本文選題：新生兒 + 彌散張量成像��； 參考：《南京醫(yī)科大學(xué)》2016年博士論文

【摘要】：第一部分磁共振彌散張量成像在新生兒腦髓鞘發(fā)育的初步研究目的:應(yīng)用磁共振彌散張量成像(diffusion tensor imaging,DTI)定量測定分?jǐn)?shù)各向異性(fractional anisotropy,FA)值,各向異性值可反映腦白質(zhì)微結(jié)構(gòu),對照研究足月兒和早產(chǎn)兒在腦內(nèi)不同部位白質(zhì)FA值的差異,探討DTI在腦白質(zhì)髓鞘發(fā)育中的應(yīng)用價值。材料和方法:將100例圍產(chǎn)史正常,無器質(zhì)性神經(jīng)系統(tǒng)疾病的足月兒和早產(chǎn)兒分為兩組:足月兒39例,胎齡37周～42周,早產(chǎn)兒61例,均糾正胎齡到40周。入組新生兒均行常規(guī)MRI和DTI掃描,測量雙側(cè)內(nèi)囊前后肢、胼胝體膝部和壓部、側(cè)腦室前角旁白質(zhì)、側(cè)腦室后角旁白質(zhì)、半卵圓中心中央部、室管膜下區(qū)以及外囊和小腦中腳區(qū)這些興趣區(qū)的FA值,分析腦內(nèi)各部位白質(zhì)的FA值在足月兒和早產(chǎn)兒的差異以及足月兒和早產(chǎn)兒腦內(nèi)不同部位FA值的差異。結(jié)果:①左右半球相同部位的FA值的差異無統(tǒng)計學(xué)意義(P0.05)。胼胝體膝部和壓部FA值比較,早產(chǎn)兒和足月兒組內(nèi)比較均有統(tǒng)計學(xué)意義(P0.05)。②早產(chǎn)兒和足月兒不同部位FA值比較,早產(chǎn)兒FA值較足月兒低。內(nèi)囊前后肢、胼胝體壓部、半卵圓中心b區(qū)及外囊和小腦中腳區(qū)FA值早產(chǎn)兒和足月兒兩組比較差異有統(tǒng)計學(xué)意義(P0.05)。胼胝體膝部、側(cè)腦室前角旁白質(zhì)、側(cè)腦室后角旁白質(zhì)、半卵圓中心a區(qū)、室管膜下區(qū)的FA值早產(chǎn)兒和足月兒兩組比較無顯著差異(P0.05)。③早產(chǎn)兒和足月兒組內(nèi)各白質(zhì)區(qū)FA值不同,兩兩比較均發(fā)現(xiàn)內(nèi)囊后肢高于前肢,側(cè)腦室后角旁白質(zhì)高于側(cè)腦室前角旁白質(zhì),胼胝體壓部高于膝部,各差異均有統(tǒng)計學(xué)意義(P0.05)。半卵圓中心中央部a和b平面比較沒有統(tǒng)計學(xué)意義(P0.05)。各ROI其中側(cè)腦室前角旁白質(zhì)FA值最低,胼胝體壓部和內(nèi)囊后肢FA值最高,兩者比較側(cè)腦室前角旁白質(zhì)與胼胝體壓部和內(nèi)囊后肢均有顯著性差異(P0.05)。結(jié)論:所選興趣區(qū)FA值早產(chǎn)兒較足月兒降低,內(nèi)囊前后肢、胼胝體壓部、半卵圓中心b區(qū)及外囊和小腦中腳區(qū)FA值早產(chǎn)兒和足月兒兩組比較差異有統(tǒng)計學(xué)意義,提示這些區(qū)域早產(chǎn)兒髓鞘成熟較足月兒晚。腦內(nèi)不同部位的FA值也有所差異,反映了髓鞘化時間、白質(zhì)纖維排列方式和髓鞘本身結(jié)構(gòu)特點的差異。FA值能定量的分析髓鞘化進(jìn)程,評估腦白質(zhì)發(fā)育情況。第二部分磁敏感加權(quán)成像在新生兒高膽紅素血癥中的應(yīng)用研究目的:探討磁敏感加權(quán)成像(susceptibility weighted imaging,SWI)在新生兒高膽紅素血癥腦內(nèi)出血中的應(yīng)用價值。材料和方法:對120例新生兒(出生28天內(nèi)的足月兒和糾正胎齡42周內(nèi)的早產(chǎn)兒)吸納入組進(jìn)行前瞻性SWI檢查,受試者分為4組,每組30例。第1組健康查體的早產(chǎn)兒;第2組健康查體的足月兒;第3組臨床診斷高膽紅素血癥的早產(chǎn)兒;第4組臨床診斷高膽紅素血癥的足月兒。對120例新生兒進(jìn)行常規(guī)MRI和SWI掃描,2名不知被檢者病史的放射科醫(yī)師采用雙盲法分析MRI和SWI圖像。記錄常規(guī)MRI和SWI檢測的出血病例數(shù)和出血灶數(shù)目;分析不同部位顱內(nèi)出血在SWI上的表現(xiàn)。結(jié)果:①MRI和SWI對新生兒顱內(nèi)出血的檢出陽性率比較有統(tǒng)計學(xué)意義,SWI優(yōu)于常規(guī)MRI(P0.001)。在高膽紅素血癥組常規(guī)MRI和SWI對出血灶的檢出陽性率有統(tǒng)計學(xué)意義(P0.05),而在正常對照組常規(guī)MRI和SWI對出血灶的檢出陽性率比較沒有統(tǒng)計學(xué)意義(P0.05)。②常規(guī)MRI和/或SWI上診斷為腦出血的病例共43例,其中早產(chǎn)兒27例,足月兒16例;高膽紅素患兒29例,正常對照新生兒14例。在發(fā)生率上早產(chǎn)兒和足月兒差異有統(tǒng)計學(xué)意義(P0.05)。比較高膽紅素血癥和健康新生兒,發(fā)生率差異是顯著性的(P0.05),包括足月兒和早產(chǎn)兒。③43例中14例新生兒顯示顱內(nèi)腦外出血(5例為硬膜下出血,1例為硬膜下出血合并小腦出血,8例為蛛網(wǎng)膜下腔出血),14例均在MRI和SWI圖像中顯示。對腦外出血的檢出陽性病例數(shù)上,MRI和SWI兩者之間的差異無統(tǒng)計學(xué)意義(P0.05)。④29例新生兒在SWI圖像上顯示存在腦內(nèi)出血,其中10例常規(guī)MRI未顯示。新生兒顱內(nèi)出血(包括生發(fā)基質(zhì)-腦室內(nèi)出血、大腦和小腦實質(zhì)出血)其中大腦和小腦實質(zhì)出血以微出血(直徑小于10mm)為表現(xiàn)形式,檢出陽性病例數(shù)SWI明顯優(yōu)于常規(guī)MRI,兩者之間的差異有統(tǒng)計學(xué)意義(P0.05)。SWI對生發(fā)基質(zhì)-腦室內(nèi)出血檢出陽性病例數(shù)與常規(guī)MRI比較無明顯統(tǒng)計學(xué)意義(P0.05)。⑤43例顱內(nèi)出血病例檢出數(shù)目122個,包括室管膜下-腦室內(nèi)出血19個(15.6%)、大腦實質(zhì)內(nèi)出血43個(35.2%)、小腦出血46個(37.7%)、硬膜下出血6個(4.9%)和蛛網(wǎng)膜下腔出血8個(6.6%)。常規(guī)MRI檢出數(shù)目78個,兩者比較有統(tǒng)計學(xué)意義(P0.05)。⑥本研究中早產(chǎn)兒生發(fā)基質(zhì)-腦室出血較足月兒多見,大腦實質(zhì)出血和小腦出血早產(chǎn)兒和足月兒均可發(fā)生,硬膜下出血足月兒多見,蛛網(wǎng)膜下腔出血早產(chǎn)兒多見。