發(fā)布時(shí)間：2018-06-25 23:15

  本文選題：垂體 + 發(fā)育遲緩　； 參考：《泰山醫(yī)學(xué)院》2012年碩士論文

【摘要】：目的 應(yīng)用高分辨率磁共振（Magnetic Resonance Imaging，MRI）成像，獲取生長(zhǎng)發(fā)育遲緩與健康兒童垂體體積及各徑線的測(cè)量數(shù)據(jù)，并對(duì)測(cè)量數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)分析，為臨床診斷兒童生長(zhǎng)發(fā)育遲緩提供更豐富的診斷依據(jù)與信息。 材料和方法 1.研究對(duì)象選擇： 從山東省省立醫(yī)院內(nèi)分泌科就診的兒童中，自2010年9月至2011年12月間選擇符合生長(zhǎng)發(fā)育遲緩條件的兒童90例，其中男性50例，女性49例，平均年齡8.19±3.53歲，年齡范圍3～15歲，并按3歲～6歲、6歲～10歲、10歲～15歲3個(gè)年齡段分為A1、B1、C1組；同時(shí)在健康查體者中隨機(jī)選擇年齡、性別相匹配的健康兒童99例作為對(duì)照組，其中男性53例，女性46例，平均年齡7.10±3.04歲，年齡范圍3～15歲，同樣按3歲～6歲、6歲～10歲、10歲～15歲3個(gè)年齡段分為A2、B2、C2組。正常及生長(zhǎng)發(fā)育遲緩兒童兩組間性別及年齡均無統(tǒng)計(jì)學(xué)差異。 2.儀器和設(shè)備 采用3.0T GE（SIGNA HD x GEMSGEMS）超導(dǎo)型磁共振掃描儀（美國(guó)GeneralElectric Company），頭部八通道相控陣線圈，掃描序列包括常規(guī)序列和冠狀位3D T1WIFSPGR序列。所有受試對(duì)象均進(jìn)行冠狀T2WI（TR3200ms，TE118.1ms）、T1WI（TR580ms，TE9.4ms）、矢狀位T1W（ITR580ms，TE14.1ms）以及3D T1WI FSPGR掃描，其具體參數(shù)為：TR7.6ms，TE3.3ms，F(xiàn)OV240mm×240mm，層厚1.4mm，矢狀位和冠狀位掃描線分別垂直垂體左右徑線及垂直鞍底。 常規(guī)所有的序列掃描完，利用Reformat后處理軟件對(duì)冠狀3D T1WI FSPGR原始圖像進(jìn)行矢狀位和冠狀位重建，矢狀位和冠狀位掃描線分別垂直垂直鞍底及垂體左右徑線。重建參數(shù)如下：FOV240mm，層厚1.4mm，層間距0.5mm，使定位準(zhǔn)確，圖像統(tǒng)一、一致，然后在冠狀位及矢狀位分別對(duì)垂體進(jìn)行測(cè)量；利用3D T1WI FSPGR原始圖像通過MIP技術(shù)從矢狀、冠狀及軸位三方位辨認(rèn)垂體結(jié)構(gòu)邊界，并勾繪出垂體結(jié)構(gòu)的輪廓圖像，然后保留勾繪出的垂體，利用自動(dòng)體積測(cè)量軟件進(jìn)行垂體的體積測(cè)量。 統(tǒng)計(jì)分析 采用SPSS17.0進(jìn)行統(tǒng)計(jì)學(xué)分析，所有數(shù)據(jù)資料均使用s顯示。同性別年齡不同垂體測(cè)量值的比較用單因素方差分析，相同組別不同性別垂體測(cè)量值及生長(zhǎng)發(fā)育遲緩與健康對(duì)照組之間的比較采用獨(dú)立樣本t檢驗(yàn)分析，垂體分型數(shù)據(jù)采用χ~2分析。選取P0.05為有差異，P0.01為有顯著性差異。 結(jié)果 1.正常兒童垂體體積及徑線測(cè)量：三個(gè)不同年齡段（A2、B2、C2）男性垂體體積分別為A2：（224.55±71.21）mm~3、B2：（320.20±64.80）mm~3、C2：（358.32±81.57）mm~3，女性垂體體積分別為A2：（271.69±87.51）mm~3、B2：（365.90±83.52）mm~3、C2：（496.69±128.93）mm~3；垂體正中矢狀位高徑：男性分別為A2：（4.24±0.563）mm、B2：（4.91±0.82）mm、C2：（5.87±1.29）mm，女性分別為A2：（4.51±0.83）mm、B2：(5.04±1.00) mm、C2：(6.26±1.41) mm，垂體前后徑男性各組分別為A2：（7.09±1.44）mm、B2：（7.67±1.56）mm、C2：(7.67±1.17) mm，女性分別為A2：(7.38±1.23) mm、B2：(8.02±1.01) mm、C2：(9.30±1.42) mm，垂體冠狀位正中高徑三個(gè)不同年齡段男性各組分別為A2：（3.17±0.48）、B2：（3.79±.57）mm、C2：(4.45±1.00)mm，垂體冠狀位正中高徑女性分別為A2：（3.94±0.82）mm、B2：（4.80±0.71）mm、C2：（5.76±0.90）mm，垂體冠狀位寬徑男性各組別為A2：（10.11±1.18）mm、B2：(11.35±1.58) mm、C2：(11.20±3.19) mm，女性各組分別為A2：(11.12±1.28) mm、B2：(12.06±1.26) mm、C2：(13.91±1.01) mm。 