酰胺质子转移成像在缺血性脑卒中的临床应用研究

发布时间：2018-03-15 09:48

  本文选题：卒中　切入点：脑缺血　出处：《北京协和医学院》2017年博士论文　论文类型：学位论文

【摘要】：(第一部分)酰胺质子转移成像在健康受试者及缺血性脑卒中患者的初步研究目的:酰胺质子转移加权(amide proton transfer-weighted,APTW)成像是一种新型的磁共振成像(magnetic resonance imaging,MRI)方法,可以对组织中pH进行无创性评价,先前动物研究已经证实其可以反映梗死后组织pH的变化。本研究目的是探讨APTW成像在健康受试者及临床缺血性脑卒中患者中的可行性。研究对象与方法:本研究纳入30例受试者,包括确诊急性期缺血性脑卒中(acute ischemic stroke)患者和健康受试者各15例,分别为卒中组和正常组。其中卒中组男性9例,女性6例,年龄界于44-83岁之间,平均年龄(65.2±13.2)岁;正常组男性8例,女性7例,年龄界于42-85岁之间,平均年龄(61.7±11.3)岁。所有受试者均行头部常规 T2 加权成像(T2-weighted imaging,T2WI)、扩散加权成像(diffused-weighted imaging,DWI)、T1 加权成像(T1-weighted imaging,T1WI)以及APTW成像,卒中组测量病变区及对侧正常脑白质区的酰胺质子不对称磁化转移率(MTRasym),即APTW效应值的变化,正常组选择基底节层面测量其两侧颞叶正常脑白质区的APTW值。采用配对t检验方法检测组内两侧脑区APTW值的差异,组间差异采用方差分析方法进行评估。结果:卒中组病变区APTW效应值较对侧正常脑区明显减低(P0.001),患侧与对侧的APTW值分别为(-0.67±0.27)%和(0.12±0.08)%。对照组两侧脑白质区的APTW值分别(0.13±0.03)%和(0.14±0.06)%,两侧之间无明显差异。卒中组对侧正常脑白质区与正常组两侧脑白质区之间APTW值无显著性差异。结论:作为一种无创无辐射的磁共振成像方法,APT成像可以检测出急性脑缺血病变的存在,对临床诊治具有一定的潜在应用价值。(第二部分)酰胺质子转移成像在评估不同时期缺血性脑卒中的初步应用目的:缺血性脑卒中是临床常见病及高发病,明确脑卒中病变的演变对临床诊治具有一定的价值。已经证实酰胺质子转移加权(amide proton transfer-weighted,APTW)成像可以对组织中pH变化进行无创性评价,其在反映脑梗死组织pH变化方面具有较好的应用前景。本研究目的是探讨APTW成像在评估缺血性脑卒中病变演变中的应用价值。研究对象与方法:本研究纳入我院2014年到2016年期间经临床及影像学检查确诊的缺血性脑卒中患者39例,其中男性23例,女16例,年龄界于26-90岁之间,平均年龄(62.7±14.3)岁,发病时间界于2小时至7天之间。根据其发病时间的不同将其分为四期:超急性期患者4例(发病时间≤6小时),急性期患者18例(6小时发病时间≤48小时),亚急性早期患者10例(48小时发病时间≤96小时),亚急性晚期患者7例(96小时发病时间≤168小时)。各期患者均进行APTW成像及常规MR成像,包括T2加权成像(T2-weighted imaging,T2WI)、扩散加权成像(diffused-weightedimaging,DWI)、T1 加权成像(T1-weightedimaging,T1WI)。APTW成像选择DWI显示病变最大面积层面进行横断位成像,对APTW图像进行酰胺质子(约3.5ppm处)不对称磁化转移率的分析,进而获得APTW效应值。结果:在各期患者中,与对侧正常脑白质区比较,梗死区APTW信号值均显示出了明显减低(P0.05)。各期患者梗死区APTWave值依次分别为(-0.85±0.02)%、(-0.64±0.09)%、(-0.48±0.11)%及(-0.34±0.10)%,APTWmax 值分别为(-0.02±0.04)%、(-0.24±0.07)%、(-0.23±0.10)%及(-0.11±0.07)%,APTWmin值分别为(-1.24±0.04)%、(-1.06±0.10)%、(-0.85±0.08)%及(-0.70±0.09)%,APTWmax-min值分别为(1.22±0.06)%、(0.82±0.07)%、(0.62±0.05)%及(0.59±0.07)%。与其他各期患者相比,超急性期患者APTWave及APTWmin相比其他各组降低,APTWmax-min显著高于其他各期。回归分析显示,APTWave与APTWmin与发病时间之间均存在一定的正相关性。APTWmax-min随着发病时间延长有降低的趋势(R2 = 0.44,P0.001)。结论:缺血性脑卒中后脑内梗死区相比于对侧正常脑白质区存在持续性的组织内pH的降低,即组织酸中毒的存在,随着发病时间的增加,这种组织中酸性环境有所缓解。APTW成像可以一定程度上反映脑卒中组织在不同时期及时间点的pH加权特性。(第三部分)酰胺质子转移成像在缺血性脑卒中患者中的回顾分析目的:酰胺质子转移(amide proton transfer,APT)加权磁共振成像(magnetic resonance imaging,MRI)在脑卒中患者中已经证实具有较好的应用价值。但其在不同类型缺血性脑卒中的APT影像表现特征尚无研究探讨。本研究拟探讨不同类型急性缺血性脑卒中(acute ischemic stroke,AIS)患者的APT加权(APT-weighted,APTW)成像特点。研究对象与方法:纳入81例起病在96h以内的AIS患者,其中男性56例,女性25例,年龄界于26-92岁之间,平均年龄(65.5± 13.7)岁。所有受试者均行APTW及常规MR成像检查,其中常规MR成像包括扩散加权成像(diffusion weighted imaging,DWI)、T2WI 及 T1WI。按照牛津郡社区脑卒中规划(Oxfordshire Community Stroke Project,OCSP)影像学分型,将其分为4种类型:完全前循环梗死(total anterior circulation infarcts,TACI)患者9例,部分前循环梗死(partial anterior circulation infarcts,PACI)患者28例,腔隙性脑梗死(lacunar circulation infarcts,LACI)患者33例,后循环梗死(posterior circulation infarcts,POCI)患者15例。分别测量各期梗死区APTW信号值(APTWlesion)以及对侧正常脑区APTW信号值(APTWcon),并且计算二者之间的差值APTWles-con。应用SPSS软件对各组结果进行统计学分析。结果:TACI组、PACI组及POCI组APTWlesion和APTWcon之间存在明显的差异(P0.01),但LACI组两者之间无明显差异(P=0.080)。与其他各组比较,LACI组有较高APTWlession和较低的APTWles-con(P均0.01);TACI组患者APTWlesion低于其他组,APTWles-con高于其他组(P均0.01)。脑干梗死患者梗死区及对侧正常脑区之间APTWlesion和APTWcon无明显差异。结论:TACI组患者梗死区存在较为严重的组织酸中毒,LACI组梗死区组织酸中毒较轻。APTW MRI能够检测到TACI及PACI组患者梗死灶和病变区组织酸中毒的存在。但是,对于LACI及脑干梗死患者,APTW成像效果欠佳。
