扩散张量成像对小儿脑瘫早期诊断及治疗的临床意义

发布时间：2018-01-20 12:29

本文关键词： 扩散张量成像(DTI) 脑瘫脑室周围白质软化(PVL) 儿童　出处：《新乡医学院》2014年硕士论文　论文类型：学位论文

【摘要】：背景产科和新生儿重症监护技术的日新月异,出生的条件降的越来越低,以至于早产、低出生体重及极低出生体重儿存活率逐渐增高,然而伴随的脑损伤问题也愈来愈多,严重的影响了儿童的体格、智力发育及生活质量问题。据国内外相关文献报告,在早产儿脑损伤中,脑瘫发生率是相当高的。这类患儿最后总会在运动、记忆、学习及行为等各方面留下不同程度的后遗症。导致患儿身体上的残疾和社会适应能力降低。这个问题也是一个值得全球关注的严重公共卫生问题。是什么原因导致脑瘫的产生呢?其具体机制又是什么呢?人们应该如何预防并治疗这类疾病了?为此,现代医学界进行了不断的探索。就目前而言,60%以上的脑瘫都是脑室周围白质软化(PVL)发展而来。磁共振扩散张量成像技术作为一种无创的新型的检查方法,在临床中运用广泛。主要功能是将人体内的神经纤维束的分布、走行及缺失完整的显现出来,比较敏感地提供病灶内微小病理改变的信息,因此,是否可以通过DTI来证实PVL白质的缺损,以及治疗后的恢复?更好的辅助临床。目的本研究旨在运用磁共振扩散张量成像技术对早期脑损伤及脑性瘫痪儿童脑白质纤维束治疗前后变化的评价,从而指导临床诊治及预后的判断。方法将17例临床中已经确诊为脑瘫的患儿与性别、年均相仿的6例健康儿童作为研究对象。首先进行常规头颅磁共振成像(Magnetic Resonance Imaging, MRI)平扫检查后,再行头颅的脑扩散张量成像(Diffusion tensor imaging, DTI)检查,得到各向异性分数(fractional anisotropy, FA)和彩色编码FA图。分别将内囊前／后支(anterior/posterior limb of internal capsule, ICAL/ICPL)、皮质脊髓束(corticospinal tract,CST)、胼胝体膝部(genu of corpus callosum, GCC)、胼胝体压部(splenium of corpus callosum,SCC),扣带束(cingulated gyrus, CO)设置为本次实验的感兴趣区(ROI),测定左右对称部位ROI的FA值,脑瘫组与对照组所得的FA值的变化进行非配对t检验。将实验组和对照组患儿头颅平扫按PVL分级标准,分为无异常、轻度异常、中度异常、重度异常四组,分别测量不同组别ROI的FA值。ROI组间比较采用单因素方差分析。应用SPSS17.0软件进行统计学分析,以P0.05认为有统计学差异。结果实验组与对照组比较发现左侧内囊前肢(患儿组：0.507±0.054；对照组：0.676±0.054)、右侧内囊前肢(患儿组：0.524±0.062；对照组：0.649±0.048)、左侧内囊后肢(患儿组：0.561±0.056：对照组：0.690±0.053)、右侧内囊后肢(患儿组：0.543±0.057；对照组：0.702±0.053)、左侧胼胝体膝部(患儿组：0.613±0.068；对照组：0.732±0.061)、左侧皮质脊髓束(患儿组：0.551±0.046；对照组：0.606±0.073)、右侧皮质脊髓束(患儿组：0.583±0.039；对照组：0.632±0.034)、扣带回左侧(患儿组：0.315±0.091；对照组：0.440±0.055)、扣带回右侧(患儿组：0.345±0.098；对照组：0.416±0.057)的FA值显著减低,差异具有统计学意义(t值为3.176-4.884,P0.05)。上述数据显示,脑瘫患儿的ROI较正常儿童对应部位的FA值明显下降。将入组对象按照不同PVL程度分为四组,组组间对比发现双侧皮质脊髓束、双侧内囊前肢、双侧内囊后肢、左侧胼胝体压部、双侧胼胝体膝部,双侧扣带束的FA值有差异,其差异有统计学意义(F值为5.774-34.245,P0.05)。同时,对实验组中2例患儿经过规范治疗,追踪随访,治疗前后DTI对比发现,彩色成像图明显好转,治疗前后的FA值明显升高。结论 DTI检查能够显示白质纤维损伤、中断、异常等。从微观上反应了脑白质纤维束的变化,对于脑瘫早期的诊断,指导脑损伤及脑瘫患儿治疗前后对比,疗效判断具有明显意义。
[Abstract]:background
Obstetric and neonatal intensive care technology change rapidly, birth conditions drop more and more low, so that premature birth, low birth weight and low birth weight infant survival rate increased gradually, but the problems associated with brain injury are also more and more serious impact on children's physical and mental development and the quality of life. According to the related literature at home and abroad report on brain injury in preterm infants, the incidence of cerebral palsy is very high. These children always end in sports, various aspects of learning and memory, behavior and other left sequelae in varying degrees. Which leads to the decrease of physically disabled children and the ability to adapt to the society. This is a serious public health problem of global concern what is the cause of cerebral palsy. The? What is the mechanism? People should be how to prevent and cure this kind of disease? Therefore, modern medicine for the time Exploration.
Currently, more than 60% of the cerebral palsy are periventricular leukomalacia (PVL). The development of diffusion tensor magnetic resonance imaging as a noninvasive method model, widely used in clinic. The main function is the distribution of human body nerve fiber bundle, walking and lack of complete show that is sensitive to the change of pathological lesions in small to provide information, therefore, whether can pass the DTI to confirm the PVL defect of the white matter, and recovered after treatment. Clinical assistant?
objective
The purpose of this study is to evaluate the changes of white matter fiber tracts before and after treatment in patients with early brain injury and cerebral palsy by magnetic resonance diffusion tensor imaging, so as to guide clinical diagnosis and prognosis.