2.生長(zhǎng)發(fā)育遲緩兒童垂體體積及徑線測(cè)量：三個(gè)不同年齡段（A1、B1、C1）男性垂體體積分別為A1：（226.67±30.49）mm~3、B1：（304.04±67.56）mm~3、C1：（308.31±104.64）mm~3，女性垂體體積分別分別為A1：（210.10±58.54）mm~3、B1：（307.30±82.01）mm~3、C1：（359.00±135.27）mm~3，，垂體正中矢狀位高徑男性各組分別為A1：（4.00±1.00）mm、B1：（4.53±1.28）mm、C1：（4.31±1.08）mm，女性分別為A1：（4.36±0.63）mm、B1：(4.56±0.97) mm、C1：(4.92±1.41) mm，垂體前后徑男性各組分別為A1：（7.55±1.30）mm、B1：（8.72±1.04）mm、C1：(9.37±1.46) mm，女性分別為A1：(6.92±0.91) mm、B1：(7.81±1.08) mm、C1：(8.14±1.31) mm，垂體正中冠狀位高徑男性各組分別為A1：（3.91±0.74）、B1：（4.59±0.70）mm、C1：(5.73±0.81)mm，女性分別為A1：（3.51±0.54）mm、B1：（4.23±0.57）mm、C1：（4.48±1.00）mm，垂體冠狀位寬徑男性各組別為A1：（11.06±1.05）mm、B1：(11.91±1.92) mm、C1：(13.25±1.72) mm，女性各組分別為A1：(11.13±1.61) mm、B1：(11.48±1.60) mm、C1：(12.32±2.59) mm。隨著年齡的增長(zhǎng)垂體生長(zhǎng)緩慢，以C1組最為顯著。 3.垂體分型:正常兒童A2、B2、C2組垂體分型：凹陷型30例，平坦型40例，隆凸型29例。相同性別不同年齡組間分型差異有統(tǒng)計(jì)學(xué)意義(χ~2值分別為19.92、5.66，P值均0.05)。生長(zhǎng)發(fā)育遲緩兒童A1、B1、C1組垂體分型：凹陷型35例，平坦型41例，隆凸型14例。相同性別不同年齡組間分型差異無統(tǒng)計(jì)學(xué)意義(χ~2值分別為（10.07、1.41，P值均0.05)。正常兒童垂體隨年齡增加，隆起型逐漸增加，凹陷型逐漸減少，在兒童期生長(zhǎng)發(fā)育遲緩和正常對(duì)照組三個(gè)年齡階段垂體分型均以平坦型最為多見。 結(jié)論 本研究通過3D磁化強(qiáng)度預(yù)備梯度回波序列T1WI（3D T1WI FSPGR），應(yīng)用3DMIP體積分析后處理軟件勾繪垂體及應(yīng)用Reformat后處理軟件重建，測(cè)量垂體體積及各徑線并進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果表明，生長(zhǎng)發(fā)育遲緩兒童垂體體積均較正常兒童垂體體積小，以第三年齡階段為著，差異有統(tǒng)計(jì)學(xué)意義；正常及生長(zhǎng)發(fā)育遲緩兒童垂體體積在不同年齡組（A2、B2、C2和A1、B1、C1）間差異有統(tǒng)計(jì)學(xué)意義(F值分別為18.63、19.23，和5.42、6.39P 0．05)；此研究為各種垂體疾病及生長(zhǎng)發(fā)育遲緩兒童的臨床診斷和科學(xué)研究提供客觀依據(jù)。
[Abstract]:objective
Magnetic Resonance Imaging (MRI) imaging was used to obtain the measurement data of growth retardation and healthy children's pituitary volume and each diameter line, and the measured data were statistically analyzed to provide more diagnostic basis and information for the clinical diagnosis of children's growth retardation.
Materials and methods
1. the selection of research objects:
Among the children from the Department of endocrinology in the provincial hospital of Shandong Province, 90 children were selected from September 2010 to December 2011, including 50 males and 49 females, with an average age of 8.19 + 3.53 years and 3~15 years old, and divided into A1, B1, and C1 groups at the age of 3 to 6, 6 to 10 years and 15 years. Among the healthy subjects, 99 healthy