阻塞性睡眠呼吸暂停综合征病人脑组织结构及代谢改变MRI评价
发布时间：2019-06-29 18:55
【摘要】：目的： 探讨VBM、扩散加权成像ADC图及MRS在评价OSAS脑结构及代谢改变中的价值。 材料和方法： OSAS重度组(AHI40次/小时)21例、OSAS轻中度组(5次/小时AHI40次/小时)14例及健康对照组15例。所有受试者均在hilips公司生产的Marconi Medical System (Eclipse) 1.5Tesla超导型磁共振机上进行扫描。 扫描方法为：1.T1WI-RF-FAST序列容积扫描(扫描参数：TR/TE=12 ms/4.5 ms,视野FOV 25 cm2,层厚1.2 mm,间隔0 mm,矩阵256×256,采集次数1次,FLIP 20°)。2.扩散加权像SE-EPI-DWI的横断面扫描(扫描参数：TR/TE=6000 ms/94.9 ms,层厚5.0mm,间隔1 mm,矩阵100×100,翻转角90°,1次激励,b=0 s/mm2和b=1000 s/mm2)。3.所有受试者在双侧额叶及左侧颞-顶-枕叶交界区(兴趣区20mmx20mmx20mm)、左侧海马(兴趣区15mmx15mmx20mm)行单体素氢质子波谱—点分辨自旋回波波谱序列(point-resolved echo spin spectroscopy, PRESS)扫描(扫描参数：TR/TE=1500ms/35ms,翻转角900,采集次数为192次)。 统计学分析：1.采用VBM1.5 toolkit进行单因素方差分析。采用p0.01(FDR校正),或p0.0001(未校正),体素大于50为差别具有统计学意义。2.获得ADC图后,在SPM5软件上进行图像的分析。采用单因素方差分析寻找两组间差异,采用t检验观察差异的方向性,阈值为p0.001(未校正),体素大于50个认为有统计学意义。3.MRS所测数据采用SPSS13软件进行统计分析与处理,主要的统计学方法包括,方差齐性检验,方差齐性数据采用方差分析及benoffen校正多重比较,方差不齐数据采用多组独立样本的秩和检验,P0.05为有统计学意义。 结果： 1.VBM测量显示：(1)在总体积测量中,灰质总体积OSAS轻中度组(p=0.24)及OSAS重度组(P=0.32)小于健康对照组,提示：OSAS病人组脑灰质总体积缩小较其他成份改变明显。(2).在各脑区的测量中,在以双侧额叶、边缘叶、颞中回、楔前叶及小脑为主的脑区,①灰质密度及体积OSAS病人组小于健康对照组,OSAS轻中度组小于OSAS重度组,考虑OSAS病人有神经元的丢失及胶质细胞的增生；②白质密度及体积除脑干区OSAS重度组小于健康对照组外,其它脑区OSAS病人组均大于健康对照组,OSAS轻中度组大于重度组,考虑OSAS病人有白质轴索损伤及胶质细胞的增生、肥大并在此基础上进一步出现白质稀疏。 2.ADC图分析显示：(1)OSAS轻中度组ADC值较健康对照组升高主要发生于以灰质为主的脑区,此结果与VBM测量所推测的OSAS轻中度时灰质发生轻度神经原丢失,造成灰质细胞间隙增大,而白质此期多处于胶质细胞的增生、肥大阶段的假设相符合；(2) OSAS重度组ADC值较健康对照组升高发生于以以右侧额叶、左侧楔前叶及双侧小脑前叶脑区为主的灰质和白质,且胼胝体右侧枕钳ADC值也明显升高,此结果与VBM测量所推测的OSAS重度时,灰质神经元进一步丢失、胶质细胞增生及白质内在胶质细胞增生、肥大基础上发生白质稀疏的假设相对应；(3)OSAS重度组脑干区ADC值较轻中度组增高,且VBM显示OSAS病人脑干白质密度小于健康对照组、脑干白质体积OSAS重度组小于轻中度组,提示OSAS病人组脑干区有微观结构上的改变。 3.(1)左侧额叶NAA/CrOSAS重度组明显小于健康对照组(F=6.003,p=0.004)；右侧额叶NAA/Cr, OSAS轻中度组及重度组均小于健康对照组(χ2=11.677,p=0.003)；另外,OSAS病人组左侧海马NAA/Cr较健康对照组差异虽无统计学意义,但显示有减低的趋势,提示OSAS病人组神经元的减少以双侧额叶为主,且首先发生于右侧额叶,额叶的改变先于海马区的改变；(2)右侧额叶MI/Cr, OSAS轻中度组及重度组均大于健康对照组(χ2=16.518,p=0.000),提示OSAS病人有神经胶质细胞的增生；(3)左侧额叶Glx/CrOSAS重度组明显小于健康对照组(F=4.381,p=0.019),右侧额叶Glx/CrOSAS重度组较健康对照组差异虽无统计学意义,但显示有减低的趋势,这与重度OSAS病人兴奋性低、反应能力差等的临床症状相吻合。 结论：VBM测量、应用SPM分析软件的ADC图及MRS对显示OSAS引起的脑组织结构的改变是敏感的,在评价OSAS脑部病变中起重要作用。
[Abstract]:Purpose: To investigate the effects of VBM, diffusion-weighted imaging ADC and MRS in evaluating the structure and metabolic changes of OSAS Value. Materials and Methods: OSAS severe group (AHI40 times/ hr)21 cases, OSAS mild moderate group (5 times/ hr AHI40 times/ hr)14 cases; 15 healthy controls. All subjects were Marconi Medical System (Eclipse) 1.5 Tesla superconducting magnetic produced by hilips. Scan on the resonance machine. The scanning method is 1. T1WI-RF-FAST sequence volume scanning (scanning parameters: TR/ TE = 12 ms/ 4.5 ms, visual field FOV 25 cm2, layer thickness 1.2 mm, interval 0 mm, matrix 256-256, acquisition times 1 time (FLIP 20 掳).2. Cross-sectional scan of diffusion-weighted image SE-EPI-DWI (scan parameters: TR/ TE = 6000 ms/ 94.9 ms, layer thickness 5.0 mm, interval 1 mm, matrix 100-100, flip angle 90 掳,1 excitation, b = 0 s/ mm2, and b = 1 000 s/ mm2).3. All subjects were scanned by a point-resolved echo spectrum (PRESS) scan (scan parameter: TR/ TE = 1500 ms/ 35 ms, flip angle 900 , the number of acquisition is 19 2). Statistical analysis:1. Use VBM1.5 to Univariate analysis of variance for olkit. p0.01 (FDR correction), or p0.01 (not corrected), voxel greater than 50 is of statistical significance for the difference.2. After obtaining the ADC map, The analysis of the image was carried out on the SPM5 software. The difference between the two groups was found by a single-factor analysis of variance. The directivity of the difference was observed by t-test. The threshold was p0.001 (not corrected), and the voxel was more than 50 considered to be of statistical significance. In comparison with the treatment, the main statistical methods include, the homogeneity test, the analysis of variance and the benoffen correction multiple comparison, the variance of the variance is the rank and the test of multiple sets of independent samples. Inspection, P 0.05 for statistical significance. Results: 1.VBM measurement showed: (1) In total volume measurement, the total volume of gray matter OSAS mild to moderate group (p = 0.24) and OSAS severe group (P = 0.32) were less than that of healthy control group, indicating: OSAS patient group's brain The reduction of the total volume of the gray matter was more obvious than that of