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  本文關(guān)鍵詞：IDEAL-IQ聯(lián)合IVIM-DWI對激素性股骨頭壞死脂肪含量及局部微循環(huán)的相關(guān)性研究　出處：《廣州中醫(yī)藥大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 脂肪含量 微循環(huán) 激素性股骨頭壞死 IDEAL-IQ IVIM-DWI

【摘要】：目的:利用磁共振定量技術(shù)非對稱回波的最小二乘估算法迭代水脂分離序列(iterative decomposition of water and fat with echo asymmetry and least-squares estimation quantitation sequence,IDEAL-IQ)和體素內(nèi)不相干運動磁共振擴散加權(quán)成像(Intravoxel incoherent motion diffusion weighted imaging,IVIM-DWI)分別無創(chuàng)性地測量激素性股骨頭壞死塌陷前,即ARCOⅠ期、Ⅱ期及Ⅲ早期患者的脂肪含量及局部微循環(huán)指標(biāo),分析各定量指標(biāo)與ARCO分期的相關(guān)性,并探討股骨頭壞死脂肪含量與局部微循環(huán)的相關(guān)性。利用IDEAL-IQ和IVIM-DWI定量技術(shù)無創(chuàng)性地分析單髖激素性股骨頭壞死患者正常側(cè)股骨頭的脂肪含量及局部微循環(huán)指標(biāo),并探討該定量指標(biāo)與健康對照組之間有無差異,以期對股骨頭壞死進行超早期診斷。材料與方法:1.IDEAL-IQ聯(lián)合IVIM-DWI定量技術(shù)對激素性股骨頭壞死脂肪含量及局部微循環(huán)的相關(guān)性研究本研究前瞻性地研究了 2015年10月至2017年03月,在廣州中醫(yī)藥大學(xué)第一附屬影像科經(jīng)X線、MRI及臨床證實的53例激素性股骨頭壞死病例,其中ARCO Ⅰ期3例,ARCOⅡ期 12 例,ARCOⅢ早期 14 例,ARCOⅢ 晚期 13 例,ARCOⅣ 期 11 例,共78個股骨頭受累,符合條件者共39個,受試者年齡范圍為16—58歲,中位年齡為42歲,在治療前均行X線、MRI檢查及ARCO分期,所有患者均為初治患者。股骨頭壞死患者均選取塌陷前期,即ARCOⅠ期、ARCOⅡ期及ARCO Ⅲ期早期。該研究通過了我院倫理委員會審查,所有受試者均簽署了檢查知情同意書。磁共振掃描序列包括普通序列(軸位及冠狀位T2WI/fs、矢狀位T1WI、冠狀位LAVAFLEX)及生理序列(軸位IVIM-DWI及IDEAL-IQ序列),其中IVIM-DWI采用9個b 值(10、20、30、50、80、100、200、400、1000)。掃描結(jié)束后將 IDEAL-IQ 及 IVIM-DWI圖像分別上傳至工作站進行后處理,同時將壞死股骨頭分為三個不同區(qū)域,即壞死區(qū)、硬化區(qū)及正常區(qū),分別測量不同區(qū)域的脂肪含量——FF(fat fraction)值及局部微循環(huán)f值。采用SPSS 22.0進行統(tǒng)計學(xué)計算與分析。首先采用方差分析(analysis of variance,ANOVA)比較壞死股骨頭不同區(qū)域的FF值與f值有無差異,P㩳0.05為差異有統(tǒng)計學(xué)意義。如差異有統(tǒng)計學(xué)意義,再用Pearson相關(guān)分析研究FF值、f值與ARCO分期的相關(guān)性,同時用Pearson相關(guān)分析對激素性股骨頭壞死脂肪含量FF值及局部微循環(huán)f值進行相關(guān)性分析,P㩳0.05為差異有統(tǒng)計學(xué)意義。2.單髖激素性股骨頭壞死患者正常側(cè)股骨頭脂肪含量及局部微循環(huán)研究本研究前瞻性地研究了廣州中醫(yī)藥大學(xué)第一附屬醫(yī)院確診的30例單髖激素性股骨頭壞死初治患者,選取單髖激素性股骨頭壞死患者正常側(cè)股骨頭作為對側(cè)正常組,壞死側(cè)為壞死組,同時選取16例健康志愿者作為對照組,所有病例均行X線、CT及MRI檢查,其中MRI掃描序列包括:常規(guī)序列(軸位及冠狀位T2WI/fs、矢狀位T1WI、冠狀位LAVAFLEX)及生理序列(軸位IDEAL-IQ及IVIM-DWI序列),將生理成像序列掃描所得圖像上傳至工作站進行后處理,測量出定量參數(shù)——脂肪含量FF值及局部微循環(huán)f值。采用方差分析分析對側(cè)正常組、壞死組及對照組之間的定量數(shù)值是否存在差異,P㩳0.05為差異有統(tǒng)計學(xué)意義。結(jié)果:1.IDEAL-IQ聯(lián)合IVIM-DWI定量技術(shù)對激素性股骨頭壞死脂肪含量及局部微循環(huán)的相關(guān)性研究激素性股骨頭壞死不同區(qū)域,即壞死區(qū)、硬化帶區(qū)及正常區(qū)的FF值與f值分別為(102.42±36.67、38.56±13.04、75.24±14.55,0.30±0.07、0.34±0.08、0.40±0.08),差異有統(tǒng)計學(xué)意義(F=51.76、12.36,P均0.01),壞死區(qū)的FF值最大,局部微循環(huán)f值最小,P均0.01,差異有統(tǒng)計學(xué)意義。ARCO Ⅲ期早期的FF值最大(130.50±34.75,P0.05),f 值最小(0.30±0.67,P0.05),差異有統(tǒng)計學(xué)意義。并且FF值與ARCO分期呈正相關(guān)(r=0.72,P㩳0.01),差異有統(tǒng)計學(xué)意義;f值與ARCO分期沒有明顯相關(guān)性(r=-0.17,P0.05),差異無統(tǒng)計學(xué)意義。此外,激素性股骨頭壞死內(nèi)的FF值和f值呈現(xiàn)負性相關(guān)(r=-0.37,P㩳0.05),差異有統(tǒng)計學(xué)意義。2.單髖激素性股骨頭壞死患者正常側(cè)股骨頭脂肪含量及局部微循環(huán)研究在形態(tài)學(xué)方面,傳統(tǒng)MRI檢查發(fā)現(xiàn)對側(cè)正常組同對照組并無差異,均未見明顯壞死區(qū)及硬化帶。然而通過定量技術(shù)IDEAL-IQ及IVIM-DWI測量組織內(nèi)的生理參數(shù)得出:對側(cè)正常組的FF值及f值分別為92.29±3.74、0.36±0.06,壞死組的FF值及f值分別為 102.20±36.05、0.31±0.67,對照組的 FF 值及 f 值分別為 80.88±4.58、0.37±0.07,FF值及f值比較的統(tǒng)計值F值分別為8.11、8.93,P值分別為0.001、0.000,P均0.01,差異有統(tǒng)計學(xué)意義。對照組的FF值小于對側(cè)正常組,P㩳0.05,差異有統(tǒng)計學(xué)意義;對照組的FF值小于壞死組,P0.01,差異有統(tǒng)計學(xué)意義。