3.0T MRI、擴散加權(quán)成像和擴散張量成像在早產(chǎn)兒腦病的應用研究
發(fā)布時間：2019-05-23 08:58
【摘要】：第一部分MRI及擴散加權(quán)成像在早產(chǎn)兒腦病的應用研究 研究背景：近年來，隨著圍產(chǎn)醫(yī)學和NICU呼吸支持技術(shù)的發(fā)展以及早產(chǎn)兒管理水平的提高，早產(chǎn)兒的存活率尤其是極低體重兒和超低體重兒的存活率逐年升高，這一群體的神經(jīng)系統(tǒng)發(fā)育結(jié)局也備受關(guān)注。早產(chǎn)兒腦發(fā)育不成熟，具有易損傷的特點。圍產(chǎn)期缺氧缺血、感染/炎癥等高危因素導致炎癥因子大量激活、興奮氨基酸堆積和氧自由基釋放，容易發(fā)生早產(chǎn)兒腦病(encephalopathy of prematurity，EP)。這不僅引起神經(jīng)系統(tǒng)發(fā)育障礙，并嚴重影響存活早產(chǎn)兒的生命質(zhì)量，，還會造成患兒以后的腦發(fā)育障礙，給家庭和社會帶來沉重負擔。 目的：探討早產(chǎn)兒腦病的磁共振表現(xiàn)和DWI表現(xiàn)及其分類，并比較不同胎齡早產(chǎn)兒腦損傷的影像學表現(xiàn)差異。 材料和方法：產(chǎn)前有胎膜早破、宮內(nèi)窘迫、胎盤及臍帶異常、羊水異常、多胎、母孕期患病等危險因素；產(chǎn)時或產(chǎn)后有窒息史、復蘇搶救史、反復呼吸暫停、低氧血癥、高碳酸血癥、慢性肺疾病、感染等危險因素早期臨床表現(xiàn)出現(xiàn)臨床表現(xiàn)喂養(yǎng)困難、呼吸暫停、驚跳、抽動、精神反應差等，出生后1分鐘、5分鐘Apgar評分7分以下；排除其他腦病,如低血糖腦病、遺傳代謝性腦病、膽紅素腦病、先天性腦發(fā)育異常等。符合以上條件一項或一項以上者，收入病例組，行MRI及DWI檢查。本項研究收錄90例符合條件的孕周25～36+6周的早產(chǎn)兒進行MRI及DWI檢查，其中男52例，女38例，平均孕周30.6周；檢查時平均日齡22.3天。掃描序列主要有FSE的T1、T2和T2FLAIR及SE/EPI序列DWI。分析EP的早期MRI及DWI表現(xiàn)，并與復查結(jié)果進行對照研究。 結(jié)果：常規(guī)MRI及DWI可以早期顯示并區(qū)分早產(chǎn)兒腦病的不同類型的缺血性損傷和出血性損傷；孕周32周以上和孕周32周以下的早產(chǎn)兒腦損傷類型不同，孕周32周以下的早產(chǎn)兒彌漫性白質(zhì)損傷占所有損傷類型的比例較孕周32周以上的大，合并出血性損傷的比例也較大，且彌漫性損傷后期形成PVL的比例也大于孕周32周以上的早產(chǎn)兒。復查的41例早產(chǎn)兒腦病患兒出現(xiàn)腦室周圍白質(zhì)軟化（periventricular leukomalacia, PVL）形成，部分伴膠質(zhì)增生、髓鞘化延遲、胼胝體薄、腦外間隙增寬、腦室擴大、腦容量減小等影像表現(xiàn)。結(jié)論：MRI及DWI可以客觀反映早產(chǎn)兒腦病腦損傷的嚴重程度，且可對不同孕周的早產(chǎn)兒腦損傷類型進行分組比較其差異，并可早期評估EP預后。 第二部分擴散張量成像在早產(chǎn)兒腦病的應用研究 目的：比較糾正足月的EP患兒與正常足月兒的ADC值、FA值，以評估早產(chǎn)兒腦病后期腦損傷及神經(jīng)纖維發(fā)育程度。 材料與方法：以12例無窒息史的正常足月兒為對照（平均胎齡39.8周，平均日齡10.8天），對20例糾正胎齡≥37周的EP患兒（平均糾正胎齡39.7周，平均日齡32.5天）行MRI及DTI檢查，在雙側(cè)基底節(jié)、丘腦、內(nèi)囊后肢、額葉、頂枕葉白質(zhì)等敏感易損區(qū)取感興趣區(qū)（ROI），并比較兩組間ADC、FA值差異。 結(jié)果：豆狀核外側(cè)、丘腦腹外側(cè)、內(nèi)囊后肢、額葉白質(zhì)、頂葉白質(zhì)、枕葉白質(zhì)的ADC值兩組間對比差異均具有統(tǒng)計學意義（P＜0.05）。雙側(cè)豆狀核外側(cè)FA值對比兩組間差異不顯著（P＞0.05），其余部位丘腦腹外側(cè)、內(nèi)囊后肢、額葉白質(zhì)、頂葉白質(zhì)、枕葉白質(zhì)的FA值兩組間對比差異均具有統(tǒng)計學意義（P＜0.05）。 結(jié)論：DTI序列可以無創(chuàng)性監(jiān)測早產(chǎn)兒腦病后腦發(fā)育情況，并評估臨床預后。
[Abstract]:The application of the first part of MRI and diffusion-weighted imaging in the prematurity of encephalopathy Background of the study: In recent years, with the development of the respiratory support technology of the perinatal medicine and the NICU and the raising of the management level of the premature infants The survival rate of the high and premature infants, especially the very low birth weight and the low birth weight, is increasing year by year, and the development outcome of the nervous system of this group is also well-known. Note: The premature infant brain is immature and has a very easy to be damaged. The high-risk factors, such as perinatal hypoxic-ischemia, infection/ inflammation, lead to a large number of activation of inflammatory factors, the accumulation of excitatory amino acids and the release of oxygen free radicals, which are prone to prematurity of encephalopathy (EP). ). This not only causes the development barrier of the nervous system, but also seriously affects the quality of life of the surviving premature infants, and also causes the development of the brain in the later period of the child, which brings heavy negative to the family and the society The purpose of this study was to investigate the MRI findings and the classification of DWI in prematurity, and to compare the imaging table of the brain injury of premature infants with different gestational age. Current differences. Materials and methods: pre-natal, premature rupture of the membrane, intrauterine distress, placental and umbilical cord abnormalities, abnormal amniotic fluid, multiple births, and illness in the mother's pregnancy, etc.; the history of asphyxia, the history of resuscitation, repeated