原发性青光眼视觉传导通路改变的磁共振研究

发布时间：2018-05-09 23:06

本文选题：视觉通路 + 原发性青光眼　；参考：《大连医科大学》2011年硕士论文

【摘要】：目的:采用磁共振成像技术研究原发性青光眼视觉传导通路(visual pathway)各部分的变化趋势,探讨视觉通路的变化与临床分型的相关性,以及视觉通路各部分变化程度的相关性。方法:本研究选择双眼原发性慢性青光眼患者20例(男10例,女10例;年龄范围24-72岁,平均年龄50.90±14.69岁),依据临床病理分型分为原发性开角型青光眼(primary open angle glaucoma,POAG)组及原发性闭角型青光眼(primary angle-closure glaucoma,PACG)组。所有受试者均行颅脑磁共振弥散张量成像(diffusion tensor imaging,DTI)及冠状位质子密度加权像(proton density weighted image,PDWI)扫描,手工测量视神经(optic nerve)、视束(optic tract)及视辐射(optic radiation)的部分各向异性(fractional anisotropy,FA)值、平均弥散系数(average diffusion coefficient,DCavg)及外侧膝状体(lateral geniculate body,LGN)的高度和体积。并对照正常成人健康志愿者18例(男8例,女10例,年龄范围25~69岁,平均年龄45.7±15.3岁)相同指标的测量结果,利用SPSS17.0软件,采用单因素方差分析来分析原发性青光眼患者视觉通路相较健康人的变化情况,及原发性青光眼不同临床病理分型组间的差异,对健康人和原发性青光眼组双侧视神经、视束、视放射的平均FA值及DCavg值与双侧外侧膝状体高度及体积进行Pearson相关性分析,取p0.05有统计学意义。结果: POAG左、右侧视神经FA值均明显降低(p0.001,p 0.001),DCavg值明显升高(p =0.01,p =0.003);左、右侧视束FA值明显降低(p 0.001,p 0.001),DCavg值明显升高(p 0.001,p 0.001);左、右侧视辐射FA值明显降低(p 0.001,p 0.001),DCavg值未见明显差异(p =0.328,p=0.270);左、右侧LGN体积明显减小(p0.001,p0.001),高度明显减小(p0.001,p0.001)。PACG左、右侧视神经FA值均明显降低(p0.001,p0.001),DCavg值明显升高(p=0.043,p=0.029);左、右侧视束FA值明显降低(p0.001,p0.001),DCavg值明显升高(p=0.004,p=0.017);左、右侧视辐射FA值明显降低(p0.001,p0.001),DCavg值明显升高(p=0.039,p=0.004);左、右侧LGN体积明显减小(p0.001,p0.001),高度明显减小(p0.001,p0.001)。POAG与PACG右侧LGN高度有统计学差异(p=0.016),POAG组的LGN均值略高(4.267±0.646mm)。原发性青光眼左侧视辐射FA值与左侧LGN体积呈正相关(r=0.512,p=0.021),左、右侧视神经DCavg值分别与右侧LGN体积的变化存在一定程度的正相关(r=0.523,p=0.018;r=0.449,p=0.047)。结论:本研究证实了原发性开角型青光眼及原发性闭角型青光眼视神经、视束、视辐射、外侧膝状体均有不同程度的退变性改变,且联合应用磁共振弥散张量成像及磁共振质子密度加权成像可以为视觉通路显微结构的显示和病理状态的评估提供有价值的信息。
[Abstract]:Objective: To study the changes in the visual pathway of primary glaucoma (visual pathway) by magnetic resonance imaging (MRI), and to explore the correlation between the changes of the visual pathway and the clinical typing and the degree of changes in the various parts of the visual pathway.
Methods: 20 cases of primary chronic glaucoma (10 males and 10 females, 24-72 years of age, with an average age of 50.90 + 14.69 years old) were selected and divided into groups of primary open angle glaucoma (primary open angle glaucoma, POAG) and primary angle closure glaucoma (primary angle-closure glaucoma, PACG) according to the clinicopathological classification. All subjects underwent diffusion tensor imaging (DTI) and coronary position proton density weighted imaging (proton density weighted image, PDWI), and the manual measurement of optic nerve (optic nerve), the partial anisotropy of the optic tract (optic) and visual radiation. The height and volume of the mean dispersion coefficient (average diffusion coefficient, DCavg) and the lateral geniculate body (lateral geniculate body, LGN) were measured in 18 normal adult healthy volunteers (male 8, female 10, age 25~69, and average age 45.7 + 15.3 years old). Analysis of the changes of visual pathways in primary glaucoma patients and the difference between different types of clinicopathological groups in primary glaucoma, the average FA value and DCavg value of bilateral optic nerve, optic tract, optic radiation and bilateral lateral geniculate body in healthy people and primary glaucoma group were related to Pearson correlation. Analysis, P0.05 has statistical significance.
Results: POAG left, right optic nerve FA value decreased significantly (p0.001, P 0.001), DCavg value increased significantly (P =0.01, P =0.003), left, right optic tract FA value decreased significantly (P 0.001, P 0.001), the value significantly increased (0.001, 0.001); left, apparent 0.001, 0.001, there was no significant difference (0.001, 0.001); left, left, left, The right LGN volume decreased significantly (p0.001, p0.001), the height decreased significantly (p0.001, p0.001).PACG left, and the FA value of the right optic nerve decreased significantly (p0.001, p0.001), the DCavg value increased significantly (p=0.043, p=0.029), and left, the value of the right visual tract obviously increased. 0.001, p0.001), the value of DCavg increased significantly (p=0.039, p=0.004), and the left, right LGN volume decreased significantly (p0.001, p0.001), and the height significantly decreased (p0.001, p0.001).POAG and PACG LGN height (4.267). =0.512, p=0.021). The DCavg values of left and right optic nerves were positively correlated with the LGN volume of the right side (r=0.523, p=0.018, r=0.449, p=0.047).
Conclusion: This study confirms that the optic nerve, optic tract, optic radiation, and lateral geniculate body have varying degrees of degeneration in primary open angle glaucoma and primary angle closure glaucoma, and the combination of magnetic resonance diffusion tensor imaging and magnetic resonance proton density weighted imaging can be the display and pathological state of the visual pathway microstructures. The assessment provides valuable information.

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R445.2;R775

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