ESWAN测量脑内铁含量技术在不宁腿患者中的应用研究

发布时间：2018-05-29 20:58

本文选题：磁共振成像 + 成人原发性不宁腿综合征　；参考：《南昌大学》2014年硕士论文

【摘要】：目的：通过应用ESWAN序列测量脑内铁含量技术，对成人原发性不宁腿综合征患者与年龄、性别相匹配的健康志愿者之间进行对照研究，探讨ESWAN序列在定量分析成人原发性不宁腿综合征患者脑内灰质核团铁含量改变中的作用，同时按照国际不宁腿综合征研究组制定的评分标准对RLS患者的病情程度进行临床评分，并与脑内灰质核团铁含量的幅度log值（即log(magnitude signalintensity)）、相对幅度信号强度值（relative magnitude signal intensity RMSI）、相位值（Phase value）以及R2*值进行双变量相关性分析，最后比较上述方法评估RLS患者病情程度的敏感性与特异性。材料和方法：选取2012年6月-2014年2月经我院经神经内科医师根据国际不宁腿研究小组（International Restless Legs Study Group IRLSSG）制定的RLS诊断标准诊断为原发性不宁腿的患者，有脑卒中、脑内微出血等脑血管性病变，，其他中枢神经系统疾病（如帕金森等神经退行性疾病）、周围系统疾病（如糖尿病、尿毒症等）引起的继发性周期性腿动（Periodic leg movement in sleep-PLMS）或不宁腿类似症状的患者均被排除。常规MRI检查中如发现T2WI和/或T2flair上出现直径5mm的高信号病灶或直径5mm但数量超过5个者剔除。本研究共收集61例病例，排除急性腔梗患者4例，陈旧性脑梗塞患者5例，脑内多发缺血灶符合排除标准患者7例，另有不能配合完成检查者3例，以及图像伪影较重者7例，最后纳入35例（患者组），所有患者均为年龄大于45岁的成人，平均年龄约54岁（53.71±10.12），男女比约3:2；年龄、性别相匹配的健康志愿者35例（对照组），平均年龄约54岁（54.20±9.26），男女比约3:2，对每位患者病情程度严格按照国际不宁腿综合征研究组评分标准进行临床评分。所有研究对象均行MRI头颅扫描：采用GE3.0T磁共振扫描仪及8通道头颅专用线圈进行扫描。扫描序列包括多回波采集T2*加权的三维梯度回波序列（Enhancedgradient echo T2*weighted angiography，ESWAN）、T2WI及T2FLAIR序列。图像后处理：应用GE Medical Systems Functool4.4工作站软件将ESWAN序列图像进行后处理生成校正后的幅度图、相位图，同时也可得到ESWAN序列自动生成的R2*图。在上述功能图上测量研究对象相同层面的双侧红核（RN）、黑质致密部（SNc）、黑质网状部（SNr）、苍白球（GP）、壳核（PU）、尾状核头（CN）、齿状核（DN）、丘脑（TH）的幅度信号强度值、相位值及R2*值。数据处理：采用盲法（在未知是否为患者的情况下），由一位有5年以上神经影像MRI诊断经验的大夫手动勾勒出上述感兴趣区进行测量并记录。每间隔1个月左右由同一大夫对上述感兴趣区进行重复测量，共3次。取3次测量的平均值作为最终各感兴趣区域的幅度信号强度值、相位值和R2*值。将各感兴趣区的幅度信号强度值取自然对数（原始数据较分散，为了使数据更集中，利于统计学分析），即幅度log值，同时测量所有研究对象双侧额前白质的幅度信号强度值，各感兴趣区的幅度信号强度值与额前白质的幅度信号强度值的比值即为各感兴趣区的RMSI值（可以消除个体差异）。结果：一、与对照组比较：1.幅度log值：RLS组的红核（RN）（P=0.004）、黑质致密部（SNc）（P=0.002）、黑质网状部（SNr）（P=0.024）、苍白球（GP）（P=0.024）、齿状核（DN）（P=0.032）均显著性升高，差异具有统计学意义。壳核（PU）、尾状核（CN）、丘脑（TH）的幅度log值升高，但无统计学差异。2. RMSI值：RLS组的RN（P=0.000）、SNc（P=0.025）、SNr（P=0.044）、GP（P=0.018）的均显著性升高，差异具有统计学意义。PU、CN、DN、TH的RMSI值升高，但无统计学差异。3.相位值： RLS组的RN（P=0.014）、SNc（P=0.000）、TH（P=0.027）均显著性的升高，有统计学意义， PU、CN、SNr、GPDN的相位值升高，但无统计学差异。4. R2*值：RLS患者的RN（P=0.000）、SNc（P=0.000）、SNr（P=0.000）、GP（P=0.001）、DN（P=0.007）均显著性的降低，有统计学差异。PU、CN、TH的R2*值降低但无统计学差异。二、与临床评分的相关性分析：1.红核（R=0.836，P=0.000）、黑质致密部（R=0.763，P=0.000）、苍白球（R=0.507，P=0.000）、丘脑（R=0.797，P=0.000）的幅度log值与临床评分具有相关性，即与RLS的病情呈正相关。2.丘脑的相位值与临床评分具有正性相关（R=0.399，P=0.018）。3.各感兴趣区的相对幅度信号强度值、R2*值与临床评分均不具有显著相关性。三、以红核、黑质致密部、黑质网状部、苍白球、齿状核和丘脑的幅度log值、RMSI值、相位值以及R2*值绘制受试者工作特征曲线（ROC曲线）：1.以丘脑的幅度log值绘制的ROC曲线下面积最大为0.949，其余感兴趣区ROC曲线下面积均小于0.9。2.上述各感兴趣区RSMI值、相位值、R2*值ROC曲线下面积均在0.7-0.9范围内。结论：通过应用ESWAN序列对RLS患者红核、黑质（SNr、SNc）、苍白球、壳核、尾状核头、齿状核、丘脑的铁含量定量，结果支持红核、黑质致密部、苍白球、齿状核的铁含量降低。幅度log值、R2*值对评价RLS脑内灰质核团铁含量较RMSI值和相位值相对更敏感，同时幅度log值与RLS患者的临床评分具有显著相关性， ROC曲线下面积以丘脑幅度log值最大，且取值3.36时其敏感性为100%，特异性为76.2%。综上可知，磁共振ESWAN技术在准确定量RLS患者脑内灰质核团铁含量、监测病程等方面具有一定的应用价值。
[Abstract]:Objective: To investigate the role of ESWAN sequence in quantitative analysis of iron content in the cerebral gray nucleus of adult patients with primary restless leg syndrome by using the ESWAN sequence to measure the iron content in the brain, and to study the effect of ESWAN sequence on the changes of iron content in the cerebral gray nucleus of the patients with adult primary restless leg syndrome by the control study of the adult patients with primary restless leg syndrome and the age and sex matched healthy volunteers. The score standard of the International Restless leg syndrome group was evaluated for the degree of RLS patients, with the log value of the iron content in the gray nucleus of the brain (log (magnitude signalintensity)), the relative amplitude signal intensity value (relative magnitude signal intensity RMSI), the phase value (Phase value) and the value of the two. Variable correlation analysis was used to compare the sensitivity and specificity of the above methods in evaluating the severity of RLS patients.
