本文選題：足月新生兒　切入點(diǎn)：缺氧缺血性腦病　出處：《蘭州大學(xué)》2012年碩士論文　論文類型：學(xué)位論文

【摘要】：目的探討磁共振彌散張量成像(DTI)在足月新生兒缺氧缺血性腦早期診斷和隨訪中的價(jià)值,基于其定量指標(biāo)ADC值、FA值可敏感探測(cè)水分子跨膜運(yùn)動(dòng)引起的彌散量和(或)方向異常以及各向異性彌散對(duì)腦的微結(jié)構(gòu)信息反映,重點(diǎn)研究兩方面：1.探討ADC值、FA值在評(píng)價(jià)足月新生兒缺氧缺血性腦病(HIE)早期腦損傷中的價(jià)值；2.分析FA值在HIE患兒腦白質(zhì)中的變化趨勢(shì),揭示HIE腦損傷對(duì)髓鞘發(fā)育的影響。 方法1.將26例足月HIE新生兒分為輕、中、重度3組進(jìn)行常規(guī)MRI和DTI掃描,分別測(cè)定雙側(cè)額葉深部白質(zhì)、放射冠、內(nèi)囊后肢、丘腦腹外側(cè)、豆?fàn)詈思拔矤詈祟^部的ADC值和FA值,并和對(duì)照組進(jìn)行比較,分析HIE患兒腦不同部位ADC值和FA值的變化規(guī)律以及跟新生兒神經(jīng)行為學(xué)測(cè)定(NBNA)評(píng)分的相關(guān)性。2.對(duì)26例HIE患兒中15例跟蹤隨訪,根據(jù)初次掃描時(shí)臨床分度劃分為輕、中重度2組,分別測(cè)定雙側(cè)額葉深部白質(zhì)、放射冠和內(nèi)囊后肢的FA值,對(duì)HIE早期和后期同一部位的FA值進(jìn)行對(duì)照研究,并進(jìn)行兩兩組間比較,分析FA值在HIE腦損傷后髓鞘化過程中的變化規(guī)律。 結(jié)果1.ADC值、FA值在額葉深部白質(zhì)、放射冠、內(nèi)囊后肢、丘腦腹外側(cè)的組間具有統(tǒng)計(jì)學(xué)意義,ADC值、FA值隨病情加重而減低；豆?fàn)詈撕臀矤詈祟^部的FA值組間差異無統(tǒng)計(jì)學(xué)意義；內(nèi)囊后肢的ADC值、FA值與NBNA評(píng)分的一致性最高。2.FA值在額葉深部白質(zhì)、放射冠、內(nèi)囊后肢從早期到后期均增加,但隨病情程度不同增加的幅度不同；輕度組額葉深部白質(zhì)、放射冠和內(nèi)囊后肢的FA值者大于中重度組。 結(jié)論1.與常規(guī)MRI比較,DTI技術(shù)可以早期、客觀、定量的評(píng)價(jià)HIE腦損傷的程度和范圍,尤其是腦白質(zhì)損傷的評(píng)定中具有一定的應(yīng)用價(jià)值；2.磁共振彌散張量成像的FA值,在HIE復(fù)查中可定量反映新生兒期不同輕重程度HIE患兒腦損傷對(duì)腦白質(zhì)髓鞘發(fā)育的影響程度,提出可以作為預(yù)后評(píng)估的指標(biāo)。
[Abstract]:Objective to evaluate the value of diffusion Zhang Liang DTI in early diagnosis and follow-up of hypoxic-ischemic brain in term neonates. Based on the ADC value and FA value of the quantitative index, the dispersion and / or direction anomalies caused by the transmembrane movement of water molecules can be detected sensitively, and the information of anisotropic diffusion on the microstructures of the brain can be reflected. To discuss the value of ADC value in evaluating the early brain injury of term neonates with hypoxic-ischemic encephalopathy (HIE) 2.To analyze the change trend of FA value in white matter of children with HIE, and to reveal the effect of HIE brain injury on myelin development. Methods 1. 26 cases of term HIE neonates were divided into 3 groups: mild, moderate and severe. The ADC and FA values of bilateral deep white matter of frontal lobe, corona radiata, posterior limb of internal capsule, ventrolateral thalamus, lentiform nucleus and head of caudate nucleus were measured. Compared with the control group, the changes of ADC value and FA value in different parts of brain of HIE children were analyzed, and the correlation between ADC value and neonatal neurobehavioral score was analyzed. 2. 15 cases of 26 cases of HIE were followed up. The FA values of the deep white matter of bilateral frontal lobe, the corona radiata and the hindlimb of the internal capsule were measured according to the clinical grading of the first scan. The FA values of the same site in the early and late stage of HIE were compared. The changes of FA value in the process of myelination after HIE brain injury were analyzed. Results 1. The ADC value of FA in the deep white matter of frontal lobe, corona radiata, posterior limb of internal capsule and ventrolateral thalamus was significantly lower than that in the other two groups, but there was no significant difference in FA between the lentiform nucleus and the head of caudate nucleus. The ADC value of internal capsule hind limb and NBNA score were the highest. 2. FA value increased from early to late stage in deep white matter of frontal lobe, corona radiata and hind limb of internal capsule, but the amplitude of increase was different with the degree of disease, the white matter in deep frontal lobe was increased in mild group. The FA values of the radiosurgery and internal capsule hind limbs were higher than those of the moderate and severe groups. Conclusion 1.Compared with conventional MRI, it can be used to evaluate the extent and extent of brain injury in HIE early, objectively and quantitatively, especially in the evaluation of brain white matter injury. 2.The FA value of diffusion-weighted Zhang Liang imaging. The influence of brain injury on myelin development of white matter in neonates with HIE of different severity in neonatal stage can be quantitatively reflected in HIE reexamination, and it can be used as a prognostic index.
【學(xué)位授予單位】：蘭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R445.2;R722.1

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