結(jié)論:早產(chǎn)兒高膽紅素血癥患兒顱內(nèi)出血發(fā)病率較正常新生兒高,SWI較常規(guī)MRI在新生兒高膽紅素血癥大腦和小腦實質(zhì)出血檢出的陽性率、病灶數(shù)目方面有著明顯的優(yōu)勢,可作為常規(guī)MRI的有力的補(bǔ)充。第三部分常規(guī)磁共振及磁共振波譜在新生兒缺氧缺血性腦病中的研究目的:圍產(chǎn)期缺氧缺血性損傷后腦病(HIE)可以通過不同的診斷技術(shù)評價,本研究的目的是結(jié)合常規(guī)磁共振與氫質(zhì)子波譜成像診斷HIE和評估它們的應(yīng)用價值。材料和方法:前瞻性觀察研究2012年2月到2013年2月入組的84名足月新生HIE患兒(輕至中度組StageⅠ-Ⅱ和嚴(yán)重組StageⅢ),10名正常的新生兒作為對照組。兩位放射學(xué)醫(yī)生采用雙盲法給MRI征象評分,對比分析兩組間常規(guī)磁共振成像(MRI)信號差異及1H-MRS腦代謝物膽堿復(fù)合物(Cho)/肌酸(Cr)、N-乙酰天門冬氨酸(NAA)/Cr、乳酸(Lac)/Cr結(jié)果的差異。結(jié)果:①征象分析:StageⅠ-II組(n = 53)和StageⅢ組(n = 31)在T1加權(quán)成像(T1WI)上點狀高信號損傷灶(punctate white matter lesions,PWML)和T2加權(quán)成像(T2WI)上腦水腫信號表現(xiàn)相似;基底節(jié)、丘腦、胼胝體或腦干的MRI和DWI信號異常發(fā)生在StageⅢ組,與StageⅠ-Ⅱ組比較其有顯著性差異(P=0.001)。②StageⅠ-Ⅱ組腦內(nèi)斑點狀白質(zhì)病變(PWML)平均值是5.38±4.68(數(shù)目1～43),StageⅢ組PWML平均值是16.82±17.66(數(shù)目4-59),兩組數(shù)目比較有顯著性差異(P=0.035);PWML多位于大腦髓靜脈附近,在DWI序列上多呈高信號。③StageⅠ-Ⅱ組MRI評分平均值是6.20±1.75,StageⅢ組MRI評分平均值是9.78±3.64,兩組MRI的分?jǐn)?shù)評估有顯著性差異(P=0.009)。④基底節(jié)和丘腦區(qū)波譜分析 NAA/Cr、Cho/Cr 和 Lac/Cr 比值在 HIE 組、StageⅠ-Ⅱ組和 StageⅢ組與對照組之間比較均有統(tǒng)計學(xué)意義(P0.05);而NAA/Cr、Cho/Cr.比值StageⅠ-Ⅱ組和StageⅢ組兩者比較無統(tǒng)計學(xué)意義(P0.05);Lac/Cr比值StageⅢ組較StageⅠ-Ⅱ組明顯升高,Lac/Cr比值兩組比較有顯著性差異(P0.05)。結(jié)論:常規(guī)MRI與1H-MRS相結(jié)合可客觀反映HIE患兒腦形態(tài)及代謝物變化,更為準(zhǔn)確判斷HIE患兒腦損傷嚴(yán)重程度。
[Abstract]:The first part of the first part of the study of magnetic resonance diffusion tensor imaging in the development of the brain sheath of the newborn: diffusion tensor imaging (DTI) was used to quantify the fractional anisotropy (fractional anisotropy, FA). The anisotropy value can reflect the white texture of the brain. The difference in the value of white matter FA in the same part of the value of DTI in the development of cerebral white matter myelin. Materials and methods: 100 cases of normal perinatal history, no organic nervous system disease of foot and preterm infants were divided into two groups: 39 cases of foot moon, fetal age 37 to 42 weeks, 61 premature infants to 40 weeks. All neonates in the group were routinely MRI and DT I scan was used to measure the FA values of the anterior and posterior limbs of the corpus callosum, the knee and pressure of the corpus callosum, the side of the lateral ventricle, the paraventricular accessory white matter, the posterior horn of the lateral ventricle, the central central part of the oval circle, the subependymal region, the outer capsule and the cerebellar middle foot. The difference in the FA value of the white matter in the brain at the foot and the preterm infants and the term and preterm birth were analyzed. The difference of FA values in different parts of the brain. Results: (1) there was no significant difference in the FA value of the same parts of the left and right hemispheres (P0.05). Compared with the FA value of the genu and the pressure part of the corpus callosum, the comparison between the premature and the foot month group was statistically significant (P0.05). (2) the FA value of preterm infants and the FA in the