弥散峰度成像对CO中毒急性期脑损伤定量评估的初步研究

发布时间：2018-05-20 06:45

本文选题：CO中毒 + 脑损伤　；参考：《兰州大学》2017年硕士论文

【摘要】：目的:本文通过对CO中毒急性期患者脑部各区域弥散峰度成像参数值的测量及分析,以探讨该技术对其脑组织损伤程度及微观结构变化的评估价值。方法:对26例CO中毒急性期患者及18名健康志愿者行磁共振常规轴位T1WI、T2WI、T2WI-tirm、DWI及DKI序列扫描。分别测量所有受试者6组15个感兴趣区的平均扩散系数值、平均峰度值及各向异性分数值,同一部位同一层面用体素大小相同的ROI手动测量3次,取平均值作为最终测量值。统计学软件采用SPSS 21.0版,分析弥散加权成像扫描结果相关的临床影响因素;并将病例组依据DWI扫描图像中有无病灶检出分为阳性组和阴性组,分别比较两病例组与对照组各部位MK值、MD值及FA值的组间差异,同时将多参数均存在差异部位的MD值、MK值与DWI上的表观扩散系数值作相关性分析。并绘制上述差异部位MD值及MK值的受试者工作特征曲线,比较ROC曲线下面积;计算MD、MK定量评估的最佳诊断界值及其相应的敏感度及特异度,以分析二者对CO中毒急性期脑损伤的诊断效能。所有统计数值均以均数±标准差表示,以P0.05为差异有统计学意义。结果:1.意识障碍持续时间较长、早期格拉斯哥昏迷量表得分减低是DWI扫描结果出现阳性的影响因素;2.与对照组相比,病例组各感兴趣区MD值呈减低趋势,而MK值呈升高趋势;其中病例组MD值减低部位为:双侧苍白球、半卵圆中心及侧脑室旁白质、胼胝体膝部;MK值升高部位为:双侧苍白球、丘脑、半卵圆中心及侧脑室旁白质;FA值减低部位为:双侧苍白球;且阴、阳两组患者双侧苍白球同时存在MD值减低、MK值升高,而其余部位值的改变均属阳性组;3.病例组MD值减低、MK值升高分别与DWI的ADC值减低相关性良好;4.苍白球区MK值的AUC最大,为0.900,其余值ROC曲线下面积从大到小依次为苍白球的MD值、半卵圆中心的MK值、半卵圆中心的MD值、侧脑室旁白质的MK值、侧脑室旁白质的MD值,它们的AUC分别为0.867、0.856、0.844、0.822、0.789。半卵圆中心、侧脑室旁白质、苍白球区MK值及MD值的最佳诊断界值、敏感度、特异度依次为:(MK半=1.2304;87%、83%)、(MK侧=1.2516;83%、77%)、(MK苍=1.0633;91%、84%)、(MD半=0.8736;93%、70%)、(MD侧=0.8522;90%、73%)、(MD苍=0.9445;86%、81%)。上述差异均具有统计学意义(P0.05)。结论:1.DKI技术可以对CO中毒患者的急性期脑损伤进行定量评估与诊断。2.DKI参数MK、MD可以反映CO中毒患者脑组织的微观结构信息,特别是MK能够反映灰质的微结构改变,可更敏感的发现急性期CO中毒患者脑部灰白质异常,有利于临床客观评估患者病情,并及早干预和给予恰当治疗。
[Abstract]:Objective: to evaluate the value of diffusion kurtosis imaging parameters of brain in patients with acute CO poisoning by measuring and analyzing the diffusion kurtosis imaging parameters of the brain in order to evaluate the degree of brain injury and the changes of microstructures. Methods: a total of 26 patients with acute CO poisoning and 18 healthy volunteers were examined with conventional T1WII-T2WI-T2WI-T2WI-tirm MRI and DKI sequences. The average diffusion coefficient, average kurtosis and anisotropic fraction of 15 regions of interest were measured in all 6 groups of subjects. The ROI of the same area and the same dimension were manually measured three times, and the average value was taken as the final measurement value. The statistical software was used to analyze the clinical influencing factors related to the results of diffusion-weighted imaging in SPSS 21.0, and the patients were divided into positive group and negative group according to whether the lesions were detected in DWI scanning images. The differences of MK and FA between the two groups were compared, and the correlation between MK and the apparent diffusion coefficient on DWI was analyzed. The operating characteristic curves of MD and MK were drawn to compare the area under the ROC curve, and the optimal diagnostic threshold value, sensitivity and specificity of the quantitative evaluation of MDMK were calculated. To analyze the diagnostic efficacy of both for acute brain injury caused by CO poisoning. All the statistical values were expressed as mean 卤standard deviation, with P0.05 as the difference was statistically significant. The result is 1: 1. The longer the duration of consciousness disorder and the lower score of Glasgow coma scale in early stage were the positive factors of DWI scan. Compared with the control group, the MD value of each region of interest in the case group showed a decreasing trend, while the MK value showed an increasing trend, in which the decreased MD value of the case group was bilateral globus pallidus, the central semiovale and the paraventricular white matter of the lateral ventricle. The increase of MK value in genu of corpus callosum was: bilateral globus pallidus, thalamus, center of semiovale and lateral ventricular paracentricular leukoplasm decreased FA value: bilateral globus pallidus, and both groups of Yin and Yang had decreased MK and increased MK in bilateral globus pallidus. The changes of the other sites were all positive. There was a good correlation between the increase of MK and the decrease of ADC in DWI. The AUC of MK in the globus pallidus was the highest (0.900). The area under the ROC curve was the MD value of the globus pallidus, the MK value of the center of the hemi-oval circle, the MK value of the white matter of the lateral ventricle and the MD value of the white substance of the lateral ventricle, respectively. Their AUC were 0.886 7 ~ 0.856 ~ 0. 844 ~ 0. 822 ~ 0. 789, respectively. The best diagnostic threshold, sensitivity and specificity of MK value and MD value in globus pallidus were 1.230487, 1.2516, 8377, 1.2516, 8377, and 1.2516, 837,7777, respectively, in the middle of MK: 1. 06 33 911 MK, 0. 8736 93Md, 0. 852290 Md, 0. 852290. All the above differences were statistically significant (P 0.05). Conclusion: 1. DKI technique can quantitatively evaluate and diagnose acute brain injury in patients with CO poisoning. 2. DKI parameter MKMd can reflect the microstructural information of brain tissue in patients with CO poisoning, especially MK can reflect the microstructural changes of gray matter. It is more sensitive to detect gray matter abnormalities in the brain of patients with acute CO poisoning, which is helpful to evaluate the patients' condition objectively, and to intervene and give appropriate treatment as soon as possible.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.2;R595.1;R747.9

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