癫痫的静息态功能磁共振海马功能连接研究

发布时间：2018-04-20 00:07

本文选题：功能磁共振成像 + 静息态　；参考：《天津医科大学》2017年硕士论文

【摘要】：目的:利用静息态功能磁共振成像(resting-state functional MRI,rsfMRI),采用功能连接的种子点分析方法,观察癫痫患者双侧海马头部与脑内的功能连接的变化,分析总结这些变化的病理生理意义,为癫痫的诊断治疗提供更多、更可靠的影像学依据。对象与方法:收集我院2014～2016诊断为癫痫的患者,根据患者临床表现、头皮脑电图的放电特点以及相关的多项影像学检查进行综合评价,将癫痫患者分为两组,即颞叶内侧癫痫(mesial temporal lobe epilepsy,mTLE)17例和伴中央颞区棘波良性儿童癫痫(benign epilepsy with centrotemporal spikes,BECT)患者12例,另社会招募健康志愿者19例。采用德国西门子Trio Tim 3.0T磁共振扫描仪和32通道头线圈扫描设备对结构MRI和功能MRI(functional MRI,fMRI)进行数据采集。fMRI数据预处理在MATLAB平台用SPM8软件来完成,种子点选在双侧海马头部,以画小球的方式获得双侧海马头部的ROI,ROI中心点坐标为±27,-12,-17,小球半径5mm。采用REST1.8软件对数据进行功能连接分析处理得到所有被试的功能连接图。用REST1.8软件对mTLE组、BECT组和正常对照组进行统计分析:(1)三组分别做组内单样本t检验,观察各组病例在全脑水平上的功能连接强度差异。(2)对三组两两组间分别行两独立样本t检验,观察mTLE组和正常对照组之间海马头部与全脑功能连接的改变;BECT组和正常对照组之间海马头部与全脑功能连接的变化;最后将mTLE组和BECT组进行比较,观测两种不同类型癫痫海马头部与全脑功能连接的差异。(3)在海马外结构选取12个兴趣区:双侧额中回、双侧中央前回、双侧中央后回、双侧枕上回、双侧丘脑、双侧尾状核,分别计算三组被试双侧海马头部与以上这些兴趣区之间的相关系数,然后对三组相关系数采用两独立样本t检验进行两两组间比较观察海马头部功能连接的变化,认为P0.05具有统计学意义。(1)、(2)的统计结果图在REST1.8上以软件自带的标准T1结构像作为底图模板,将统计图叠加在底图上的方式进行显示,统计结果经AlphaSim矫正,认为P0.05具有统计学意义。结果:1.正常对照组、mTLE组和BECT组组内分析结果显示,海马头部与杏仁核及海马旁回呈正相关性功能连接,且相关性最强,其他正相关性功能连接脑区还有颞叶外侧皮层、岛叶、丘脑、基底节区等脑区,三组表现基本一致。海马头部与额叶、顶叶、枕叶等皮层区域表现为负相关,mTLE组和BECT组皮层的负激活区域范围比正常对照组缩小,mTLE组更为明显。2.mTLE组与正常对照组比较:相比正常对照组,mTLE组海马头部与全脑功能连接整体显示为连接强度的减低。减低的脑区有右侧海马旁回,右侧海马,右侧颞上回,右侧颞中回,右侧颞极-颞上回,右侧豆状核,右侧中央沟盖,双侧楔前叶及右侧岛叶。3.BECT组和正常对照组比较:相比正常对照组,BECT组海马头部与全脑功能连接整体显示为连接强度的增加。增加的脑区有双侧缘上回,左侧中央沟盖,左侧中央后回,左侧颞极-颞上回、左侧舌回,右侧楔叶,左侧枕上回,左侧中扣带回及双侧补充运动区。4.mTLE组和BECT组比较:mTLE组相较于BECT组海马头部与全脑功能连接强度普遍显示减低。减低的脑区有双侧海马,双侧海马旁回,左侧中央后回,左侧颞上回,双侧中央沟盖,双侧颞极-颞上回,双侧距状裂周围皮层,右侧小脑,右侧岛叶及右侧中扣带回。5.海马头部与海马外结构之间的功能连接变化:mTLE组海马头部与双侧额中回功能连接强度较正常对照组减低;BECT组海马头部与左侧中央后回及左侧尾状核功能连接强度较正常对照组增加;mTLE组与BECT组比较海马头部与左侧额中回、右侧中央前回、左侧中央后回及左侧尾状核功能连接强度发生改变。结论:1.海马头部与皮层呈负相关激活,癫痫患者的负激活范围比正常人明显减小,且mTLE比BECT变化更明显。2.mTLE和BECT的海马与全脑功能连接改变模式完全不同,mTLE主要表现在脑网络的连接强度减低,而BECT则表现为大脑功能活动的增强。mTLE相比BECT对边缘系统、中央区的损害更为明显,这可能是mTLE比BECT的病情更加严重难治的一个原因,也更易出现认知障碍。3.海马头部与海马外结构之间功能连接的分析显示m TLE患者额叶损害较为显著,考虑和mTLE患者易出现认知障碍相关。
[Abstract]:Objective: To observe the changes in the functional connection between the bilateral hippocampal head and the brain in epileptic patients by using the resting-state functional MRI (rsfMRI) and the function connection seed point analysis method, to analyze and summarize the pathophysiological significance of these changes, and to provide more and more reliable imaging for the diagnosis and treatment of epilepsy. Basis. Objects and methods: 2014~2016 patients diagnosed as epilepsy were collected in our hospital. According to the clinical manifestations of the patients, the characteristics of the discharge of the scalp electroencephalogram and the related multiple imaging examinations, the epileptic patients were divided into two groups, namely, 17 cases of mesial temporal lobe epilepsy, mTLE, and the central temporal area eanthosis. 12 patients with benign epilepsy with centrotemporal spikes (BECT) and 19 healthy volunteers were recruited by the German SIEMENS Trio Tim 3.0T magnetic resonance scanner and 32 channel head coil scanning equipment. M8 software is completed. The seed points are selected in the bilateral hippocampal head to get the ROI of the bilateral hippocampal head in the way of small balls. The coordinates of the ROI center point are + 27, -12, -17, and the radius 5mm. of the ball are processed by REST1.8 software for functional connection analysis of the data. The mTLE group, BECT group and normal control are used by REST1.8 software Group for statistical analysis: (1) a single sample t test was performed in the three groups to observe the difference in the functional connection intensity of all the cases in the whole brain. (2) two independent sample t tests were performed between the three groups and 22 groups, and the changes in the connection between the hippocampus head and the whole brain were observed between the mTLE group and the normal control group; the sea between the BECT group and the normal control group was between the normal control group and the normal control group. The changes in the connection between the head of the horse and the whole brain; finally, the differences between the mTLE group and the BECT group were compared to observe the differences in the connection between the head of the hippocampus and the whole brain of two different types of epilepsy. (3) in the outer hippocampal structure, 12 regions of interest were selected: bilateral frontal gyrus, bilateral anterior central gyrus, bilateral central posterior gyrus, bilateral occipital gyrus, bilateral thalamus and bilateral caudate nucleus, respectively. The correlation coefficients between the three groups of hippocampus heads and these regions were calculated, and the correlation coefficient of the three groups was compared with the two independent sample t test to observe the changes in the functional connection of the hippocampus head between the 22 groups. (1), (2) the statistical results of (2) were on the REST1.8 with the standard T1 with the software. The structure image was shown as the template of the bottom map, and the statistical results were displayed on the bottom map. The statistical results were corrected by AlphaSim. The results showed that P0.05 had statistical significance. Results: 1. normal control group, mTLE group and BECT group analysis showed that the hippocampus head was positively related to the amygdala and parahippocampal gyrus, and the correlation was strongest. The three groups showed negative correlation in the three groups, such as the frontal lobe, the thalamus, the basal ganglia, the frontal lobe, the parietal lobe, the occipital lobe, and the cortex of the mTLE group and the BECT group were narrower than the normal control group, and the group mTLE was more obviously.2.mTLE and normal. Comparison group: compared with the normal control group, the whole brain functional connection in the hippocampus of the mTLE group was shown to be a reduction in the connection strength. The reduced brain area was the right side of the parahippocampal gyrus, right hippocampus, right temporal gyrus, right temporal gyrus, right temporal - superior temporal gyrus, right lenticular nucleus, right lateral central sulcus cover, bilateral wedge anterior lobe and right Island leaf.3.BECT group. Comparison of the normal control group: compared with the normal control group, the whole brain function connection of the hippocampus in the BECT group showed an increase in the connection strength. The increased brain area had the upper side of the bilateral margin, the left central sulcus cover, the left central posterior gyrus, the left temporal - upper temporal gyrus, the left lingual gyrus, the right cuneate lobe, the left occipital gyrus, the left cingulate gyrus and bilateral supplementary movement. Compared with group BECT, group.4.mTLE and group mTLE showed a general decrease in the strength of the head and the whole brain function in the hippocampus of the BECT group. There were bilateral hippocampus, bilateral parahippocampal gyrus, left posterior central gyrus, left temporal gyrus, bilateral central sulcus cover, bilateral temporal - superior temporal gyrus, double lateral fissure peri cortex, right cerebellum, right Island lobe, and right The functional connection between the hippocampal head and the outer hippocampal structure of the lateral cingulate gyrus.5.: the intensity of the functional connection between the hippocampus head and the bilateral frontal gyrus was lower in the mTLE group than in the normal control group; the functional connection between the hippocampus head and the left caudal caudate nucleus in the BECT group was higher than that in the normal control group; the hippocampus head and the left hippocampus were compared with the BECT group in the group mTLE and the BECT group. The lateral frontal gyrus, the right anterior central gyrus, the left central posterior gyrus and the left caudate nucleus function change. Conclusion: 1. the hippocampal head and the cortex are negatively related to the cortex, and the negative activation range of the epileptic patients is significantly lower than that of the normal people, and the mTLE is more obvious than the BECT change, and the hippocampus and the whole brain function connection change pattern of.2.mTLE and BECT is completely not. In the same way, mTLE is mainly manifested in the decrease in the connection intensity of the brain network, while BECT shows that the enhancement.MTLE of brain function activity is more obvious than that of the BECT on the marginal system and the central region. This may be a cause of the more severe and difficult treatment of mTLE than the BECT, and is also more likely to be a cognitive obstacle between the hippocampal and the outer hippocampal structures of the cognitive impairment.3.. The analysis of connectivity indicated that frontal lobe damage was more significant in M TLE patients, and it was more likely to be associated with cognitive impairment in mTLE patients.

【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.2;R742.1

【参考文献】