different parts of the foot moon was lower than that of the full moon. The hind limbs, the pressure of the corpus callosum, the central B area of the semi oval circle and the FA value of the outer capsule and the middle cerebellum in the two groups were statistically significant (P0.05). The corpus callosum, the lateral ventricle anterior corner of the white matter, the lateral ventricle corner of the white matter, the center of the semi oval center a, the FA value in the subependymal region and the two groups of the foot months were not significantly different (P0 .05). (3) the FA values in the white matter area of the preterm and foot moon group were different. 22 the posterior limb of the inner capsule was higher than the forelimb. The accessory white matter in the posterior horn of the lateral ventricle was higher than the side of the lateral ventricle, and the pressure of the corpus callosum was higher than the knee. The difference was statistically significant (P0.05). There was no statistical significance (P0.05) in the central central part of the central part of the center of the oval center and in the B plane. ROI of the anterior horn of the lateral ventricle was the lowest in the lateral ventricle, with the highest value of the corpus callosum and the posterior limb of the inner capsule. There were significant differences between the anterior horn of the ventricle and the posterior limb of the corpus callosum (P0.05). Conclusion: the FA value of the selected region of interest was lower than that of the foot, the anterior hind limbs of the internal capsule, the pressure of the corpus callosum, the center of the corpus callosum, the center of the corpus callosum, and the center of the B and the outside of the center of the oval circle. The difference between the FA value of the preterm and the two groups of the cerebellar and cerebellar feet was statistically significant, suggesting that the myelin maturation of the premature infants in these areas was later than that of the foot. The FA values in different parts of the brain were also different, reflecting the time of myelination, the difference between the arrangement of white matter fibers and the characteristics of the myelin itself, the.FA value can be used to quantify the myelination. Process, evaluation of brain white matter development. Second application of magnetic sensitive weighted imaging in neonatal hyperbilirubinemia Objective: To explore the value of susceptibility weighted imaging (SWI) in neonatal hyperbilirubinemia intracerebral hemorrhage. Materials and methods: 120 cases of newborn (28 days of birth) The full-term infants and the preterm infants who corrected the gestational age for 42 weeks were divided into 4 groups, 30 cases in each group, 30 in each group, first in the early birth of healthy body examination, second in the full term for healthy body examination, third in the prematurity in the diagnosis of hyperbilirubinemia, and in the fourth groups in the foot for the diagnosis