發(fā)布時(shí)間：2018-02-11 13:30

  本文關(guān)鍵詞： 帕金森病 腦白質(zhì) 磁共振成像 基于體素形態(tài)學(xué)測(cè)量方法 磁共振彌散張量成像 基于纖維束追蹤空間統(tǒng)計(jì)分析 功能磁共振　出處：《昆明醫(yī)科大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：[目的] 采用磁共振基于體素的形態(tài)學(xué)(voxel-based morphometry method of magnetic resonance imaging, VBM-MRI)分析方法及磁共振彌散張量成像(diffusion tensor imaging, DTI)基于纖維束追蹤空間統(tǒng)計(jì)分析(tract-based spatial statistics, TBSS)方法觀察早期(HoehnYahrl-II級(jí))帕金森病患者腦白質(zhì)結(jié)構(gòu)改變的特征,為帕金森病發(fā)病機(jī)制的研究提供功能神經(jīng)解剖學(xué)依據(jù)。[資料與方法](1)研究對(duì)象：本次試驗(yàn)分別設(shè)定一個(gè)早期帕金森病組(PD組)和一個(gè)正常對(duì)照組(HC組),PD組由神經(jīng)內(nèi)科錐體外系疾病專家參照英國(guó)帕金森病學(xué)會(huì)腦庫(kù)的臨床診斷標(biāo)準(zhǔn)確診早期帕金森病患者29例,年齡、性別、利手、受教育程度相匹配的正常對(duì)照組30例。(2)磁共振成像部分：采用荷蘭PHILIPS Achieva 3.0TTX超導(dǎo)磁共振掃描儀,8通道頭部相控陣線圈進(jìn)行常規(guī)全腦掃描,排除腦器質(zhì)性病變,腦內(nèi)結(jié)構(gòu)正常者進(jìn)入磁共振實(shí)驗(yàn)數(shù)據(jù)采集,兩組均進(jìn)行全腦3D T1WI及DTI數(shù)據(jù)采集。(3)數(shù)據(jù)后處理：方法一：3DT1WI結(jié)構(gòu)像數(shù)據(jù),采用以SPM8軟件包為基礎(chǔ)的全自動(dòng)VBM技術(shù)進(jìn)行處理,對(duì)處理過的數(shù)據(jù)進(jìn)行兩樣本t檢查,比較PD組與HC組之間的腦白質(zhì)體積差異,P0.005,差異有統(tǒng)計(jì)學(xué)意義。方法二：DTI圖像數(shù)據(jù),采用FSL (FMRIB's Software Library)軟件內(nèi)TBSS技術(shù)對(duì)數(shù)據(jù)進(jìn)行預(yù)處理和分析。分析兩組受試者腦白質(zhì)纖維DTI各相關(guān)參數(shù),包括FA(部分各向異性),MD(平均彌散系數(shù)),AD(軸向彌散系數(shù)),RD(平行彌散系數(shù))。①首先對(duì)DTI原始數(shù)據(jù)進(jìn)行頭動(dòng)校正和渦流校正并計(jì)算獲取FA圖,再由所有參與者的FA圖像構(gòu)建一個(gè)常規(guī)的平均白質(zhì)骨架,將每個(gè)參與者的FA圖像配準(zhǔn)到平均骨架圖上,再轉(zhuǎn)換到MNI空間坐標(biāo)上,最后進(jìn)行統(tǒng)計(jì)分析,觀察纖維骨架上FA值存在顯著變化的腦區(qū)。(MD、RD、AD平均模板及骨架圖的創(chuàng)建同上)。②記錄兩組間DTI各參數(shù)有顯著差異的腦區(qū)(P0.05)。[結(jié)果]1、早期PD組白質(zhì)體積減小的腦區(qū)是：右額上回皮層下白質(zhì),右額中回皮層下白質(zhì),右中央前回皮層下白質(zhì),右扣帶回白質(zhì),左額中回皮層下白質(zhì),左額下回皮層下白質(zhì),右頂下小葉皮層下白質(zhì),左楔前葉皮層下白質(zhì),右顳上回皮層下白質(zhì),右顳下回皮層下白質(zhì),左顳中回皮層下白質(zhì),左海馬旁回白質(zhì),右楔葉皮層下白質(zhì),雙側(cè)胼胝體壓部,中腦右份。P0.005。2、早期PD組白質(zhì)體積增加的腦區(qū)是：左側(cè)嗅束,右海馬旁回白質(zhì),右楔前葉皮層下白質(zhì),左緣上回皮層下白質(zhì),右小腦前葉皮層下白質(zhì),左小腦后葉皮層下白質(zhì)。P0.005。3、早期PD組腦白質(zhì)纖維束中FA值降低的區(qū)域包括：胼胝體膝部,胼胝體體部,胼胝體壓部,左側(cè)內(nèi)囊前肢,雙側(cè)前放射冠,雙側(cè)上放射冠,左丘腦后輻部,雙側(cè)扣帶回,左側(cè)上縱束。4、早期PD組腦白質(zhì)纖維束中MD值升高的區(qū)域包括：胼胝體膝部,胼胝體體部,胼胝體壓部,穹窿,左側(cè)大腦腳,雙側(cè)內(nèi)囊前肢,雙側(cè)內(nèi)囊后肢,雙側(cè)前放射冠,雙側(cè)上放射冠,雙側(cè)后放射冠,雙側(cè)丘腦后輻射,雙側(cè)外囊,右側(cè)上縱束,左上額枕束。5、早期PD組腦白質(zhì)纖維束中RD值升高的區(qū)域包括：胼胝體膝部,胼胝體體部,胼胝體壓部,穹窿,左側(cè)內(nèi)囊前肢,雙側(cè)前放射冠,雙側(cè)上放射冠,雙側(cè)后放射冠,雙側(cè)丘腦后輻射,雙側(cè)外囊,雙側(cè)扣帶回,左側(cè)上縱束,右鉤束。6、早期PD組FA值降低并MD值、RD值升高的腦區(qū)是：胼胝體膝部,胼胝體體部,胼胝體壓部,左側(cè)內(nèi)囊前肢,雙側(cè)前放射冠,雙側(cè)上放射冠,左側(cè)丘腦后輻射。總之,PD組與HC組相比,PD組多個(gè)腦白質(zhì)纖維束FA值降低,MD、RD值升高(P0.05),而AD未見明顯變化(P0.05)。