apnea, hypoxemia, hypercapnia, The early clinical manifestation of the risk factors such as chronic lung disease, infection and the like has the clinical manifestation, the feeding difficulty, the apnea, the shock, the movement, the mental reaction difference and the like, the Apgar score of 5 minutes after the birth is below 7 points, and the other encephalopathy, such as the hypoglycaemic encephalopathy, the genetic metabolic encephalopathy, Bilirubin encephalopathy, congenital brain Abnormal development, etc. In accordance with one or more of the above conditions, the income case group, the line MRI, and the DWI was examined by DWI. In this study,90 cases of prematurity with 25-36 + 6 weeks of gestational age were examined by MRI and DWI. Among them,52 were male,38 were female, 30.6 weeks in average, and average age at the time of examination. 22.3 days. The scan sequence has mainly FSE T1, T2 and T2FLAIR and SE/ EPI Sequence DWI. The early MRI and DWI performance of EP were analyzed and compared with the results of the review. Line-control studies. Results: Conventional MRI and DWI can identify and differentiate between different types of ischemic and hemorrhagic injury in prematurity with early-term MRI and DWI. Preterm infants below 32 weeks of gestation and below 32 weeks of gestation The type of brain injury was different. The proportion of diffuse white matter lesions in the premature infants under the age of 32 weeks was greater than that of the gestational period of 32 weeks, the proportion of the combined hemorrhagic injury was also large, and the proportion of the late-stage formation of PVL in the late stage of the diffuse injury was also greater than that of the gestational week 32. The periventricular leukomalacia (PVL) was found in 41 of the 41 premature infants with prematurity. Conclusion: MRI and DWI can objectively reflect the severity of brain injury in prematurity, and can compare the types of brain injury of premature infants with different gestational weeks. The second part of the diffusion tensor imaging The purpose of this study is to compare the value of the ADC and FA of the normal term infants with the value of the normal term and the value of the FA to assess the post-term brain of the prematurity. Injury and nerve fiber development degree. Materials and Methods:12 cases of normal foot-term infants with no asphyxia history were used as control (mean age of 39.8 weeks, average age of 10.8 days), and 20 cases of EP (mean corrected gestational age, 39.7 weeks, mean age of 32.5 days) were performed with MRI and DT. I examined the region of interest (ROI) in sensitive and vulnerable areas, such as the bilateral basal ganglia, the thalamus, the hindlimb of the inner capsule, the frontal lobe, the top occipital white matter, and the like, and Results: The difference between the two groups of ADC and FA values in the outside of the pea-like nucleus, the outside of the ventral thalamus, the hindlimb of the inner capsule, the white matter of the frontal lobe, the white matter of the parietal white matter and the white matter of the occipital lobe There was no significant difference between the two groups (P> 0.05), the difference between the two groups was not significant (P> 0.05), and the difference between the two groups of the FA values of the white matter and the white matter of the occipital lobe, the white matter of the frontal lobe, the white matter of the occipital lobe, the white matter of the occipital lobe and the white matter of the frontal lobe, the white matter of the frontal lobe and the white matter of the occipital lobe were all significant (P <0.05). Conclusion: DTI can be used for non-invasive monitoring of premature delivery.
