DTI在颈髓脱髓鞘疾病及急性脊髓炎中的应用
发布时间：2018-03-28 15:42
本文选题：颈髓 切入点：磁共振弥散张量成像 出处：《吉林大学》2014年硕士论文
【摘要】：目的： 利用3.0T磁共振DTI技术对MS、NMO及ATM三种疾病在颈髓的病变特点进行定量研究，以此对这三种神经内科的脊髓常见疾病有更进一步的认识，为疾病的鉴别诊断及治疗、预后提供一定程度上的帮助。 资料与方法： 自2013年1月至2014年1月期间于吉林大学白求恩第一医院神经内科住院病人中依据McDonald诊断标准收集急性期MS患者4例；依据Wingerchuk诊断标准收集NMO患者3例；依据急性脊髓炎诊断标准收集了急性脊髓炎患者2例；招募健康志愿者9例。就所收集的相关数据，本研究展开了以下几组分析比较： 1、急性期的脑型MS患者颈髓与正常对照组之间颈髓DTI的比较； 2、急性期脑脊髓型MS、静止期脑脊髓型MS患者分别与正常对照组颈髓之间DTI的比较； 3、急性期NMO患者颈髓T2异常区、T2正常区及正常对照组之间的比较； 4、急性脊髓炎患者颈髓T2异常区与正常对照组之间的比较； 5、急性期MS患者颈髓T2异常区、NMO患者T2异常区及正常对照组之间的比较； 6、对实验组颈髓T2异常区内左右两侧、颈髓无T2异常区患者的颈髓全节段的左右两侧进行比较； 7、对实验组中颈髓存在T2异常的患者的病灶中心区的左右两侧进行比较。 扫描设备采用的是由德国Siemens公司生产的超导型Trio Tim3.0T MR成像仪。统计学数据处理采用的是SPSS17.0windows软件处理数据，结果均以均数±标准差表示，以P㩳0.5为有统计学意义。 结果： 1、急性期的脑型MS的颈髓FA值均值较正常对照组明显降低（P＜0.05）；急性期及静止期的脑脊髓型MS颈髓病灶内FA值均值均较正常对照组有明显下降（P＜0.05），且前者较后者下降程度更显著（P＜0.05）；MS病灶处FA图、DEC图的颜色信号明显减低，所显示的病灶面积未发现明显大于常规序列T1、T2上所显示的病灶面积；在DTT上可以看到MS病灶处纤维束较正常对照相对稀疏，，未看见明显的纤维束中断现象。 2、急性期的NMO患者颈髓T2异常处、T2正常处与正常对照组比较FA值均值均有明显下降（P＜0.05）。 3、急性脊髓炎患者颈髓病灶处与正常对照组比较FA均值有明显下降（P＜0.05）。 4、急性期的NMO患者颈髓病灶中心区较急性期的MS患者颈髓病灶中心区的FA值下降明显（P＜0.05）；NMO病灶处FA图、DEC图的颜色信号明显减低，在DTT上可以看到NMO病灶处纤维束较正常对照相对稀疏。 5、脑型MS、急性期脑脊髓型MS、静止期脑脊髓型MS、急性期NMO及急性脊髓炎的颈髓左右两侧FA值均值比较未见明显差异性（P＞0.05）；发现一例MS、一例NMO患者颈髓病灶中心区内左右两侧FA值均值比较有明显差异（P＜0.05）,神经功能缺损严重侧FA均值下降更明显。 结论： 1、脑型MS患者的颈髓亦存在隐匿性损伤； 2、 NMO患者看似正常的脊髓(NASC, normal-appearing spinal cord)区内存在隐匿性损伤，NMO颈髓病损程度较MS较严重； 3、DTI在一定程度上可对MS、NMO及急性脊髓炎的病情进行量化的评判，进而对患者的预后判断有一定的帮助。
[Abstract]:Objective:
Using 3.0T magnetic resonance DTI technology, we quantitatively studied the characteristics of the three diseases of MS, NMO and ATM in the cervical spinal cord, so as to further understand the three common diseases of the spinal cord, and provide some help for the differential diagnosis, treatment and prognosis of the disease.
Information and methods:
From January 2013 to January 2014 in the first hospital of Jilin University, Bethune Department of neurology patients according to the diagnostic criteria for McDonald were collected in 4 cases of acute MS patients; according to the diagnostic criteria for Wingerchuk 3 patients with NMO; according to the standard in diagnosis of acute spinal cord were collected in patients with acute myelitis in 2 cases; 9 cases of healthy volunteers were recruited. The relevant data collected in this study, the following group analysis:
1, the comparison of cervical spinal cord DTI between the cervical spinal cord and the normal control group in the acute cerebral MS patients.
2, the acute phase of cerebral spinal cord MS, the rest of the brain and spinal cord MS patients were compared with the normal control group of the cervical spinal cord of DTI.
3, in the acute phase of NMO, the abnormal T2 area of the cervical spinal cord, the normal T2 area and the normal control group were compared.
4, the comparison between the abnormal T2 area of the cervical spinal cord and the normal control group in the patients with acute myelitis.
5, the abnormal T2 area of the cervical spinal cord in the acute MS patients, the comparison of the abnormal T2 area of the NMO patients and the normal control group.
6, the left and right sides of the cervical spinal cord in the cervical spinal cord T2 abnormal area in the experimental group and the cervical spinal cord with no T2 abnormal area were compared.
7, the left and right sides of the center of the lesion were compared in the patients with T2 abnormalities in the cervical spinal cord in the experimental group.
The scanning device is a superconducting Trio Tim3.0T MR imager produced by Siemens company. The data are processed by SPSS17.0windows software, and the results are all expressed by mean + standard deviation. P 0.5 has statistical significance.
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