睡眠状态下正常儿童上气道的磁共振电影序列评估

发布时间：2018-05-27 02:18

本文选题：磁共振 + 电影成像　；参考：《重庆医科大学》2011年硕士论文

【摘要】：背景与目的：近年来，随着睡眠医学的不断发展，人们逐渐认识到睡眠障碍是影响儿童生长发育的重要因素之一。儿童中最常见且最为严重的睡眠障碍是阻塞性睡眠呼吸暂停低通气综合征（Obstructive Sleep ApneaHypoventilation Syndrome）。过去，对该综合征的研究主要采用整夜多导睡眠监测仪、鼻喉咽镜、X线、CT等检测设备，但均存在一定缺点。近年来，随着MR成像技术的发展，尤其是MR电影序列的开发应用，MRI开始被用于上气道及其相关疾病的研究，目前，国内有关MR电影成像评估睡眠状态下正常儿童上气道的研究尚未见报道。本研究利用MR电影成像对2~7岁正常儿童睡眠状态下的上气道大小及动度进行测量和评估，初步建立国内儿童上气道MRI测量的正常值范围及评估标准，为进一步研究上气道及其相关疾病提供理论依据和参考。方法：对2010.6~2011.2在重庆医科大学附属儿童医院影像科行头颅MR检查的2-7岁（中位年龄4岁）儿童进行睡眠状况的问卷调查和临床筛选，选择无任何OSAHS临床症状者112人(男性69人，女性43人)行正中矢状位及舌中部横断位电影MR序列及快速自旋回波反转恢复序列成像。评估上气道通气状态（分为四种状态—静止开放、存在一定动度、间断闭合及持续闭合），测量上气道前后径、动度，同时测量腺样体大小，并评估软腭的形态、大小及其信号强度。结果： 1112例中，存在一定程度的气道动度占较高比例，喉咽部存在动度50例(44.6%)，鼻咽部存在动度44例（39.3%），口咽部存在动度8例（7.2%）。喉咽部平均气道动度为2.5mm（范围0.5mm-7.1mm），鼻咽部腔平均气道动度为2.1mm（范围0.5mm-4.6mm），口咽部平均气道动度为2.8mm（范围0.5mm-5.0mm）。 2喉咽部存在一定动度的50例中主要表现为舌后缀5例（10%）、喉咽后壁向前运动26（52%）、舌后缀同时伴有喉咽后壁向前运动19（38%）。 3张嘴状态下鼻咽部和口咽部运动出现的比率分别为63.9%（23/36）和19.4%（7/36），显著高于闭嘴状态27.6%(21/76)和1.3%（1/76）；张嘴状态下喉咽部运动出现比率33.3%（12/36），与闭嘴状态50.0%（38/76）无显著差异。 4腺样体厚度（10.6±2.1）mm，其中＞12mm者7例（6.3%）。9例（8.0%）软腭覆盖并邻接舌，无1例软腭下部向下延伸低于舌中部水平，软腭呈较均匀稍低信号（与舌肌肉组织信号类似）。结论： 1MRI及MRI电影序列能较准确地测量上气道各段管腔直径并判断有无动度，，是一种可用于评估上气道及其相关疾病的理想检查手段。 2正常儿童睡眠状态下可以存在一定程度的气道动度，气道动度一般小于5mm。 3喉咽部动度主要表现为舌后缀、喉咽后壁向前运动及舌后缀同时伴有喉咽后壁向前运动三种方式。 4张、闭嘴状态对上气道的动度有一定影响，张嘴状态下鼻咽和口咽动度出现的比率显著高于闭嘴状态。
[Abstract]:Background and purpose: In recent years, with the continuous development of sleep medicine, people have come to realize that sleep disorder is one of the important factors affecting the growth and development of children. The most common and severe sleep disorder in children is obstructive Sleep ApneaHypoventilation Syndrometic syndrome (OSAS). In the past, the study of this syndrome was mainly carried out by means of overnight polysomnography, nasopharyngeal X ray CT and so on, but all of them had some shortcomings. In recent years, with the development of Mr imaging technology, especially the application of Mr film sequence, MRI has been used in the study of upper airway and its related diseases. There has been no report on the evaluation of upper airway in normal children by Mr film imaging in China. In this study, Mr film imaging was used to measure and evaluate the upper airway size and motility of normal children aged 2 to 7 years, and to establish the normal range and evaluation standard of upper airway MRI measurement in children in China. To provide theoretical basis and reference for further study of upper airway and its related diseases. Methods: The sleep status of children aged 2-7 years (median age 4 years) who underwent cephalic Mr examination in the Department of Imaging of affiliated Children's Hospital of Chongqing Medical University was investigated by questionnaire and clinical screening. 112 patients (69 males) without any clinical symptoms of OSAHS were selected. The median sagittal and middle tongue transection Mr sequences and fast spin echo inversion recovery sequences were performed in 43 women. To evaluate the upper airway ventilation status (divided into four states-static opening, presence of certain motility, intermittent closure and continuous closure, measurement of the anteroposterior diameter and motility of the upper airway, measurement of adenoid size, and evaluation of the shape of the soft palate. Size and signal strength. Results: In 1112 cases, there was a higher proportion of airway motility, 50 laryngopharynx motility, 44 nasopharynx motility, 8 oropharynx motility. The mean airway motility of laryngopharynx was 2.5 mm (range 0.5 mm ~ 7.1 mm), that of nasopharynx was 2.1 mm (range 0.5 mm ~ 4.6 mm), and that of oropharynx was 2.8 mm (range 0.5 mm -5.0 mm). (2) in the 50 cases with certain movement of laryngopharynx, there were 5 cases with tongue suffix, 10 cases with tongue suffix, 2652% with forward movement of larynx wall, and 193838 fold with tongue suffix with forward movement of laryngeal pharynx wall. 3 the ratios of nasopharyngeal and oropharyngeal movements in open mouth were 63.9 / 36) and 19.4 / 36, respectively, which were significantly higher than those in shut up state 27.661 / 21 / 76) and 1.33 / 76 / 76, respectively, but there was no significant difference between 33 / 3 / 36 / 36 of laryngopharynx movement under open mouth and 50.00 / 38 / 76 of shut up state. (4) the thickness of adenoid was 10.6 卤2.1 mm, of which 7 cases (> 12mm) were covered with soft palate and adjacent to tongue. None of them had a lower soft palate extending down below the level of middle tongue, and the soft palate showed a relatively homogeneous low signal intensity (similar to the signal intensity of tongue muscle tissue). Conclusion: 1MRI and MRI film sequences can accurately measure the lumen diameter of upper airway and judge whether there is movement. It is an ideal method for the evaluation of upper airway and its related diseases. 2A certain degree of airway motility can be found in normal children during sleep, and the airway motility is generally less than 5 mm. 3 the laryngopharynx motility is mainly manifested as tongue suffix, the laryngopharyngeal posterior wall moves forward and the tongue suffix is accompanied by the laryngopharyngeal wall moving forward simultaneously. The ratio of nasopharynx and oropharynx motility in open mouth was significantly higher than that in shut up state.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R766;R445.2

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