【學位授予單位】：華中科技大學
【學位級別】：碩士
【學位授予年份】：2012
【分類號】：R445.2;R722.6
本文編號：2483763
[Abstract]:The application of the first part of MRI and diffusion-weighted imaging in the prematurity of encephalopathy Background of the study: In recent years, with the development of the respiratory support technology of the perinatal medicine and the NICU and the raising of the management level of the premature infants The survival rate of the high and premature infants, especially the very low birth weight and the low birth weight, is increasing year by year, and the development outcome of the nervous system of this group is also well-known. Note: The premature infant brain is immature and has a very easy to be damaged. The high-risk factors, such as perinatal hypoxic-ischemia, infection/ inflammation, lead to a large number of activation of inflammatory factors, the accumulation of excitatory amino acids and the release of oxygen free radicals, which are prone to prematurity of encephalopathy (EP). ). This not only causes the development barrier of the nervous system, but also seriously affects the quality of life of the surviving premature infants, and also causes the development of the brain in the later period of the child, which brings heavy negative to the family and the society The purpose of this study was to investigate the MRI findings and the classification of DWI in prematurity, and to compare the imaging table of the brain injury of premature infants with different gestational age. Current differences. Materials and methods: pre-natal, premature rupture of the membrane, intrauterine distress, placental and umbilical cord abnormalities, abnormal amniotic fluid, multiple births, and illness in the mother's pregnancy, etc.; the history of asphyxia, the history of resuscitation, repeated apnea, hypoxemia, hypercapnia, The early clinical manifestation of the risk factors such as chronic lung disease, infection and the like has the clinical manifestation, the feeding difficulty, the apnea, the shock, the movement, the mental reaction difference and the like, the Apgar score of 5 minutes after the birth is below 7 points, and the other encephalopathy, such as the hypoglycaemic encephalopathy, the genetic metabolic encephalopathy, Bilirubin encephalopathy, congenital brain Abnormal development, etc. In accordance with one or more of the above conditions, the income case group, the line MRI, and the DWI was examined by DWI. In this study,90 cases of prematurity with 25-36 + 6 weeks of gestational age were examined by MRI and DWI. Among them,52 were male,38 were female, 30.6 weeks in average, and average age at the time of examination. 22.3 days. The scan sequence has mainly FSE T1, T2 and T2FLAIR and SE/ EPI Sequence DWI. The early MRI and DWI performance of EP were analyzed and compared with the results of the review. Line-control studies. Results: Conventional MRI and DWI can identify and differentiate between different types of ischemic and hemorrhagic injury in prematurity with early-term MRI and DWI. Preterm infants below 32 weeks of gestation and below 32 weeks of gestation The type of brain injury was different. The proportion of diffuse white matter lesions in the premature infants under the age of 32 weeks was greater than that of the gestational period of 32 weeks, the proportion of the combined hemorrhagic injury was also large, and the proportion of the late-stage formation of PVL in the late stage of the diffuse injury was also greater than that of the gestational week 32. The periventricular leukomalacia (PVL) was found in 41 of the 41 premature infants with prematurity. Conclusion: MRI and DWI can objectively reflect the severity of brain injury in prematurity, and can compare the types of brain injury of premature infants with different gestational weeks. The second part of the diffusion tensor imaging The purpose of this study is to compare the value of the ADC and FA of the normal term infants with the value of the normal term and the value of the FA to assess the post-term brain of the prematurity. Injury and nerve fiber development degree. Materials and Methods:12 cases of normal foot-term infants with no asphyxia history were used as control (mean age of 39.8 weeks, average age of 10.8 days), and 20 cases of EP (mean corrected gestational age, 39.7 weeks, mean age of 32.5 days) were performed with MRI and DT. I examined the region of interest (ROI) in sensitive and vulnerable areas, such as the bilateral basal ganglia, the thalamus, the hindlimb of the inner capsule, the frontal lobe, the top occipital white matter, and the like, and Results: The difference between the two groups of ADC and FA values in the outside of the pea-like nucleus, the outside of the ventral thalamus, the hindlimb of the inner capsule, the white matter of the frontal lobe, the white matter of the parietal white matter and the white matter of the occipital lobe There was no significant difference between the two groups (P> 0.05), the difference between the two groups was not significant (P> 0.05), and the difference between the two groups of the FA values of the white matter and the white matter of the occipital lobe, the white matter of the frontal lobe, the white matter of the occipital lobe, the white matter of the occipital lobe and the white matter of the frontal lobe, the white matter of the frontal lobe and the white matter of the occipital lobe were all significant (P <0.05). Conclusion: DTI can be used for non-invasive monitoring of premature delivery.
【學位授予單位】：華中科技大學
【學位級別】：碩士
【學位授予年份】：2012
【分類號】：R445.2;R722.6
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