children were randomly selected as the control group, including 53 males and 46 females, the average age was 7.10 + 3.04 years, the age range was 3~15 years old, the same according to 3 years to 6 years, 6 to 10 years, 10 years to 15 years, group C2. Normal and growth retarded children between groups of sex and sex between groups. There was no statistical difference in age.
2. instruments and equipment
Using the 3.0T GE (SIGNA HD x GEMSGEMS) superconducting magnetic resonance scanner (American GeneralElectric Company), the eight channel phased array coils in the head, the scanning sequence includes the conventional sequence and the coronal 3D T1WIFSPGR sequence. And 3D T1WI FSPGR scan, the specific parameters are: TR7.6ms, TE3.3ms, FOV240mm x 240mm, layer thickness 1.4mm, sagittal and coronal scan lines perpendicular to the vertical pituitary diameter and vertical saddle bottom respectively.
After routine scanning, the sagittal and coronal reconstruction of the original image of coronary 3D T1WI FSPGR was reconstructed with Reformat post-processing software. The sagittal and coronal scan lines were vertically perpendicular to the saddle bottom and the left and right hypophysis lines. The reconstruction parameters were as follows: FOV240mm, the thickness 1.4mm, the interval spacing 0.5mm, making the positioning accurate, the image unifying, and the same. Then the hypophysis was measured in the coronal and sagittal positions, and the pituitary structure boundary was identified from the sagittal, coronal and axial three directions by using the 3D T1WI FSPGR original image, and the outline image of the pituitary structure was plotted. Then the pituitary gland was retained and the volume measurement of the pituitary gland was measured by the auto volume measurement software.
statistical analysis
SPSS17.0 was used for statistical analysis. All data were displayed by s. Single factor variance analysis was used to compare the measured values of hypophysis in the same sex age. The comparison of pituitary measurement values and growth retardation with healthy control groups was analyzed by independent sample t test, and the pituitary classification data were analyzed by X ~2 score. P0.05 was selected as the difference. P0.01 showed significant difference.
