海马硬化型颞叶癫痫患者的脑白质微结构损害与临床相关性的弥散张量成像研究

发布时间：2018-02-26 18:16

本文关键词： 海马硬化颞叶癫痫弥散张量成像基于纤维束的空间统计　出处：《广西医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：【目的】磁共振弥散张量成像（diffusion tensor imaging, DTI）是近年来发展比较迅速的一种可以在活体无创地测量生物组织结构中水分子扩散速率的新的成像方法。本文旨在利用DTI技术研究伴有海马硬化（hippocampal sclerosis, HS）的颞叶癫痫(temporal lobe epilepsy, TLE)患者全脑白质微结构损害的特点,并探索其与患者发病年龄、病程的相关关系，以期对伴有HS的TLE患者脑部病变的早期发现和早期干预等提供客观有效的形态学指标。【对象及方法】所选患者来自2009年至2012年在我院门诊或住院治疗的伴有海马硬化的颞叶癫痫病人，共30名，其中13名为左侧海马硬化（lefthippocampal sclerosis, LHS）患者,17名为右侧海马硬化（righthippocampal sclerosis, RHS）患者,同时选择23名年龄及性别匹配的健康志愿者作为对照。对30名伴有HS的TLE患者以及23名正常被试进行全脑DTI扫描。DTI数据由FMRIB software library提供的软件工具包处理，通过基于纤维束的空间统计（track-based spatial statistics，TBSS）方法分别比较左侧HS组与健康对照组、右侧HS组与健康对照组脑白质图像的各向异性分数（fractional anisotropy, FA）值，寻找有显著性差异的脑白质区域，并将其作为感兴趣区域（region of interest, ROI），采用双变量spearman相关分析方法，研究伴有HS的TLE患者发病年龄及病程与ROI的FA值的相关性。所有统计学处理均采用SPSS16.0统计分析软件包，统计结果用P表示，p0.05时认为有统计学意义。【结果】1.与健康对照组相比，伴有左侧HS的TLE患者FA值降低的区域主要为双侧放射冠、左侧胼胝体膝部、右侧胼胝体体、胼胝体压部、后丘脑辐射、外囊及上纵束，未发现FA值升高的脑白质区域；2.与健康对照相比，伴有右侧HS的TLE患者FA值降低的区域主要为双侧胼胝体、放射冠、丘脑后辐射、扣带、上纵束，右侧内囊前肢、内囊的晶状体后部、外囊，未发现FA值升高的脑白质区域；3.左侧HS组右侧放射冠前部的FA值与起病年龄正相关；左侧HS组左侧的胼胝体膝部的FA值与病程呈负相关，右侧HS组双侧放射冠上部的FA值均与病程正相关，余受损区域的FA值改变与病程无显著线性相关关系。【结论】1.DTI可以无创有效地研究海马硬化型TLE患者全脑白质微结构的改变。2.海马硬化型TLE可以产生较广泛的大脑双侧半球白质结构的异常，而不仅仅局限于颞叶或患侧大脑半球。3.左侧HS的TLE患者的发病年龄对放射冠前部的改变存在影响,这个区域可能易受到早期痫性发作的损伤，或受到致痫因素的影响；4.左侧HS的癫痫患者左侧的胼胝体膝部的FA值与病程呈负相关，，右侧HS组双侧放射冠上部的FA值均与病程呈正相关，提示白质纤维受痫性放电的损害与病程长短有关。
[Abstract]:[objective] diffusion-diffusion Zhang Liang imaging (DTI) is a new imaging method which can be used to measure diffusion rate of water molecules in living tissue structures in vivo. The purpose of this paper is to use DTI technique to measure the diffusion rate of water molecules in living tissues. To study the characteristics of global white matter structure damage in patients with temporal lobe epilepsy with hippocampal sclerosis (HSS) and temporal lobe epilepsys. In order to provide objective and effective morphological indicators for early detection and early intervention of brain lesions in TLE patients with HS, the correlation between the age of onset and the course of disease was explored. [participants and methods] Thirty patients with temporal lobe epilepsy with hippocampal sclerosis were selected from 2009 to 2012. 13 of them were left hippocampus sclerosis (LHS) and 17 were right hippocampal sclerosis (RHS). Meanwhile, 23 healthy volunteers with age and gender matched were selected as control. The whole brain DTI scanning. DTI data were processed by FMRIB software library software kit in 30 TLE patients with HS and 23 normal subjects. The anisotropic fraction of white matter images in left HS group and healthy control group, right HS group and healthy control group were compared by using the spatial statistics based on fiber bundle spatial statistics (TBS) to find the white matter areas with significant differences. Using bivariate spearman correlation analysis method, the correlation between onset age and duration of TLE with HS and FA value of ROI was studied. All statistics were processed by SPSS16.0 statistical analysis software package. The statistical results showed that there was statistical significance when P 0.05 was used. [results] 1.Compared with the healthy control group, the decreased FA values of TLE patients with left HS were mainly bilateral coronas, the genu of the left corpus callosum, the right corpus callosum, the splenium of the corpus callosum, the posterior thalamus radiation, the external capsule and the superior longitudinal bundle. Compared with healthy controls, the decrease of FA in TLE patients with right HS was mainly bilateral corpus callosum, coronal radiosurgery, retrothalamic radiation, cingulate band, superior longitudinal bundle, right anterior limb of internal capsule. In the posterior part of the lens and the outer capsule of the internal capsule, no increase in FA value was found in the white matter region of the brain. There was a positive correlation between the FA value of the right anterior part of the coronal radiography in the left HS group and the onset age, and there was a negative correlation between the FA value of the left corpus callosum knee and the course of disease in the left HS group. The FA values of bilateral upper coronas in the right HS group were positively correlated with the course of disease. There is no significant linear correlation between FA changes and course of disease. [conclusion] 1. DTI can effectively and noninvasively study the changes of white matter microstructure in hippocampal sclerosing TLE patients. 2. Hippocampal sclerosing TLE can produce a wide range of brain. 2. Abnormal white matter structure in both hemispheres, It is not confined to the temporal lobe or the affected hemisphere.3.The age of TLE patients with left HS has an effect on the changes in the anterior part of the radiographic corona. This area may be vulnerable to early epileptic seizures. The FA value of left corpus callosum genu was negatively correlated with the course of disease in the left HS group, and the FA value of the upper part of the bilateral radiographic corona in the right HS group was positively correlated with the course of the disease. The results suggest that the damage of white matter fiber caused by epileptic discharge is related to the duration of disease.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R742.1

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