[Abstract]:(the first part) amide proton transfer imaging in healthy subjects and patients with ischemic stroke Objective: preliminary study of amide proton transfer (amide proton transfer-weighted, APTW weighted imaging) is a kind of new type of magnetic resonance imaging (magnetic resonance, imaging, MRI) method, can pH in the noninvasive evaluation, previously animal studies have confirmed that it can reflect the change of pH after infarction. The purpose of this study is to explore the APTW imaging in healthy subjects and patients with the clinical feasibility of ischemic cerebral stroke. Subjects and methods: the study included 30 subjects, including the diagnosis of acute ischemic stroke (acute ischemic stroke) patients and healthy subjects 15 cases respectively, stroke group and normal group. 9 cases of stroke in males, 6 females, aged 44-83 years old, the average age (65.2 + 13.2) years; 8 cases of normal male group, 7 cases were female, aged 42-85 years old, the average age (61.7 + 11.3) years old. All subjects were performed conventional T2 weighted imaging (T2-weighted imaging, T2WI), diffusion weighted imaging (diffused-weighted imaging, DWI), T1 (T1-weighted imaging, T1WI weighted imaging) and APTW imaging, amide proton asymmetry magnetization measurement stroke lesions and contralateral normal brain white matter transfer rate (MTRasym), the change of APTW value effect, normal group level measurement of basal ganglia on both sides of the temporal lobe of normal brain white matter APTW values. The difference by paired t test method for detection of group APTW value on both sides of the brain. The variance analysis method was employed to assess the differences between the groups. Results: the stroke group APTW lesion effect value than that of the normal brain area was significantly decreased (P0.001), ipsilateral and contralateral APTW = (-0.67 + 0.27)% and (0.12 + 0.08)%. The control group on both sides of the brain white matter APT The values of W were (0.13 + 0.03)% and (0.14 + 0.06)%, no significant difference between both sides. Between APTW and contralateral normal white matter stroke group and the control group on both sides of the brain white matter was no significant difference. Conclusion: as a noninvasive magnetic resonance imaging method without radiation, APT imaging can detect acute cerebral ischemia lesion, have certain potential application value for clinical diagnosis and treatment. (part second) amide proton transfer imaging in the evaluation of different periods of ischemic stroke application Objective: ischemic stroke is a common clinical disease and high incidence of stroke lesions clearly, evolution has certain clinical value in the diagnosis and treatment has been confirmed. Amide proton transfer (amide proton transfer-weighted, APTW weighted imaging) can the organization of pH changes for noninvasive evaluation, and has good application prospects in the pH reflect the changes of cerebral infarction tissue. The purpose of this study The application value of APTW imaging in assessment of ischemic stroke lesions in the evolution. Subjects and methods: This study included in our hospital during 2014 to 2016 by clinical and imaging examination in patients with ischemic stroke in 39 cases, including 23 cases of male, female 16 cases, aged 26-90 years old, the average age of (62.7 + 14.3) years old, the onset time from 2 hours to 7 days. According to the onset time divided into four period: 4 cases of patients with hyperacute (onset within 6 hours), 18 cases of patients with acute (48 hours and 6 hours of onset time less than), early subacute patients 10 cases (48 hours of onset within 96 hours), 7 patients with subacute stage (96 hours of onset within 168 hours). The patients underwent APTW imaging and conventional MR imaging, including T2 weighted imaging (T2-weighted imaging, T2WI), diffusion weighted imaging (diffused-weightedimaging, DWI), T1 鍔犳潈鎴愬儚(T1-weightedimaging,T1WI).APTW鎴愬儚閫夋嫨DWI鏄剧ず鐥呭彉鏈，

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