非痴呆型血管性认知障碍的氢质子磁共振波谱和扩散张量成像研究

发布时间：2018-06-21 07:59

本文选题：非痴呆型血管性认知障碍 + 氢质子磁共振波谱　；参考：《华中科技大学》2013年硕士论文

【摘要】：本研究分为两个部分，分别采用氢质子磁共振波谱（Proton Magnetic ResonanceSpectroscopy，~1H-MRS）技术、扩散张量成像（Diffusion Tensor Imaging，DTI）技术了解非痴呆型血管性认知障碍（vascular cognitive impairment no dementia，VCIND）患者脑灰质代谢变化和脑白质隐匿性损伤特点，分析VCIND组各感兴趣区~1H-MRS、DTI指标与蒙特利埃认知评估量表（Montreal Cognitive Assessment，MoCA）评分之间的相关性，评价脑灰质~1H-MRS检测及脑白质DTI检查在VCIND早期诊断和病情评价中的应用价值。第一部分非痴呆型血管性认知障碍的氢质子磁共振波谱研究目的：通过单体素~1H-MRS技术来探讨VCIND患者脑灰质的代谢变化特点，评价脑灰质~1H-MRS检测在VCIND早期诊断、病情评价中的应用价值。材料和方法：收集34名VCIND患者和26名条件匹配的志愿者，所有研究对象均接受头部单体素~1H-MRS技术扫描，检测双侧丘脑的N-乙酰天门冬氨酸（N-acetylaspartate，NAA）、胆碱化合物(Choline，Cho)、肌酸/磷酸肌酸(Creatine,Cr)，采用相对定量法得出NAA/Cr、Cho/Cr，比较VCIND组与对照组两侧丘脑NAA/Cr、Cho/Cr的差异，并分析VCIND组两侧丘脑NAA/Cr、Cho/Cr与MoCA评分间的相关性。结果：1.VCIND组两侧丘脑NAA/Cr较对照组降低，差异有统计学意义（P0.05），Cho/Cr较对照组无明显差异(P0.05）；2.VCIND组内，两侧丘脑NAA/Cr与MoCA评分呈正相关（P0.05），Cho/Cr与MoCA评分无相关性(P0.05）。结论：1.VCIND患者两侧丘脑存在神经元损伤，两侧丘脑代谢异常可能是导致 VCIND患者认知损害的重要因素；2.~1H-MRS技术可以敏感地检测出VCIND患者脑灰质代谢异常；3. VCIND患者丘脑NAA/Cr的变化在一定程度上可以反映认知损害的程度；4.丘脑的~1H-MRS检测有助于VCIND的早期诊断和病情评价。第二部分非痴呆型血管性认知障碍磁共振扩散张量成像研究目的：利用DTI技术了解VCIND患者脑白质隐匿性损伤特点，探讨脑白质的DTI检查在VCIND早期诊断、病情评价中的价值。材料和方法：收集27例VCIND患者和24例志愿者，所有研究对象均接受DTI技术扫描。扫描完成后，将图像传至后处理工作站，测量两侧额叶白质、胼胝体膝部和压部的各向异性分数（Fractional anisotropy，FA）和表观扩散系数（Apparent diffusioncoefficient，ADC）。比较VCIND组与对照组感兴趣区FA值、ADC值的差异，分析VCIND组各感兴趣区FA值、ADC值与MoCA评分之间的相关性。结果：1.VCIND组两侧额叶白质FA值较对照组降低，ADC值较对照组升高，，差异具有统计学意义（P 0.05），胼胝体膝部、压部FA、ADC值较对照组均无明显差异（P0.05）；2. VCIND组内，两侧额叶白质FA值与MoCA评分呈正相关（P 0.05），ADC值与MoCA评分呈负相关性（P 0.05），胼胝体膝部、压部FA值、ADC值与MoCA评分均无显著相关性（P0.05）。结论：1.VCIND患者两侧额叶白质纤维存在隐匿性损伤，这可能是导致VCIND患者认知损害的重要原因；2. DTI指标可以敏感地反映VCIND患者脑白质存在的隐匿性损伤；3. VCIND患者额叶白质FA值、ADC值变化在一定程度上可以反映认知损害的程度；4.额叶白质的DTI检查有助于VCIND的早期诊断和病情评价。
[Abstract]:This study was divided into two parts , using proton magnetic resonance spectroscopy ( ~ 1H - MRS ) and diffusion tensor imaging ( DTI ) . The correlation between ~ 1H - MRS , DTI and Montreal Cognitive Assessment ( MoCA ) was used to evaluate the correlation between ~ 1H - MRS , DTI and Montreal Cognitive Assessment ( MoCA ) .