the other components. (2) In the measurement of each brain region, the density of the gray matter and the volume of OSAS in the brain of the two-sided frontal lobe, the marginal leaf, the middle and the back of the wedge, the density of the gray matter and the volume of the OSAS in the volume of OSAS were less than that of the healthy control group, and the OSAS mild group was less than the OSAS severe group, taking into account the O In SAS patients, the loss of neurons and the proliferation of glial cells were found in SAS patients. The density and volume of the white matter and the volume of OSAS in the brain stem were lower than those in the healthy control group, and the OSAS patients in the other brain regions were greater than those in the healthy control group, and the OSAS mild to moderate group was greater than the severe group. The white matter axonal injury and the glial cell in the SAS patients 2. ADC graph analysis showed: (1) The higher ADC value of the OSAS mild-to-moderate group occurred mainly in the brain area dominated by gray matter, and this result was slightly moderate with the estimated OSAS in the VBM measurement. (2) The higher ADC value in the OSAS group occurred in the right frontal lobe in the healthy control group. The gray matter and the white matter were the main gray matter and white matter in the left wedge and the anterior lobe of the bilateral cerebellum, and the ADC value of the right occipital forceps in the left wedge was also significantly increased. (3) The ADC value of the brain stem region of the OSAS group was higher than that of the mild and moderate group, and the white matter density of the brain stem of the OSAS patients was lower than that of the healthy control group, and the OSAS severe group of the brain stem white matter volume was less than that of the normal control group. group, The changes of the micro-structure in the brain stem region of the patients with OSAS were indicated. (1) The severe group of the left frontal lobe of the NAA/ CrOSAS was significantly lower than that in the healthy control group (F = 6.003, p = 0.004); the right frontal lobe, NAA/ Cr, OSAS mild to moderate group, and the severe group were less than that of the healthy control group (Sup2 = 11.677, p = 0.003); in addition, the OSAS patients The difference of NAA/ Cr in the left-hand hippocampus of the group was not statistically significant, but there was a tendency to decrease, suggesting that the decrease of the neurons in the OSAS group was dominated by the bilateral frontal lobe, and first occurred in the right frontal lobe and the change of the frontal lobe before the changes in the hippocampus. (2) The right frontal lobe, MI/ Cr, OSAS mild to moderate, and the severe group. The number of Gx/ CrOSAS in the left frontal lobe was significantly lower than that in the healthy control group (F = 4.381, p = 0.019). Meaning, but there is a tendency to be reduced, which is the same as the weight Conclusion: The measurement of VBM, the application of the ADC map of SPM and MRS on the display of the brain caused by OSAS
【学位授予单位】：天津医科大学
【学位级别】：博士
【学位授予年份】：2011
【分类号】：R766
本文编号：2508032
[Abstract]:Purpose: To investigate the effects of VBM, diffusion-weighted imaging ADC and MRS in evaluating the structure and metabolic changes of OSAS Value. Materials and Methods: OSAS severe group (AHI40 times/ hr)21 cases, OSAS mild moderate group (5 times/ hr AHI40 times/ hr)14 cases; 15 healthy controls. All subjects were Marconi Medical System (Eclipse) 1.5 Tesla superconducting magnetic produced by hilips. Scan on the resonance machine. The scanning method is 1. T1WI-RF-FAST sequence volume scanning (scanning parameters: TR/ TE = 12 ms/ 4.5 ms, visual field FOV 25 cm2, layer thickness 1.2 mm, interval 0 mm, matrix 256-256, acquisition times 1 time (FLIP 20 掳).2. Cross-sectional scan of diffusion-weighted image SE-EPI-DWI (scan parameters: TR/ TE = 6000 ms/ 94.9 ms, layer thickness 5.0 mm, interval 1 mm, matrix 100-100, flip angle 90 掳,1 excitation, b = 0 s/ mm2, and b = 1 000 s/ mm2).3. All subjects were scanned by a point-resolved echo spectrum (PRESS) scan (scan parameter: TR/ TE = 1500 ms/ 35 ms, flip angle 900 , the number of acquisition is 19 2). Statistical analysis:1. Use VBM1.5 to Univariate analysis of variance for olkit. p0.01 (FDR