Method
17 cases in children have been diagnosed with cerebral palsy and gender, 6 healthy children were similar to the average as the research object. Firstly, the conventional brain magnetic resonance imaging (Magnetic Resonance, Imaging, MRI) scan, then underwent brain diffusion tensor imaging (Diffusion tensor imaging, DTI), get the anisotropy score (fractional anisotropy, FA) and FA respectively. The color encoding map before and after internal capsule branch (anterior/posterior limb of internal capsule ICAL/ICPL (corticospinal), corticospinal tract tract, CST), corpus callosal (genu of corpus callosum knee GCC), splenium of corpus callosum (splenium of corpus callosum, SCC) (cingulated, midcingulate gyrus, CO) is set to the region of interest (ROI), the determination of the symmetrical part of ROI FA, the change of cerebral palsy group and the control group of the FA value of non paired t test of the experimental group. And the control group were plain scanning according to the PVL classification standard, divided into abnormal, mild abnormal, moderate abnormal, four severe abnormal group, ROI in different groups were measured FA values in.ROI group compared with single factor analysis of variance. SPSS17.0 software was used for statistical analysis, using P0.05 as a statistically significant difference.
Result
The experimental group compared with the control group found that the left anterior limb of the internal capsule (children group: 0.507 + 0.054; control group: 0.676 + 0.054), right anterior limb of internal capsule (Group: 0.524 + 0.062; control group: 0.649 + 0.048), the left posterior limb of the internal capsule (group: 0.561 + 0.056: control group: 0.690 + 0.053). On the right side of the posterior limb of the internal capsule (Group: 0.543 + 0.057; control group: 0.702 + 0.053), the left genu (Group: 0.613 + 0.068; control group: 0.732 + 0.061), the left corticospinal tract (group: 0.551 + 0.046; control group: 0.606 + 0.073), on the right side of the corticospinal tract (children group 0.583 + 0.039; control group: 0.632 + 0.034), cingulate gyrus (left group: 0.315 + 0.091; control group: 0.440 + 0.055), right cingulate (Group: 0.345 + 0.098; control group: 0.416 + 0.057) FA value was significantly decreased, the difference was statistically significant (t value 3.176-4.88 4, P0.05). The data showed that children with cerebral palsy ROI than normal children of the corresponding part of the value of FA decreased significantly. The subjects according to the different degree of PVL were divided into four groups, group comparison between the two groups showed bilateral corticospinal tract, bilateral anterior limb of internal capsule, bilateral posterior, left splenium, bilateral genu bilateral midcingulate, FA value difference, the difference was statistically significant (F-measure 5.774-34.245, P0.05). At the same time, the trace of the experimental group in 2 cases after standard treatment, follow-up, found DTI compared before and after treatment, color image is improved obviously, before and after the treatment of FA increased obviously.
conclusion
DTI examination can show white matter fiber damage, interruption, abnormality, etc. it reflects the change of white matter fiber bundle from microcosmic. It is significant for early diagnosis of cerebral palsy, guiding brain injury and comparing children's cerebral palsy before and after treatment.

【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R742.3;R445.2

【参考文献】