眼眶MRI三维重建技术的建立及其在TAO中的应用

发布时间：2018-03-08 16:26

本文选题：甲状腺相关性眼病　切入点：眼眶磁共振　出处：《南方医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：甲状腺相关性眼病(Thyroid Associated Ophthalmopathy,TAO)是一种病因复杂的自身免疫性疾病,基本病变包括脂肪从头合成(DeNovo Adipogenesis)、透明质酸形成、间质水肿、眼外肌增大。眼球突出是TAO最常见的症状,患者通常可伴随眼睑挛缩、眼睑肿胀、结膜发红等一系列影响容貌的症状。同时,该疾病通常表现为症状快速进展的活动期和症状缓慢消退的非活动期,在活动期进行免疫抑制、球后放射等治疗效果较好,非活动期则效果差。所以,早期识别激素有效的治疗时机对疾病预后至关重要。定量测量TAO患者球后软组织体积有助于进一步理解该病的发病机制,也为临床诊治提供更多客观依据。研究目的:1.本研究拟应用Mimics(Materialise,Louvain,Belgium)软件建立TAO患者及正常人球后软组织(球后脂肪及眼外肌)体积的精准化三维重建测量技术,并验证该方法的精准度和可行性。2.利用TAO患者球后脂肪体积指标结合现已公认的活动期指标及临床相关指标,初步探索TAO患者球后脂肪体积测定的临床价值。材料与方法:我们手工利用黄油及鸡肉制作模拟球后软组织的模具,并将模具已知体积和3D重建体积进行比较,以验证该方法的精准度,同时募集10名TAO患者,分别由3名观察者三维重建并计算TAO患者球后软组织体积,通过比较观察者内误差和观察者间误差以验证该方法的可重复性。此外,我们收集2016-1月～2016-12月在我院初诊的35例TAO患者的临床资料。测量1.5T眼眶MRI球后脂肪体积及SIR值分析其与临床各项指标的相关性,并收集12例健康人,初步比较TAO组及健康组球后脂肪体积的差异。研究结果:1.两名观察者测量模具所得体积与其真实体积相比的相对误差显示:球后脂肪组织为-4.60%～-2.78%之间,眼外肌在-4.13%～0.71%之间。球后脂肪测量观察者内误差在4%以内,眼外肌为5.84%。由三名观察者测量所得组内相关系数在0.976～0.996 之间。2.脂肪体积与病程有相关性(r=0.521,P0.01),病程1年以上为脂肪生成的高峰期;脂肪体积与突眼度存在相关性(r=0.609,P0.01),突眼度每增加1mm,脂肪体积增加0.82ml;脂肪体积是疾病严重度的独立危险因素;临床活动性评分(CAS)与SIR值及TRAb存在相关性(r=0.536,r=0.416,P0.01);TAO组球后脂肪体积显著高于正常组(P0.01)。结论:1.在薄层MRI(0.8mm)通过Mimics软件三维重建眼眶软组织,并定量测量球后软组织体积是一种科学、精准、高效的方法。2.TAO病程1年以上可能是球后脂肪组织增多的高峰阶段,球后脂肪体积结合SIR值的测量有助于最佳激素治疗时机的探索及预后分析。
[Abstract]:Thyroid associated ophthalmopathy (Thyroid Associated ophthalmopathy) is an autoimmune disease with complex etiology. Basic diseases include DeNovo Adipogenesism, hyaluronic acid formation, interstitial edema, and extraocular muscle enlargement. Exophthalmos is the most common symptom of TAO. Patients are usually accompanied by eyelid contracture, swelling of the eyelid, redness of the conjunctiva, and a series of symptoms that affect appearance. Immunosuppression in the active phase, Retrobulbar radiation and other treatments are better, but the inactivity phase is poor. So, The timing of early hormone recognition is crucial to the prognosis of the disease. Quantitative measurement of the volume of retrobulbar soft tissue in patients with TAO helps to further understand the pathogenesis of the disease. Objective\\\%\\\ -\\\. The accuracy and feasibility of the method were verified. 2. Using the Retrobulbar Fat Volume Index of TAO patients combined with the accepted active stage index and clinical related indexes, To explore the clinical value of retroglobular fat volume measurement in TAO patients. Materials and methods: we use butter and chicken to make a model of soft tissue behind a ball by hand, and compare the known volume with 3D reconstruction volume. To verify the accuracy of the method, 10 patients with TAO were recruited, and 3 observers were used to reconstruct and calculate the volume of soft tissue at the back of the ball in patients with TAO. The repeatability of the method is verified by comparing the intra-observer error with the inter-observer error. We collected the clinical data of 35 patients with TAO who were first diagnosed in our hospital from June to December, 2016-12. We measured 1.5 T orbital MRI ball fat volume and SIR value to analyze their correlation with clinical indexes, and collected 12 healthy people. The results of the study showed that the relative error between the two observers in measuring the volume of the mould compared with its real volume was -4.60% -2.78%. The extraocular muscle was between -4.13% and 0.71%. The intraobserver error of retrobulbar fat measurement was less than 4%. The extraocular muscle was 5.84. The correlation coefficient was between 0.976 and 0.996 in the group measured by three observers. There was a correlation between the volume of fat and the course of the disease. The peak period of adipogenesis was more than one year. There was a correlation between the volume of fat and the degree of exophthalmos. The volume of fat increased by 0.82ml with the increase of 1 mm in the degree of exophthalmos, and the volume of fat was an independent risk factor for the severity of the disease. The correlation between clinical activity score and SIR value and TRAb is that the volume of retrobulbar fat in group A is significantly higher than that in group A (P 0.01). Conclusion: 1. Three-dimensional reconstruction of orbital soft tissue by Mimics software is a scientific and accurate method. 2. The course of TAO for more than one year may be the peak stage for the increase of retrobulbar adipose tissue. The measurement of retrobulbar fat volume and SIR value may be helpful to explore the best time for hormone therapy and to analyze the prognosis.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R581;R771.3

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