Proton magnetic resonance spectroscopy of the first part of non - dementia vascular cognitive disorder

Objective : To evaluate the changes of cerebral gray matter metabolism in patients with VCIND , and to evaluate the value of brain gray ~ 1H - MRS in early diagnosis and evaluation of VCIND in patients with VCIND .

Materials and Methods : 34 volunteers with VCIND and 26 matched conditions were collected . All the subjects received N - acetylaspartate ( NAA ) , choline compound ( Choline , Cho ) , creatine / creatine phosphocreatine ( Creatine , Cr ) . The differences of NAA / Cr and Cho / Cr were determined by relative quantitative method , and the correlation between NAA / Cr , Cho / Cr and MoCA scores on both sides of VCIND group was analyzed .

Results : 1 . The NAA / Cr of the thalamus on both sides of the VCIND group was lower than that of the control group ( P0.05 ) . Cho / Cr had no significant difference compared with the control group ( P0.05 ) .
2 . There was positive correlation between NAA / Cr and MoCA scores on both sides of the VCIND group ( P0.05 ) . Cho / Cr had no correlation with MoCA score ( P0.05 ) .

Conclusion : 1 . There are neuronal damage in the thalamus of both sides of VCIND patients , and the abnormal metabolism of the thalamus in both sides may be caused .

The important factors of cognitive impairment in patients with VCIND ;
2 . The abnormality of gray matter metabolism in patients with VCIND can be detected sensitively by 1H - MRS technique .
3 . The changes of NAA / Cr in the thalamus of VCIND patients can reflect the course of cognitive impairment to some extent

Degree ;
4 . The detection of ~ 1H - MRS in thalamus contributes to the early diagnosis and evaluation of VCIND .

Magnetic resonance diffusion tensor imaging in the second part of non - dementia vascular cognitive impairment

Objective : To investigate the characteristics of brain white matter ( VCIND ) in patients with VCIND ( VCIND ) and to explore the value of DTI in early diagnosis and evaluation of VCIND .

Materials and Methods : Twenty - seven patients with VCIND and 24 volunteers were collected . All the subjects were scanned by DTI . After the scan was completed , the images were transferred to the post - processing workstation to measure the anisotropy fraction ( FA ) and apparent diffusion coefficient ( ADC ) of frontal white matter , corpus callosal knee and pressure part on both sides . The FA values and ADC values were compared between VCIND group and control group . The correlation between FA value , ADC value and MoCA score in VCIND group was analyzed .

Results : The FA values of frontal lobes on both sides of the VCIND group were lower than those in the control group , and the ADC values were significantly higher than those in the control group ( P0.05 ) .
2 . In VCIND group , the FA value of frontal lobes on both sides was positively correlated with MoCA score ( P 0.05 ) . The ADC value was negatively correlated with MoCA score ( P 0.05 ) . There was no significant correlation between ADC value and MoCA score ( P0.05 ) .

Conclusion : 1 . There is hidden injury of frontal white matter fibers on both sides of VCIND patients , which may be an important cause of cognitive impairment in patients with VCIND .
2 . DTI can sensitively reflect the latent damage of brain white matter in VCIND patients .
3 . The change of ADC value can reflect the degree of cognitive impairment to some extent in VCIND patients .
4 . DTI of frontal white matter contributes to early diagnosis and evaluation of VCIND .
【学位授予单位】：华中科技大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R749.13;R445.2

【参考文献】