壞死組的f值小于對側(cè)正常組,P㩳0.01,差異有統(tǒng)計學(xué)意義;壞死組的f值小于對照組,P=0.000,P㩳0.01,差異有統(tǒng)計學(xué)意義。結(jié)論:1.IDEAL-IQ聯(lián)合IVIM-DWI定量技術(shù)對激素性股骨頭壞死脂肪含量及局部微循環(huán)的相關(guān)性研究磁共振IDEAL-IQ聯(lián)合IVIM-DWI定量成像技術(shù)可分別無創(chuàng)地用于激素性股骨頭壞死塌陷前期脂肪含量及局部微循環(huán)的測量,股骨頭壞死ARCO Ⅲ期早期的脂肪含量最高,而局部微循環(huán)最小,且股骨頭壞死脂肪含量隨著ARCO分期的增長而增長,而局部微循環(huán)則隨著ARCO分期的增長有減少的趨勢。激素性股骨頭壞死脂肪含量與局部微循環(huán)呈負相關(guān)。2.單髓激素性股骨頭壞死患者正常側(cè)股骨頭脂肪含量及局部微循環(huán)研究單髖股骨頭壞死對側(cè)正常組經(jīng)傳統(tǒng)MRI檢查并未發(fā)現(xiàn)異常形態(tài)學(xué)改變,其影像學(xué)表現(xiàn)同正常股骨頭沒有明顯不同。但磁共振生理成像技術(shù)IDEAL-IQ及IVIM-DWI卻通過定量參數(shù)檢測出其內(nèi)的生理指標(biāo)已發(fā)生改變。其脂肪含量FF值較正常人升高,局部微循環(huán)較壞死股骨頭升高。這就提示股骨頭壞死對側(cè)正常股骨頭在壞死發(fā)生形態(tài)學(xué)改變之前其內(nèi)的生理指標(biāo)(尤指脂肪含量的變化)就已經(jīng)發(fā)生改變,即進入壞死超早期。
[Abstract]:Objective: by using the least square magnetic resonance quantitative technique of asymmetric echo estimation method of iterative water fat separation (iterative decomposition of water and sequence fat with echo asymmetry and least-squares estimation quantitation sequence, IDEAL-IQ) and intravoxel incoherent motion of magnetic resonance diffusion weighted imaging (Intravoxel incoherent motion diffusion weighted imaging, IVIM-DWI) were non invasively measurement of steroid induced necrosis of femoral head collapse before the ARCO stage, the fat content in patients with early phase II and III and the local microcirculation index, analysis of the correlation between the index and the stage of ARCO, and to explore the relationship between the content of fat necrosis of the femoral head and the microcirculation. Using IDEAL-IQ and IVIM-DWI quantitative noninvasive analysis of single the hip of the femoral head necrosis in patients with the normal side of the femoral head microcirculation index and fat content, and to explore the There is no difference between the quantitative index and the healthy control group, with a view to avascular necrosis of super early diagnosis. Materials and methods: To study the correlation of 1.IDEAL-IQ combined with IVIM-DWI quantitative technique on the treatment of femoral head necrosis and local microcirculation of the fat content of this study prospectively studied from October 2015 to 2017 03, X-ray at the Guangzhou University of Chinese Medicine the first affiliated Department of Radiology, MRI and clinical confirmed 53 cases of steroid induced necrosis of the femoral head cases, including 3 cases of ARCO stage, 12 cases of ARCO II, ARCO III early in 14 cases, 13 cases of advanced ARCO ARCO III, IV in 11 cases, a total of 78 femoral head involvement, in line with the conditions of a total of 39. The subjects aged 16 - 58 years old, the median age was 42 years old, before treatment underwent X-ray, MRI examination and ARCO staging, all patients were newly diagnosed patients. Patients with avascular necrosis of the femoral head were selected before collapse, namely the first stage of ARCO, ARCO II and AR Early CO stage. The research by our hospital ethics review committee and all subjects signed the informed consent. MRI scanning sequences included common sequence (axial and coronal T2WI/fs, sagittal T1WI, coronal LAVAFLEX) and physiological (axial IVIM-DWI sequence and IDEAL-IQ sequence), which IVIM-DWI uses 9 b values (10,20,30,50,801002004001000). After scanning the IDEAL-IQ and IVIM-DWI images were uploaded to the workstation for postprocessing, and necrosis of the femoral head is divided into three different regions, namely the necrosis area, hardening area and normal area were measured, the fat content in different regions of the FF (fat fraction) and local the microcirculation F value. SPSS 22 was used for statistical calculation and analysis. Firstly, by analysis of variance (analysis of, variance, ANOVA) between different regions of bone necrosis of femoral FF values had no difference, and the value of F P 0.05 is the difference? There was a significant correlation. The difference was statistically significant, FF correlation analysis and Pearson value, correlation between F value and ARCO stage, and Pearson correlation analysis of steroid induced necrosis of the femoral head fat content FF value and F value of local microcirculation correlation analysis, P? 0.05 for the difference was statistically significant.2. single hip hormone femoral head necrosis of femoral head in patients with normal fat content and microcirculation in this study prospectively studied diagnosed the First Affiliated Hospital of Guangzhou University of Chinese Medicine, 30 cases of single hip necrosis of the femoral head in untreated patients, the hip of the femoral head necrosis of femoral head in patients with normal contralateral normal group, necrosis necrosis side group, while 16 healthy volunteers were enrolled as control group. All patients underwent X-ray, CT and MRI examination, MRI scanning sequences included conventional sequence (axial and coronal sagittal T2WI /fs. T1WI, coronal LAVAFLEX) and physiological (axial IDEAL-IQ sequence and IVIM-DWI sequence), the physiological imaging sequence scanned image upload to the workstation for postprocessing, measurement of quantitative parameters - fat content FF value and F value of local microcirculation. By analysis of variance analysis of the normal side group, whether there are differences between the quantitative values necrosis group and control group, P? 0.05 for the difference was statistically significant. Results: 1.IDEAL-IQ combined with IVIM-DWI quantitative technique on the treatment of femoral head necrosis and fat content of local microcirculation correlation study of femoral head necrosis in different regions, namely the necrosis area, hardening area and normal area of the FF and F values respectively (102.42 + 36.67,38.56 + 13.04,75.24 + 14.55,0.30 + 0.07,0.34 + 0.08,0.40 + 0.08), the difference was statistically significant (F=51.76,12.36, P 0.01), the necrosis area of the FF value of local micro circulation f minimum, P 0.01, There was a significant difference between the phase III.ARCO early FF maximum (130.50 + 34.75, P0.05), f (minimum 0.30 + 0.67, P0.05), the difference was statistically significant. And FF was positively correlated with the stage of ARCO (r=0.72, P? 0.01), the difference was statistically significant; the value of F and ARCO stage had no obvious correlation (r=-0.17, P0.05), the difference was not statistically