多模态功能磁共振成像在小儿脑瘫中的应用价值

发布时间：2018-03-20 18:16

本文选题：磁共振波谱成像　切入点：磁共振扩散张量成像　出处：《新乡医学院》2017年硕士论文　论文类型：学位论文

【摘要】：背景小儿脑性瘫痪是由各种原因所致的非进行性脑损伤综合征,给家庭和社会造成沉重精神和经济的负担。大量的研究证实对脑瘫高危儿进行早期干预(康复治疗)的效果是肯定的。目前多模态磁共振技术在许多方面有着广泛的运用,但国内外将多模态磁共振成像技术用于小儿脑瘫的研究尚未见报道。目的本研究旨在探讨磁共振多模态成像在小儿脑性瘫痪(脑瘫)中的临床应用价值。方法选取经临床诊断为脑瘫的患儿50例为试验组(A组),其中男28例,女22例,年龄0~6个月,主要为新生儿缺氧缺血性脑病的患儿。选取50例正常的新生儿作为对照组(B组),男27例,女23例,对照组纳入标准:新生儿无围生期窒息及宫内窘迫表现,出生后1min、7min的Apgar评分均≥8分;无中枢系统传染和畸形;无显著代谢障碍和染色体病症;无神经系统疾病症状。A组、B组均行核磁共振常规序列(T1WI、T2WI等)及多模态功能磁共振检查(MRS、DTI、SWI),其中两组均采用MRS及DTI扫描检查,并比较两组影像学图像,测定两组胆碱复合物(Cho)、N-乙酰基天门冬氨酸(NAA)、肌酸复合物(Cr)、乳酸(LAC)、肌醇(ml)等代谢产物,然后进行比较;对比分析SWI与常规序列对脑实质、脑室及蛛网膜下腔和硬膜下出血检出数目;比较常规磁共振检查与多模态磁共振检查对患儿大脑不同兴趣区的敏感度及多模态磁共振成像技术对脑瘫患儿检查的有效率其差异有无统计学意义,采用t检验及X2检验分析。结果相比于常规的磁共振检查,多模态磁共振检查在对患儿大脑不同区的敏感度相对较高;SWI与常规MR序列对颅内出血检出数目比较统计,可见SWI对颅脑出血灶的诊断优于常规MRI;DTI与常规MRI检测情况通过我们的研究发现,对照组未见DTI的异常信号;而试验组中,使用DTI序列检出病灶者为43例,诊断准确率为86.0%;普通MRI序列检出21例,占42.0%,可见DTI的诊断准确率明显高于常规MR,其差异具有统计学意义,P0.05;试验组NAA/Cr低于对照组,而Cho/Cr、Lac/Cr及ml/Cr高于对照组,差异具有统计学意义,P0.05。结论SWI与常规序列联合应用能够提高新生儿颅内出血的诊断;临床应用DTI可于HIE早期检测中有效显示其病灶范围及数目,同时采用MRS可无创地测量患儿脑部组织缺氧、缺血过程中所产生的代谢产物,三者结合可提高患儿临床诊断准确性,为患者预后评估提供有力价值。目的研究磁共振成象技术(MRI)多序列扫描在小儿脑瘫康复治疗期间的应用价值。方法选取我院2015年12月至2016年5月65例小儿脑瘫患者为研究对象,所有患儿均进行MRI多序列扫描,以小儿脑瘫患儿康复治疗后的康复程度为参考标准,计算MRI检查的灵敏度、特异度、阳性预测值、阴性预测值、准确性、Kappa值。结果MRI检查的灵敏度为87.9%,特异度为93.75%,阳性预测值为93.5%,阴性预测值为88.2%,诊断符合率为90.8%,Kappa值为0.82。结论小儿脑瘫患儿的病灶改善情况和患儿康复程度存在一定的相关性。MRI多序列扫描对小儿脑瘫患儿的病情诊断、治疗指导、预后评估具有重要价值。
[Abstract]:Background cerebral palsy is non progressive brain damage syndrome caused by various reasons, caused heavy mental and economic burden to families and society. Many studies have confirmed that early intervention for high-risk infants with cerebral palsy (rehabilitation) the effect is positive. The multi modality magnetic resonance imaging technology in many areas has been widely use, but domestic and international multimodal magnetic resonance imaging technology for children with cerebral palsy is unclear. Objective this study aimed to investigate the paralysis in children with cerebral magnetic resonance multi modality imaging (CP) in clinical application. Methods the clinical diagnosis of cerebral palsy in 50 cases as experimental group (group A), which male 28 cases, female 22 cases, aged 0~6 months, mainly for neonatal HIE. Selected 50 cases of normal newborns as control group (B group), male 27 cases, female 23 cases, the control group included in the standards: newborn Without perinatal asphyxia and fetal distress, after the birth of 1min, the 7min Apgar scores were more than 8 points; no central nervous system infection and deformity; no significant metabolic disorders and chromosomal disorders; no neurological symptoms of the disease in.A group, B group underwent conventional MRI sequences (T1WI, T2WI) and multi modal function magnetic resonance imaging (MRS, DTI, SWI), the two groups were treated with MRS and DTI scan, and compare the two groups of images, determination of two groups of choline (Cho), N- acetylaspartate (NAA), creatine compounds (Cr), lactic acid (LAC), inositol (ML) and other metabolites, and compared with conventional SWI; sequence