correction), or p0.01 (not corrected), voxel greater than 50 is of statistical significance for the difference.2. After obtaining the ADC map, The analysis of the image was carried out on the SPM5 software. The difference between the two groups was found by a single-factor analysis of variance. The directivity of the difference was observed by t-test. The threshold was p0.001 (not corrected), and the voxel was more than 50 considered to be of statistical significance. In comparison with the treatment, the main statistical methods include, the homogeneity test, the analysis of variance and the benoffen correction multiple comparison, the variance of the variance is the rank and the test of multiple sets of independent samples. Inspection, P 0.05 for statistical significance. Results: 1.VBM measurement showed: (1) In total volume measurement, the total volume of gray matter OSAS mild to moderate group (p = 0.24) and OSAS severe group (P = 0.32) were less than that of healthy control group, indicating: OSAS patient group's brain The reduction of the total volume of the gray matter was more obvious than that of the other components. (2) In the measurement of each brain region, the density of the gray matter and the volume of OSAS in the brain of the two-sided frontal lobe, the marginal leaf, the middle and the back of the wedge, the density of the gray matter and the volume of the OSAS in the volume of OSAS were less than that of the healthy control group, and the OSAS mild group was less than the OSAS severe group, taking into account the O In SAS patients, the loss of neurons and the proliferation of glial cells were found in SAS patients. The density and volume of the white matter and the volume of OSAS in the brain stem were lower than those in the healthy control group, and the OSAS patients in the other brain regions were greater than those in the healthy control group, and the OSAS mild to moderate group was greater than the severe group. The white matter axonal injury and the glial cell in the SAS patients 2. ADC graph analysis showed: (1) The higher ADC value of the OSAS mild-to-moderate group occurred mainly in the brain area dominated by gray matter, and this result was slightly moderate with the estimated OSAS in the VBM measurement. (2) The higher ADC value in the OSAS group occurred in the right frontal lobe in the healthy control group. The gray matter and the white matter were the main gray matter and white matter in the left wedge and the anterior lobe of the bilateral cerebellum, and the ADC value of the right occipital forceps in the left wedge was also significantly increased. (3) The ADC value of the brain stem region of the OSAS group was higher than that of the mild and moderate group, and the white matter density of the brain stem of the OSAS patients was lower than that of the healthy control group, and the OSAS severe group of the brain stem white matter volume was less than that of the normal control group. group, The changes of the micro-structure in the brain stem region of the patients with OSAS were indicated. (1) The severe group of the left frontal lobe of the NAA/ CrOSAS was significantly lower than that in the healthy control group (F = 6.003, p = 0.004); the right frontal lobe, NAA/ Cr, OSAS mild to moderate group, and the severe group were less than that of the healthy control group (Sup2 = 11.677, p = 0.003); in addition, the OSAS patients The difference of NAA/ Cr in the left-hand hippocampus of the group was not statistically significant, but there was a tendency to decrease, suggesting that the decrease of the neurons in the OSAS group was dominated by the bilateral frontal lobe, and first occurred in the right frontal lobe and the change of the frontal lobe before the changes in the hippocampus. (2) The right frontal lobe, MI/ Cr, OSAS mild to moderate, and the severe group. The number of Gx/ CrOSAS in the left frontal lobe was significantly lower than that in the healthy control group (F = 4.381, p = 0.019). Meaning, but there is a tendency to be reduced, which is the same as the weight Conclusion: The measurement of VBM, the application of the ADC map of SPM and MRS on the display of the brain caused by OSAS
【学位授予单位】：天津医科大学
【学位级别】：博士
【学位授予年份】：2011
【分类号】：R766
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