DTI联合~1H-MRS对肝豆状核变性脑组织微观结构损害的定量研究

发布时间：2018-03-20 06:15

  本文选题：肝豆状核变性　切入点：磁共振波谱学　出处：《安徽医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景肝豆状核变性(Hepatolenticular degeneration,HLD)是一种少见且为数不多可以治疗的遗传代谢障碍疾病,又称Wilson disease(WD)。HLD诊断主要基于临床表现、实验室检查及眼角膜K-F环。一旦患者出现失代偿期肝硬化和或严重的神经系统症状则预后不佳,早发现早治疗对患者预后有极大帮助,然而HLD的临床表现多样,早期诊断尤为困难。常规MRI对HLD的诊断、治疗及随访评估有重要价值。弥散张量成像(Diffusion tensor imaging,DTI)及磁共振氢质子波谱成像(~1H-Magnetic Resonance Spectroscopy,~1H-MRS)是一种基于磁共振原理的新技术,较常规MRI更为敏感。MRS能反应潜在病变的生化指标,DTI能敏感的反应微观结构改变。目前国内外学者运用MRS或DTI技术对HLD报道较少,并且研究结果存在争议。目的应用DTI和~1H-MRS评估肝豆状核变性患者脑灰质核团及白质的微观结构损害。探讨HLD患者平扫示之脑白质正常区是否存在微观结构损害;研究HLD组与健康对照组平均弥散系数(Average diffusion coefficient,ADC)、部分各向异性值(Fractional anisotropy,FA)、弥散张量本征值(Eigenvalue,E1、E2、E3)及NAA/Cr、NAA/Cho、NAA/Cho比值的差异;分析FA值与NAA/Cr比值的相关性;通过DT I与MRS定量数据绘制受试者操作特征曲线(Receiver operating characteristic,R OC),评价其诊断效能。方法选取HLD患者26例及正常对照组20例行DTI及~1H-MRS成像,感兴趣区(Region of interest,ROI)置于受试者大脑两侧壳核、丘脑、额叶及胼胝体压部,比较两组不同脑区FA、ADC、E1、E2、E3值及NAA/Cr、Cho/Cr、NAA/Cho比值的差异,应用Pearson等级相关进行相关分析,以临床确诊结果为金标准绘制ROC曲线,P0.05为差异有统计学意义。结果HLD患者双侧壳核及丘脑的FA及ADC值高于正常组,其中壳核差异有统计学意义(P0.05),而双侧丘脑差异无统计学意义(P0.05);双侧额叶白质及胼胝体压部FA值降低,ADC值升高,与正常组对比差异均有统计学意义(P0.05);HLD组各兴趣区本征值均高于对照组,其中双侧壳核E1、E2、E3值、双侧丘脑E1值、双侧额叶白质及胼胝体压部E2、E3值差异均有统计学意义(P0.05)。HL D组双侧壳核、双侧丘脑及胼胝体压部的NAA/Cr比值低于正常对照组,差异有统计学意义(P0.05)。双侧丘脑、额叶白质及胼胝体FA值与NAA/Cr比值呈中等正相关(P0.05)。右侧壳核FA值诊断效能较高,诊断取值0.160(10-3mm2/s),敏感度76.9%、特异度80%,FA值和NAA/Cr比值串联特异度达90%,二者并联敏感度达96.2%。结论DTI能发现HLD患者平扫示之脑白质正常区存在微观结构损害,较常规MR显示脑实质损伤更为敏感;壳核的FA值反向升高,可能与HLD患者铁异常过量沉积于该部位有关;MRS能无创检测HLD患者脑组织损害的代谢异常;部分感兴趣区FA值与NAA/Cr比值存在中等程度的正相关;DTI与MRS两者结合可以反应真实的脑组织损害并提供定量数据,有一定的诊断效能,为应用临床奠定基础。
[Abstract]:Background Hepatolenticular degeneration (HLD) is a rare and rarely treatable disorder of genetic metabolism, also known as Wilson disease(WD).HLD diagnosis based on clinical manifestations. Laboratory examination and corneal K-F ring. Once patients have decompensated cirrhosis and severe nervous system symptoms, the prognosis is not good. Early detection of early treatment is of great help to the prognosis of patients. However, the clinical manifestations of HLD are diverse. Early diagnosis is particularly difficult. Conventional MRI is of great value in the diagnosis, treatment and follow-up evaluation of HLD. Diffusion Zhang Liang imaging tensor imaging and magnetic resonance proton spectroscopy imaging are a new technique based on the principle of magnetic resonance. It is more sensitive than conventional MRI. Mrs can reflect the changes of microstructures of potential lesions. At present, there are few reports on HLD by using MRS or DTI techniques at home and abroad. Objective to evaluate the microstructural damage of gray matter and white matter in patients with hepatolenticular degeneration by DTI and 1H-MRS. To study the difference of average diffusion coefficient and fractional anisotropy between HLD group and healthy control group, and to analyze the correlation between FA value and NAA/Cr ratio. DTI and MRS quantitative data were used to draw the receiver operating characteristic curve and evaluate its diagnostic efficacy. Methods 26 patients with HLD and 20 normal controls underwent DTI and 1H-MRS imaging. The region of interest ROI was placed in the bilateral putamen nucleus of the brain. The thalamus, frontal lobe and corpus callosum were compared between the two groups. The difference of E _ (2) E _ (3) and the ratio of NAA / Cr Cho-r / Cr ~ (2 +) NAA / Cho were compared between the two groups. The correlation between the two groups was analyzed by Pearson grade correlation. Results the FA and ADC values of bilateral putamen and thalamus in patients with HLD were higher than those in normal controls. There was significant difference in putamen nucleus (P 0.05), but no significant difference in bilateral thalamus (P 0.05), and the FA value of bilateral frontal white matter and corpus callosum decreased. Compared with the normal group, the difference was statistically significant (P 0.05). The intrinsic values of each region of interest in the HLD group were higher than those in the control group, including the E _ (1) E _ (2) E _ (3) of the bilateral putamen nucleus and the E _ (1) E _ (1) value of the bilateral thalamus. The NAA/Cr ratio of bilateral putamen nucleus, bilateral thalamus and corpus callosum in group HL-D was lower than that in control group (P 0.05), and the difference was statistically significant (P 0.05) between the two sides of the white matter of frontal lobe and the splenium of corpus callosum (P 0.05), and the ratio of NAA/Cr in bilateral thalamus was significantly lower than that in the control group (P < 0.05). The ratio of FA and NAA/Cr in the white matter of frontal lobe and corpus callosum showed a moderate positive correlation (P 0.05). The diagnostic value was 0.160 ~ 10 ~ (-3) mm ~ (-2) / s, sensitivity was 76.9, the specificity of FA value and NAA/Cr ratio was 90, and the sensitivity of parallel connection between them was 96.2.Conclusion DTI can detect the microstructural damage in normal white matter area of HLD patients on plain scan. The increased FA value of putamen nucleus may be related to the excessive deposition of iron in HLD patients and the noninvasive detection of metabolic abnormalities in brain tissue damage in patients with HLD by magnetic resonance spectroscopy (Mrs). The moderate positive correlation between FA value and NAA/Cr ratio in some regions of interest can reflect the real brain tissue damage and provide quantitative data. It has certain diagnostic efficacy and lays a foundation for clinical application.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.2;R742.4
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