Materials and methods: the patients with primary restless legs were diagnosed by the RLS diagnostic criteria of the International Restless Leg research group (International Restless Legs Study Group IRLSSG) by the neurosurgeon in June 2012 -2014 2 period, with cerebral apoplexy, intracerebral hemorrhage and other cerebrovascular diseases, and other central nervous system diseases. (for example, Parkinson and other neurodegenerative diseases), patients with secondary periodic leg movement (Periodic leg movement in sleep-PLMS) or restless leg similar symptoms caused by peripheral systemic diseases (such as diabetes, uremia, etc.) are excluded. In routine MRI examination, a high signal lesion or diameter 5mm but a diameter of 5mm in T2WI and / or T2flair is found. In this study, more than 5 cases were eliminated. A total of 61 cases were collected, including 4 cases of acute infarction, 5 cases of old cerebral infarction, 7 cases of focal cerebral ischemia, 3 cases of complete examination, 7 cases of image artifact, and 35 cases (patient group), all patients were older than 45 years old. In adults, the average age was about 54 years (53.71 + 10.12), the ratio of men and women was about 3:2, and the age and sex matched healthy volunteers were 35 (control group), the average age was about 54 years (54.20 + 9.26), and the ratio of men and women was about 3:2. The clinical score of each patient was strictly according to the standard of the International Restless Leg Syndrome Study Group. All the subjects were MRI Head scan: scanning with GE3.0T magnetic resonance scanner and 8 channel skull special coil. The scanning sequence includes multiple echo acquisition T2* weighted three-dimensional gradient echo sequence (Enhancedgradient echo T2*weighted angiography, ESWAN), T2WI and T2FLAIR sequence. Image post-processing: application of GE Medical Systems workstation software The ESWAN sequence image is processed to generate the corrected amplitude map, phase map, and the R2* map generated automatically by ESWAN sequence. On the above functional map, the bilateral red nucleus (RN), the substantia nigra dense part (SNc), the substantia nigra reticularis (SNr), the globus pallidus (GP), the putamen (PU), the caudate nucleus (CN), the dentate nucleus (DN), the thalamus, and the thalamus are measured. The amplitude signal intensity, phase and R2* value of (TH). Data processing: a blind method (in the case of an unknown patient), by a doctor with more than 5 years of neuroimaging MRI diagnosis, is manually outlined and recorded by the above region of interest. The same doctor repeats the area of interest to the above 1 months or so. Measurement, 3 times. The average value of 3 measurements is taken as the amplitude signal intensity value, phase value and R2* value of the final regions of interest. The amplitude signal intensity value of each region of interest is taken as the natural logarithm (the original data is scattered, in order to make the data more concentrated, for statistical analysis), that is, the amplitude log value, and measure both the bilateral forehead of all the subjects at the same time. The amplitude signal intensity of the anterior white matter, the ratio of the amplitude signal intensity value of each region of interest to the amplitude signal intensity of the prefrontal white matter is the RMSI value of each region of interest (the individual difference can be eliminated).