significant. In addition, steroid induced necrosis of the femoral head within the FF and F values showed a negative correlation (r=-0.37, P? 0.05), the difference was statistically significant.2. single hip femoral head necrosis of femoral head in patients with normal fat content and local microcirculation in morphology MRI, the traditional examination showed contralateral normal group with no difference in the control group, there were no obvious necrosis and hardening zone. However the physiological parameters of quantitative techniques IDEAL-IQ and IVIM-DWI measurements within the organization that contralateral normal group of FF and F values were 92.29 + 3.74,0.36 + 0.06, Necrosis group FF value and F value were 102.20 + 36.05,0.31 + 0.67, the control group of the FF and F values were 80.88 + 4.58,0.37 + 0.07, FF value and F value of the statistical value of F-measure respectively 8.11,8.93, P = 0.001,0.000, P was 0.01, there were statistically significant differences in the control group. The FF value is less than the contralateral normal group, P? 0.05, the difference was statistically significant; the control group of the FF value is less than P0.01, necrosis group, the difference was statistically significant. The F value is less than the normal group, P group 0.01, necrosis? The difference was statistically significant; the f value is less than the control group, P=0.000, P necrosis group? 0.01, the difference was statistically significant. Conclusion: 1.IDEAL-IQ combined with IVIM-DWI quantitative technique on the treatment of femoral head necrosis and fat content of local microcirculation correlation study on magnetic resonance imaging quantitative IDEAL-IQ combined with IVIM-DWI can noninvasively for collapse of osteonecrosis of the femoral head in early fat The measurement and microcirculation, avascular necrosis of the femoral head in early stage ARCO the highest fat content, while the local microcirculation and minimal necrosis of the femoral head lipid content increases with the stage of ARCO growth, while the local microcirculation with ARCO stage growth decreased. Necrosis of the femoral head microcirculation and fat content was negative.2. single spinal cord of the femoral head necrosis of femoral head in patients with normal fat content and local microcirculation of single hip avascular necrosis of the contralateral normal group after conventional MRI examination did not find abnormal morphological changes, the imaging appearance with normal femoral head was not significantly different. But the magnetic resonance imaging and physiological IDEAL-IQ IVIM-DWI but by quantitative parameters to detect the physiological indexes in it have changed. The fat content of FF was higher than in normal people, the local microcirculation of femoral head necrosis is increased. This suggests that stocks The physiological index (especially the change of fat content) has been changed before the morphological change of normal femoral head on the contralateral side of the femoral head.

【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R445.2;R681.8

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