Result
1. the measurement of pituitary volume and diameter in normal children: three different age groups (A2, B2, C2) were A2: (224.55 + 71.21) mm~3, B2: (320.20 + 64.80) mm~3, C2: (358.32 + 81.57) mm~3, A2: (271.69 + 87.51) mm~3, B2: 365.90 + 83.52); pituitary median sagittal Height diameter: the male was A2: (4.24 + 0.563) mm, B2: (4.91 + 0.82) mm, C2: (5.87 + 1.29) mm, A2: (4.51 + 0.83) mm, B2: (5.04 + 1) mm, C2: (6.26 + 1.41) mm. M, B2: (8.02 + 1.01) mm, C2: (9.30 + 1.42) mm, A2: (3.17 + 0.48), B2: (3.79 +.57) mm, C2: (4.45 + 1) mm, B2: (3.79 +.57) mm, and C2: (4.45 + 1) mm in the pituitary coronal median height, respectively. The groups were A2: (10.11 + 1.18) mm, B2: (11.35 + 1.58) mm, C2: (11.20 + 3.19) mm, A2: (11.12 + 1.28) mm, B2: (12.06 + 1.26) mm, C2: (13.91 + 1.01) mm.) in female groups.
2. the measurements of pituitary volume and diameter in children with growth retardation: three different age groups (A1, B1, C1) were A1: (226.67 + 30.49) mm~3, B1: (304.04 + 67.56) mm~3, C1: (308.31 + 104.64) mm~3, and A1: (210.10 + 58.54) mm~3, respectively, B1: (307.30 + 82.01), respectively. The median sagittal height of the pituitary was A1: (4 + 1) mm, B1: (4.53 + 1.28) mm, C1: (4.31 + 1.08) mm, A1: (4.36 + 0.63) mm, B1: (4.56 + 0.97) mm, C1: (4.92 + 1.41) mm. (6.92 + 0.91) mm, B1: (7.81 + 1.08) mm, C1: (8.14 + 1.31) mm, A1: (3.91 + 0.74), B1: (4.59 + 0.70) mm, C1: (5.73 + 0.81) mm, and A1: (3.51 + 0.81) mm respectively. Mm, B1: (11.91 + 1.92) mm, C1: (13.25 + 1.72) mm, the female groups were A1: (11.13 + 1.61) mm, B1: (11.48 + 1.60) mm, C1: (12.32 + 2.59) mm., with the increase of age, the growth of the pituitary was slow, which was the most significant in the C1 group.
3. pituitary classification: normal children's A2, B2, C2 group hypophysis: 30 cases of depression, 40 flat type, 29 cases of protuberance. The difference between the same sex and different age groups is statistically significant (19.92,5.66, P, 0.05). The A1, B1, and C1 group of children with growth retardation: 35 cases, 41 flat type, and 14 cases of protruding. There was no statistical difference between the different age groups of the same sex (~2 value (10.07,1.41, P value, respectively 0.05). The pituitary gland of normal children increased with age, the protruding type increased gradually, and the depression type decreased gradually. In children, the three stages of growth retardation and normal control group were most common in flat type.
conclusion
In this study, the gradient echo sequence T1WI (3D T1WI FSPGR) was prepared by the 3D magnetization. After 3DMIP volume analysis, the pituitary volume and the Reformat post-processing software were rebuilt, and the pituitary volume and the diameter lines were measured and analyzed statistically. The results showed that the pituitary volume of children with slow growth and development was smaller than that of normal children. The difference between normal and growth retarded children was statistically significant in different age groups (A2, B2, C2 and A1, B1, C1) in normal and growth retarded children (F value was 18.63,19.23, and 5.42,6.39P 0.05) in normal and growth retarded children (F value was 18.63,19.23, and 5.42,6.39P 0.05). The study was the clinical diagnosis and science of various pituitary diseases and growth retarded children. The research provides an objective basis.
【學(xué)位授予單位】：泰山醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R723;R445.2

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