of hyperbilirubinemia in the fourth groups, and 120 neonates. With routine MRI and SWI scans, 2 radiologists who did not know the history of the subjects were used to analyze the MRI and SWI images by double blind method. The number of bleeding cases and the number of hemorrhagic foci were recorded by the routine MRI and SWI tests, and the expression of intracranial hemorrhage in different sites on SWI. Results: (1) the positive rates of MRI and SWI on neonatal intracranial hemorrhage were statistically compared. SWI was better than conventional MRI (P0.001). In the high bilirubinemia group, the positive rate of MRI and SWI was statistically significant (P0.05), but the positive rate of MRI and SWI in normal control group was not statistically significant (P0.05). (2) 43 cases of normal MRI and / or SWI were diagnosed as cerebral hemorrhage. 27 preterm infants, 16 foot months, 29 cases of high bilirubin and 14 normal newborns. There were significant differences in the incidence of premature and foot months (P0.05). The difference in the incidence of hyperbilirubinemia and healthy newborns was significant (P0.05), including the full moon and preterm infants. 14 of the 43 cases of newborns showed intracranial Extradural hemorrhage (5 cases of subdural hemorrhage, 1 cases of subdural hemorrhage with cerebellar hemorrhage, 8 cases of subarachnoid hemorrhage), 14 cases were shown in MRI and SWI images. There was no statistical difference between MRI and SWI (P0.05) in the positive cases of extradural hemorrhage (P0.05). (4) 29 cases of newborn infants showed intracerebral hemorrhage in SWI images. 10 cases of conventional MRI were not shown. Intracranial hemorrhage (including germinal matrix - intraventricular hemorrhage, cerebral and cerebellar parenchyma hemorrhage) in which cerebral and cerebellar parenchyma hemorrhage was characterized by micro bleeding (diameter less than 10mm), the number of positive cases SWI was significantly better than that of conventional MRI, and the difference between the two was statistically significant (P0.05).SWI for birth. The number of positive cases in matrix intracerebroventricular hemorrhage was not statistically significant (P0.05). (5) 43 cases of intracranial hemorrhage were detected in 122 cases, including 19 (15.6%) intraventricular intraventricular hemorrhage, 43 cerebral hemorrhage (35.2%), 46 cerebellar hemorrhage (37.7%), 6 subdural hemorrhage (4.9%) and 8 subarachnoid hemorrhage (6) (6). .6%). The number of normal MRI was 78, and there was a significant difference between them (P0.05). 