients were right-handed and entered with a 3.0 T MR scanner. Routine MRI and unfiltered SWI scans were performed. QSM images were obtained from unfiltered phase images. Magnetic susceptibility values of bilateral frontal white matter and deep gray matter nuclei were measured on QSM images of hemodialysis patients and normal subjects respectively. Two independent t-test samples were used to compare frontal white matter and deep gray matter between hemodialysis patients and normal subjects. Spearman correlation analysis was used to observe the correlation between magnetic susceptibility of white matter of frontal lobe and deep gray matter nucleus of hemodialysis patients and neuropsychiatric test scores. Multivariate stepwise regression analysis was used to observe the frontal lobe of hemodialysis patients. The correlation between magnetic susceptibility of white matter and deep gray nuclei and epidemiological and clinical blood biochemical indices.
Result:
The ROI magnetic susceptibility values measured in this study were positively correlated with the iron content of the brain structures obtained from autopsy brain tissue staining and elemental analysis using electro-coupled plasma mass spectrometry (r = 0.905, P = 0.002; r = 0.900, P = 0.037), respectively.
(1) The magnetic susceptibility of globus pallidus in normal subjects was the highest, followed by substantia nigra, and the magnetic susceptibility of frontal white matter was the smallest (magnetic susceptibility values were 95.019 ppb, 86.687 ppb, - 12.845 ppb, respectively).
(2) There were significant differences in magnetic sensitivity between the caudate nucleus, substantia nigra, red nucleus and dentate nucleus (P 0.05).
(3) There were significant differences in magnetic sensitivity between male and female on both sides of globus pallidus in normal subjects. The P value of left globus pallidus was 0.024, and that of right globus pallidus was 0.016.
(4) The magnetic susceptibility values of bilateral caudate nucleus, putamen nucleus, red nucleus and dentate nucleus in normal subjects were all correlated with age (P 0.05), and the mean magnetic susceptibility values of bilateral caudate nucleus, putamen nucleus, red nucleus and dentate nucleus were positively correlated with age (P 0.05).
(5) The magnetic susceptibility values of caudate nucleus, putamen nucleus, substantia nigra, red nucleus and dentate nucleus on both sides of hemodialysis patients were higher than those of normal people (P 0.01).
(6) There was a negative correlation between the magnetic sensitivity of the caudate nucleus on both sides of hemodialysis patients and the Mini-Mental State Examination (MMSE) score (r =-0.415 on the left side, R =-0.311 on the right side, P 0.05).
(7) In hemodialysis patients, the magnetic susceptibility values of some brain structures were correlated with the epidemiological and clinical blood biochemical parameters. The duration of dialysis was positively correlated with the magnetic susceptibility values of both left and right putamen and right dorsal thalamus, and the content of cholesterol was positively correlated with the magnetic susceptibility values of left caudate nucleus. Force was positively correlated with the magnetic susceptibility of the left globus pallidus; systolic blood pressure was positively correlated with the magnetic susceptibility of the right globus pallidus after dialysis; beta 2 microglobulin was positively correlated with the magnetic susceptibility of the left dorsal thalamus; hemoglobin was positively correlated with the magnetic susceptibility of the right dentate nucleus; and C-reactive protein was positively correlated with the magnetic susceptibility of the right frontal There was a negative correlation between the pulse pressure after dialysis and the susceptibility value of the right substantia nigra (P0.05).
(8) The magnetic susceptibility values of bilateral frontal white matter and deep gray matter nuclei in hemodialysis patients were not correlated with serum ferritin content (P 0.05).
Conclusion:
QSM maps obtained by SWI unfiltered phase mapping and amplitude mapping can clearly show the iron-rich structures in the brain, such as gray matter nuclei, showing high signal; QSM maps can accurately assess the iron content of brain structures, consistent with the results obtained by autopsy brain tissue staining; bilateral caudate nucleus, putamen nucleus, red nucleus, tooth. The iron content of the nucleus increased with age.
The iron deposition in some gray matter nuclei (bilateral caudate nucleus, putamen nucleus, substantia nigra, red nucleus and dentate nucleus) in hemodialysis patients was higher than that in normal subjects, and the iron deposition in some nuclei was positively correlated with the duration of dialysis, that is, increased with the prolongation of dialysis time. Magnetic susceptibility can be used as a clinical index to reflect the changes of iron content in the brain.
【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
本文编号：2243787
[Abstract]:Objective:
To evaluate the feasibility of quantitative susceptibility mapping (QSM) in measuring brain iron content in normal subjects and hemodialysis patients, the distribution characteristics of brain iron content and its changing trend with age were observed by using QSM. The magnetic susceptibility values of frontal white matter and deep gray matter nuclei in hemodialysis patients were compared with those of normal subjects matched with age and sex. The correlation between magnetic susceptibility values and neuropsychiatric test scores, epidemiology and clinical blood biochemical indexes were discussed.