[結(jié)論]1、早期PD患者存在多個(gè)腦白質(zhì)區(qū)體積和DTI各相關(guān)參數(shù)(FA、MD、RD、AD)的改變。提示早期PD腦白質(zhì)不僅存在宏觀的結(jié)構(gòu)變化,還有白質(zhì)纖維微觀結(jié)構(gòu)的改變。2、早期PD患者可能存在多個(gè)腦白質(zhì)區(qū)體積萎縮及部分白質(zhì)體積代償性增加。3、PD的發(fā)生可能與特征性局部腦白質(zhì)纖維完整性異常相關(guān),單純RD升高區(qū)域可能反應(yīng)病變初期的輕度改變,即以脫髓鞘為主,FA降低及MD、RD升高同時(shí)存在提示除脫髓鞘損傷外,還存在白質(zhì)纖維排列紊亂及疏密程度改變,可能代表病變進(jìn)一步發(fā)展。采用MD值及RD值來反映PD患者腦白質(zhì)纖維的改變可能更加敏感。4、利用VBM-MRI技術(shù)聯(lián)合DTI-TBSS分析可以有效的顯示腦白質(zhì)結(jié)構(gòu)改變的區(qū)域,二種方法相互補(bǔ)充,能較好的為早期PD發(fā)病機(jī)制的研究提供功能神經(jīng)解剖學(xué)依據(jù)。
[Abstract]:[Objective] using MRI voxel based morphometry (voxel-based morphometry method of magnetic resonance imaging, VBM-MRI) analysis method and magnetic resonance diffusion tensor imaging (diffusion tensor, imaging, DTI) fiber tracking based on spatial statistical analysis (tract-based spatial, statistics, TBSS) method (HoehnYahrl-II) to observe the early changes of white matter structure characteristics Parkinson brain disease patients, to provide functional anatomy for the materials and methods.] to study the pathogenesis of Parkinson's disease (1) research object: the test set an early Parkinson disease group (PD group) and a normal control group (HC group), PD group from the Department of Neurology of extrapyramidal diseases expert reference British Institute of Parkinson's disease brain bank clinical diagnostic criteria of early diagnosis of Parkinson's disease in 29 patients, age, gender, handedness, normal control group and education level matched 30 cases (2). Magnetic resonance imaging: the Holland PHILIPS Achieva 3.0TTX superconducting magnetic resonance scanner head 8 channel phased array coil for conventional whole brain scans, out of organic brain lesions, normal brain structure in magnetic resonance experiment data acquisition, two groups of whole brain 3D and DTI data T1WI collection. (3) data postprocessing: method one: 3DT1WI like structure data, using SPM8 software package based automatic VBM technology for processing, the two sample t inspection of the processed data, the comparison between PD group and HC group of brain white matter volume differences, P0.005, the difference was statistically significant. Method: two DTI image data, using FSL (FMRIB's Software Library) TBSS software technology to preprocess and Analysis on the data analysis. The related parameters of two groups of subjects with cerebral white matter fiber DTI, including FA (fractional anisotropy), MD (average diffusion coefficient (AD), axis 鍚戝譏鏁ｇ郴鏁，

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