of brain parenchyma compared to that of the ventricle and subarachnoid and subdural hemorrhage detected number; compared with conventional magnetic resonance imaging and magnetic resonance imaging in children with multi modality in different brain region of interest sensitivity and multimodal magnetic resonance imaging examination of children with cerebral palsy The effective rate had no significant difference, with the t test and X2 test analysis. Results compared to the conventional magnetic resonance imaging, multi modality magnetic resonance imaging in children with relatively high sensitivity in different brain regions; SWI sequence and conventional MR for intracranial hemorrhage detected the number of statistics, showing that SWI diagnosis of cerebral hemorrhage foci better than the conventional MRI; DTI and conventional MRI detection through our research found that the control group had no abnormal signal of DTI; while in the experimental group, using DTI sequence detected lesions in 43 cases, the diagnostic accuracy rate was 86%; the common MRI sequence detected 21 cases, accounting for 42%, the accuracy rate of diagnosis showed that DTI was significantly higher than that of conventional MR, the difference was statistically significant, P0.05; experimental group than in control group. NAA/Cr, Cho/Cr, Lac/Cr and ml/Cr higher than the control group, the difference was statistically significant. Conclusion P0.05. SWI and conventional sequences combined with can improve the freshmen Fetal diagnosis of intracranial hemorrhage; clinical application of DTI HIE in early detection of the lesions showed the effective range and number, and the MRS can be used for noninvasive measurement of children with brain tissue hypoxia, metabolites produced during ischemia, the combination of the three can improve the clinical diagnostic accuracy, provide value for prognosis as. Objective to study the technology of magnetic resonance (MRI) application value of multi sequence scan during the rehabilitation of children with cerebral palsy. Methods in our hospital from December 2015 to May 2016, 65 cases of cerebral palsy patients as the research object, all the patients were treated with MRI sequence scanning, to the extent of recovery of rehabilitation of infantile cerebral palsy were treated as the reference standard, the sensitivity calculation. MRI check the specificity, positive predictive value, negative predictive value, accuracy and Kappa value. The results of the sensitivity of MRI examination was 87.9%, the specificity was 93.75%, the positive predictive value was 93.5%, The negative predictive value was 88.2%, the diagnostic coincidence rate was 90.8%, Kappa value was 0.82. conclusion infantile cerebral palsy lesion improvement and rehabilitation of children with certain degree of correlation between.MRI sequence scanning of cerebral palsy in children with the disease diagnosis and treatment guidelines, prognosis evaluation has important value.

【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.2;R742.3

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