Results: (1) compared with the control group, 1. log values: the red nucleus (RN) (P=0.004) of group RLS, SNc (P=0.002), SNr (P=0.024), globus globus (GP) (GP) (P=0.024), and the dentate nucleus (P=0.032) increased significantly, and the difference was statistically significant, but the amplitude of the amplitude of the shell nucleus, caudate nucleus and thalamus increased, but no unification. .2. RMSI value: RN (P=0.000), SNc (P=0.025), SNr (P=0.044), GP (P=0.018) in the RLS group increased significantly, and the difference was statistically significant, but there was no statistical difference. The phase value of N increased, but there was no statistically significant difference in.4. R2* value: RN (P=0.000), SNc (P=0.000), SNr (P=0.000), GP (P=0.001), and GP (P=0.001) in RLS patients.
Two, correlation analysis with clinical score: 1. R=0.836 (P=0.000), R=0.763 (P=0.000), globus pallidus (R=0.507, P=0.000), log value of the thalamus (R=0.797, P=0.000), and the correlation between the amplitude of the thalamus (R=0.797, P=0.000) and the clinical score, that is, the phase of the.2. thalamus is positively correlated with the condition of the RLS. The relative amplitude signal intensity and R2* value of each region of interest had no significant correlation with clinical score.
Three, the amplitude log value, the RMSI value, the phase value and the R2* value of the red nucleus, the dense part of the substantia nigra, the globus pallidus, the dentate nucleus and the thalamus, draw the maximum area of the area under the ROC curve of the log value of the thalamus by the amplitude of the amplitude log of the thalamus, and the area under the ROC curve of the remaining region of interest is less than the above 0.9.2. above the sense of 0.9.2.. The area of interest area RSMI value, phase value, R2* value and ROC curve are all within 0.7-0.9 range.
Conclusion: the iron content of the red nucleus, black matter (SNr, SNc), globus pallidus, caudate nucleus, dentate nucleus and thalamus of RLS patients is quantified. The results support the reduction of iron content in the red nucleus, the dense part of the substantia nigra, the globus pallidus and the dentate nucleus. The value of R2* is relatively more sensitive to the evaluation of the iron content in the gray nucleus of the brain of RLS than the value of RMSI and the phase value in the evaluation of RLS. There is a significant correlation between the log value and the clinical score of the patients with RLS. The area under the ROC curve is the maximum of the log value of the thalamus, and the sensitivity is 100% when the value is 3.36. The specificity is known as 76.2%., and magnetic resonance ESWAN technology has a certain application in the accurate quantitative determination of iron content in the gray nucleus of the brain of RLS patients and the monitoring of the course of disease. Value.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R741;R445.2

【引证文献】