急性期弥漫性轴索损伤磁共振弥散张量成像研究

发布时间：2018-05-21 15:39

  本文选题：急性期弥漫性轴索损伤 + 磁共振　； 参考：《中南大学》2014年硕士论文

【摘要】：目的：探讨磁共振弥散张量成像(diffusion tensor imaging,DTI)在急性期弥漫性轴索损伤中的诊断价值,并评估DTI对急性期弥漫性轴索损伤的严重程度以及预后的意义。 材料和方法：研究对象分为DAI组及正常对照组,DAI组为符合弥漫性诊断诊断标准的21例急性期(4.05±1.63d)弥漫性轴索损伤患者,男性15例,女性6例,年龄19-57岁,平均37.2岁。对照组选择与DAI组年龄、性别匹配的健康自愿者(对照组)21例。均进行常规磁共振T1加权(T1weighted imaging, T1WI)、T2加权(T2weighted imaging,T2WI)、液体衰减反转恢复序列(Fluid attenuated inversion recovery, FLAIR)序列及DTI。使用思创(CreaLife) DTI分析软件对图像进行处理,选取包括胼胝体膝部、胼胝体体部、胼胝体压部、内囊前肢、内囊后肢、大脑脚感兴趣区,得到不同感兴趣区的各项异性分数(fractional anisotropy, FA),相对各项异性指数(relative anisotropy, RA),表观弥散系数(apparent diffusion coefficient,ADC)。然后比较DAI组与对照组相应区域的FA值,RA值,ADC值。 用思创DTT软件用选取感兴趣区法在矢状位FA图勾勒胼胝体、内囊及大脑脚,进行纤维束追踪,重建出所通过的纤维束三维图像,请三位有经验的医师对重建的纤维束进行分析。 在DAI患者急性期(4.05±1.63d)与恢复期(7.86±1.49m)分别进行GCS (Glasgow Coma Scale)评分及GOS (Glasgow Outcome Scale)评分,并与DAI组不同感兴趣区FA值,RA值,ADC值进行相关性分析。 结果： 1、急性期DAI与正常对照的DTI成像比较： 急性期DAI胼胝体压部(0.59±0.07)、胼胝体膝部(0.68±0.05)、内囊后肢(0.64±0.03)、大脑脚(0.58±0.05)FA值与对照组比较,差异有统计学意义(P0.05)；急性期DAI胼胝体压部(0.58±0.03)、胼胝体体部(0.60±0.02)、内囊后肢(0.52±0.03)、大脑脚(0.49±0.04)RA值与对照组比较,差异有统计学意义(P0.05);急性期DAI胼胝体压部(0.73±0.04)、内囊后肢(0.65±0.03)ADC值与对照组比较,差异有统计学意义；两组间胼胝体体部、内囊前肢FA值的差异无统计学意义(P0.05)。 2、急性期DAI的DTI改变与DAI严重程度的相关性分析： 急性期DAI组胼胝体压部、内囊后肢、大脑脚FA值与GCS评分有相关性(P0.05),胼胝体压部、大脑脚RA值与GCS评分有相关性(P0.05),胼胝体压部ADC值与GCS评分有相关性(P0.05)。 3、急性期DAI组的DTI改变与DAI预后的相关性分析： 急性期DAI组的胼胝体压部、大脑脚FA值与GOS评分有相关性(P0.05),胼胝体压部RA值与GOS评分有相关性,各感兴趣区ADC值与GOS评分无相关性(P0.05)。 4、急性期DAI组的弥散张量纤维束成像：其中12例表现为受损部位白质纤维束略稀疏,4例表现为损伤部位纤维束中断,5例未见明显异常。 结论： 1.急性期DAI组患者的脑深部白质纤维束的DTI的FA、RA、ADC值与正常对照组比较有差异,提示DTI能反映DAI白质纤维束损伤的异常弥散改变,DTI可成为早期诊断DAI的手段。 2.急性期DAI组患者脑深部白质纤维束的DTI的FA,RA、ADC值与GCS评分有相关性,DTI可作为评估DAI患者严重程度的方法。 3、急性期DAI组患者脑深部白质纤维束的DTI的FA、RA值与GOS评分有相关性,ADC值与GOS评分无相关性。DTI可在一定程度上判断DAI患者预后。 4、DTT能提供白质纤维束受损的可视化依据。
[Abstract]:Objective: To evaluate the diagnostic value of diffusion tensor imaging (DTI) in acute diffuse axonal injury and to evaluate the significance of DTI for the severity and prognosis of acute diffuse axonal injury.
Materials and methods: the subjects were divided into DAI group and normal control group. Group DAI was 21 patients with diffuse axonal injury (4.05 + 1.63d) with diffuse diagnostic criteria, 15 men, 6 women, 19-57 years old and 37.2 years old. The control group was selected with the age of DAI and 21 cases of sex matched healthy volunteers (control group). Routine magnetic resonance T1 weighted (T1weighted imaging, T1WI), T2 weighted (T2weighted imaging, T2WI), liquid attenuation inversion recovery sequence (Fluid attenuated inversion recovery) sequence and processing software were used to deal with the image, including the corpus callosum, corpus callosum, corpus callosum pressure part. The capsular forelimb, the inner capsule hind limbs, the cerebrum sense of interest, the fractional anisotropy, FA, the relative heterosexual index (relative anisotropy, RA), the apparent dispersion coefficient (apparent diffusion coefficient, ADC). Then the FA value, the value, and the value of the DAI group and the control group are compared.
Using the selected DTT software, the corpus callosum, the inner capsule and the cerebrum foot were outlined in the sagittal FA map with the selected region of interest method. The fiber bundle was tracked and the three-dimensional image of the fiber bundle was reconstructed. Three experienced doctors were asked to analyze the reconstructed fiber bundle.
The scores of GCS (Glasgow Coma Scale) and GOS (Glasgow Outcome Scale) were scored in the acute phase (4.05 + 1.63d) and the recovery period (7.86 + 1.49M) of the patients with DAI, and the correlation analysis was carried out with the values, values and values of the different regions of interest in the DAI group.
Result锛，

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