6. In this study, the primary matrix hemorrhage of premature infants in this study is more common than that of the full moon, the cerebral parenchymal hemorrhage and cerebellar hemorrhage may occur in premature infants and foot moon infants. Subdural hemorrhage is more common and subarachnoid hemorrhage is common in premature infants. Conclusion: preterm infant Gao Danhong The incidence of intracranial hemorrhage in children with hyperbilirubinemia is higher than that of normal newborns. SWI is more effective than conventional MRI in the positive rate of brain and cerebellar parenchymal hemorrhage in neonates with hyperbilirubinemia and the number of lesions, which can be used as a powerful supplement to conventional MRI. Third parts of the conventional magnetic resonance and magnetic resonance spectroscopy are in the hypoxic and ischemic neonates. The purpose of the study in encephalopathy: perinatal hypoxic ischemic encephalopathy (HIE) can be evaluated by different diagnostic techniques. The purpose of this study was to combine conventional magnetic resonance and proton spectroscopy in the diagnosis of HIE and evaluate their application value. Materials and methods: a prospective study of 84 full months from February 2012 to 2 2013. New HIE children (mild to moderate group Stage I - II and severe group Stage III) and 10 normal newborns were used as control group. Two radiologists used double blind method to score the MRI signs, compared and analyzed the difference between the two groups of conventional magnetic resonance imaging (MRI) signal and 1H-MRS brain metabolite (Cho) / creatine (Cr), N- acetyl aspartate (NAA). /Cr, lactate (Lac) /Cr results. Results: (1) analysis of signs: Stage I -II group (n = 53) and Stage III (n = 31) were similar to the signal of brain edema on T1 weighted imaging (T1WI) on the point like high signal lesion (punctate white) and weighted imaging, and the basal ganglia, thalamus, corpus callosum or brain stem and signal differentiation It often occurred in group Stage III and compared with Stage I - II Group (P=0.001). The average value of intramedullary white matter lesions (PWML) in group Stage I - II was 5.38 + 4.68 (number 1~43), and the average value of PWML in group Stage III was 16.82 + 17.66 (4-59). The number of two groups was significantly different (P=0.035), and PWML was located near the medullary vein of the brain. The average value of MRI score in group Stage I - II group was 6.20 + 1.75, and the average value of MRI score in group Stage III was 9.78 + 3.64. The scores of two groups of MRI were significantly different (P=0.009). (4) basal ganglia and thalamic region spectrum analysis NAA/Cr, Cho/Cr and Lac/Cr ratio in HIE group, Stage I group and group III and control group There were statistical significance (P0.05), while NAA/Cr, Cho/Cr. ratio Stage I - II group and Stage III group had no statistical significance (P0.05), Lac/Cr ratio Stage III group was significantly higher than Stage I - II group, and Lac/Cr ratio two groups had significant difference (P0.05). Conclusion: the combination of conventional MRI and conventional MRI can objectively reflect the brain shape of children. Changes in state and metabolites are more accurate in judging the severity of brain injury in children with HIE.

【學(xué)位授予單位】：南京醫(yī)科大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2016
【分類號】：R445.2;R742

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