Materials and methods:
Siemens MAGNETOM Trio Tim 3.0T superconducting magnetic resonance scanner was used. Firstly, 63 healthy right-handed normal persons, 24 males and 39 females, aged 20 to 63 years, with an average age of 37 13, were collected from Tianjin residents between November 2012 and July 2013. All normal subjects underwent conventional magnetic resonance imaging (MRI) and unfiltered MRI. The unfiltered phase and amplitude maps of normal brain SWI were obtained by susceptibility weighted imaging (SWI). The unfiltered phase and amplitude maps were processed by SMART post-processing software to obtain QSM maps. The bilateral frontal white matter and gray matter nuclei (caudate nucleus, pale) in QSM maps were manually drawn by SPIN software. The region of interest (ROI) of the sphere, putamen, dorsal thalamus, red nucleus, substantia nigra and dentate nucleus was measured. The magnetic susceptibility values of the ROI were linearly correlated with the iron contents of the brain structures obtained by elemental analysis using electro-coupled plasma mass spectrometry (ECP-MS) and staining of cadaveric brain tissues, respectively, as reported in the two literatures. Then, 53 patients (31 males and 22 females) undergoing hemodialysis in our hospital from November 2012 to December 2013 were collected. Mean dialysis time was 26.7 months (1 to 114 months). Forty-five normal subjects (18 males and 27 females) aged 25 to 70 years old, with an average age of 42.3 to 11.7 years, were collected from Tianjin local healthy residents as control group. All normal subjects and hemodialysis patients were right-handed and entered with a 3.0 T MR scanner. Routine MRI and unfiltered SWI scans were performed. QSM images were obtained from unfiltered phase images. Magnetic susceptibility values of bilateral frontal white matter and deep gray matter nuclei were measured on QSM images of hemodialysis patients and normal subjects respectively. Two independent t-test samples were used to compare frontal white matter and deep gray matter between hemodialysis patients and normal subjects. Spearman correlation analysis was used to observe the correlation between magnetic susceptibility of white matter of frontal lobe and deep gray matter nucleus of hemodialysis patients and neuropsychiatric test scores. Multivariate stepwise regression analysis was used to observe the frontal lobe of hemodialysis patients. The correlation between magnetic susceptibility of white matter and deep gray nuclei and epidemiological and clinical blood biochemical indices.
Result:
The ROI magnetic susceptibility values measured in this study were positively correlated with the iron content of the brain structures obtained from autopsy brain tissue staining and elemental analysis using electro-coupled plasma mass spectrometry (r = 0.905, P = 0.002; r = 0.900, P = 0.037), respectively.
(1) The magnetic susceptibility of globus pallidus in normal subjects was the highest, followed by substantia nigra, and the magnetic susceptibility of frontal white matter was the smallest (magnetic susceptibility values were 95.019 ppb, 86.687 ppb, - 12.845 ppb, respectively).
(2) There were significant differences in magnetic sensitivity between the caudate nucleus, substantia nigra, red nucleus and dentate nucleus (P 0.05).
(3) There were significant differences in magnetic sensitivity between male and female on both sides of globus pallidus in normal subjects. The P value of left globus pallidus was 0.024, and that of right globus pallidus was 0.016.
(4) The magnetic susceptibility values of bilateral caudate nucleus, putamen nucleus, red nucleus and dentate nucleus in normal subjects were all correlated with age (P 0.05), and the mean magnetic susceptibility values of bilateral caudate nucleus, putamen nucleus, red nucleus and dentate nucleus were positively correlated with age (P 0.05).
(5) The magnetic susceptibility values of caudate nucleus, putamen nucleus, substantia nigra, red nucleus and dentate nucleus on both sides of hemodialysis patients were higher than those of normal people (P 0.01).
(6) There was a negative correlation between the magnetic sensitivity of the caudate nucleus on both sides of hemodialysis patients and the Mini-Mental State Examination (MMSE) score (r =-0.415 on the left side, R =-0.311 on the right side, P 0.05).
(7) In hemodialysis patients, the magnetic susceptibility values of some brain structures were correlated with the epidemiological and clinical blood biochemical parameters. The duration of dialysis was positively correlated with the magnetic susceptibility values of both left and right putamen and right dorsal thalamus, and the content of cholesterol was positively correlated with the magnetic susceptibility values of left caudate nucleus. Force was positively correlated with the magnetic susceptibility of the left globus pallidus; systolic blood pressure was positively correlated with the magnetic susceptibility of the right globus pallidus after dialysis; beta 2 microglobulin was positively correlated with the magnetic susceptibility of the left dorsal thalamus; hemoglobin was positively correlated with the magnetic susceptibility of the right dentate nucleus; and C-reactive protein was positively correlated with the magnetic susceptibility of the right frontal There was a negative correlation between the pulse pressure after dialysis and the susceptibility value of the right substantia nigra (P0.05).
(8) The magnetic susceptibility values of bilateral frontal white matter and deep gray matter nuclei in hemodialysis patients were not correlated with serum ferritin content (P 0.05).
Conclusion:
QSM maps obtained by SWI unfiltered phase mapping and amplitude mapping can clearly show the iron-rich structures in the brain, such as gray matter nuclei, showing high signal; QSM maps can accurately assess the iron content of brain structures, consistent with the results obtained by autopsy brain tissue staining; bilateral caudate nucleus, putamen nucleus, red nucleus, tooth. The iron content of the nucleus increased with age.
The iron deposition in some gray matter nuclei (bilateral caudate nucleus, putamen nucleus, substantia nigra, red nucleus and dentate nucleus) in hemodialysis patients was higher than that in normal subjects, and the iron deposition in some nuclei was positively correlated with the duration of dialysis, that is, increased with the prolongation of dialysis time. Magnetic susceptibility can be used as a clinical index to reflect the changes of iron content in the brain.
【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
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相关期刊论文 前2条
1 林冬;丁晶;汪昕;;铁代谢异常与中枢神经系统疾病[J];中国临床神经科学;2011年01期
2 苗延巍;刘婷;伍建林;宋清伟;张清;张竞文;杨志宏;倪鸣飞;;磁敏感加权成像评价正常人大脑灰质核团铁含量[J];中国医学影像技术;2009年03期
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