本文關(guān)鍵詞： 磁共振成像 擴(kuò)散張量成像 神經(jīng)電生理學(xué) 腰骶神經(jīng)病 骶叢神經(jīng) 坐骨神經(jīng)　出處：《河北醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:運(yùn)用磁共振擴(kuò)散張量成像(diffusion tensor imaging,DTI)技術(shù)評(píng)估腰骶神經(jīng)病變,探究該成像技術(shù)診斷腰骶神經(jīng)病變的可行性,并探究腰骶神經(jīng)病DTI與其神經(jīng)電生理學(xué)之間的相關(guān)性。方法:選取2016年1月-2016年9月經(jīng)河北醫(yī)科大學(xué)第三醫(yī)院神經(jīng)科確診的腰骶神經(jīng)病患者18例作為實(shí)驗(yàn)組(男11例,女7例,年齡21-84歲,平均年齡56.49歲)。選取20例健康者志愿者作為對(duì)照組(男9例,女11例,年齡21-32歲,平均年齡25.59歲)。實(shí)驗(yàn)組按神經(jīng)電生理學(xué)檢查結(jié)果分為實(shí)驗(yàn)亞組A(脫髓鞘組,6例,其中腰骶神經(jīng)炎2例,特發(fā)性腰骶神經(jīng)病4例)和實(shí)驗(yàn)亞組B(軸索損傷伴脫髓鞘組,12例,其中格林巴利綜合征2例,特發(fā)性多發(fā)周圍神經(jīng)病7例,特發(fā)性腰骶神經(jīng)炎2例,梅毒性神經(jīng)炎1例)。實(shí)驗(yàn)組與對(duì)照組均分別進(jìn)行骶叢神經(jīng)和坐骨神經(jīng)3D STIR SPACE序列及DTI序列掃描。將兩個(gè)序列所得圖像傳至Neuro3D工作站,使兩組圖像融合,以3D STIR SPACE圖像作為解剖參考圖,采用纖維示蹤成像方法對(duì)雙側(cè)L4、L5、S1、S2和坐骨神經(jīng)(sciatic nerve,SN)(以下統(tǒng)稱“L4-SN”神經(jīng))DTI進(jìn)行量化分析,分別選取雙側(cè)L4-S2神經(jīng)近、中及遠(yuǎn)三處作為相應(yīng)神經(jīng)感興趣區(qū)(region of interesting,ROI),選取雙側(cè)SN股骨頭中心水平、股骨小轉(zhuǎn)子水平及其兩處中點(diǎn)水平作為SN ROI。在每條神經(jīng)三處預(yù)定的ROI處進(jìn)行“播點(diǎn)”,在纖維示蹤成像的同時(shí),依次測(cè)量出每條目標(biāo)神經(jīng)所“播點(diǎn)”的每個(gè)ROI范圍內(nèi)的DTI參數(shù)(FA、ADC、λ∥和λ⊥),進(jìn)而分別對(duì)每條神經(jīng)所檢測(cè)得的3處ROI DTI參數(shù)值取平均值,以此平均值作為相應(yīng)神經(jīng)的最終DTI參數(shù)。采用獨(dú)立樣本t檢驗(yàn)分別對(duì)對(duì)照組和實(shí)驗(yàn)組雙側(cè)L4-SN同節(jié)段神經(jīng)進(jìn)行DTI參數(shù)對(duì)比分析。采用獨(dú)立樣本t檢驗(yàn)對(duì)實(shí)驗(yàn)組與對(duì)照組L4-SN同節(jié)段神經(jīng)DTI參數(shù)對(duì)比分析。對(duì)照組和實(shí)驗(yàn)組FA值及λ⊥值進(jìn)行受試者工作特征曲線(receiver operating characteristic,ROC)分析,確立每條目標(biāo)神經(jīng)截?cái)嘀导捌湓\斷靈敏度和特異度。實(shí)驗(yàn)亞組A和實(shí)驗(yàn)亞組B FA值與脛神經(jīng)和腓總神經(jīng)復(fù)合肌肉動(dòng)作電位(compound muscle action potential,CMAP)和運(yùn)動(dòng)神經(jīng)傳導(dǎo)速度(motor nerve conduction velocity,m NCV)行非參數(shù)秩相關(guān)分析。對(duì)照組、實(shí)驗(yàn)亞組A及實(shí)驗(yàn)亞組B DTI參數(shù)行非參數(shù)獨(dú)立樣本Kruskal-Wallis H檢驗(yàn),三組兩兩比較采用Nemenyi檢驗(yàn)。結(jié)果:1對(duì)照組雙側(cè)L4-SN同節(jié)段神經(jīng)FA值、ADC值、λ∥值及λ⊥值獨(dú)立樣本t檢驗(yàn)不存在顯著統(tǒng)計(jì)學(xué)差異(P0.05)(表1)。2實(shí)驗(yàn)組雙側(cè)L4-SN同節(jié)段神經(jīng)之間FA值、ADC值、λ∥值及λ⊥值獨(dú)立樣本t檢驗(yàn)不存在顯著統(tǒng)計(jì)學(xué)差異(P0.05)(表2)。3實(shí)驗(yàn)組與對(duì)照組L4-SN同節(jié)段神經(jīng)FA值、ADC值、λ∥值和λ⊥值獨(dú)立樣本t檢驗(yàn)(表3)顯示,實(shí)驗(yàn)組L4-SN同節(jié)段神經(jīng)FA值顯著低于對(duì)照組L4-SN FA值(P0.05);實(shí)驗(yàn)組L4、S1-SN同節(jié)段神經(jīng)ADC值顯著高于對(duì)照組L4、S1-SN ADC之值;實(shí)驗(yàn)組與對(duì)照組L4-SN同節(jié)段神經(jīng)λ∥值之間對(duì)比分析不存在顯著統(tǒng)計(jì)學(xué)差異(P0.05);實(shí)驗(yàn)組L4-SN同節(jié)段神經(jīng)λ⊥值顯著高于實(shí)驗(yàn)組L4-SNλ⊥值(P0.05)。4實(shí)驗(yàn)組與對(duì)照組FA值和λ⊥值ROC分析(表4)顯示,L4-SN FA值曲線下面積(area under the curve,AUC)分別為0.834,0.745,0.860,0.772和0.811,截?cái)嘀捣謩e為0.427,0.421,0.418,0.414和0.438,靈敏度分別為66.7%,72.2%,77.8%,83.3%和66.7%,特異度分別為91.7%,69.4%,80.6%,61.1%和88.9%;L4-SNλ⊥值A(chǔ)UC分別為0.796,0.656,0.791,0.701和0.843,截?cái)嘀捣謩e為1208.31,1248.43,1304.96,1098.82和1072.15,靈敏度分別為55.6%,50.0%,66.7%,97.2%和88.9%,特異度分別為91.7%,77.8%,86.1%,36.1%和66.7%。由此可見FA值和λ⊥值具有中等程度鑒別實(shí)驗(yàn)組和對(duì)照組能力。5實(shí)驗(yàn)亞組A和實(shí)驗(yàn)亞組B L4-SN神經(jīng)FA值與脛神經(jīng)和腓總神經(jīng)CMAP和m NCV秩相關(guān)分析(表5)顯示,實(shí)驗(yàn)亞組A L4-S2 FA值與雙下肢脛神經(jīng)和腓總神經(jīng)CMAP及m NCV均無顯著相關(guān)性(|rs|0.6,P0.01)。SN FA值與脛神經(jīng)CMAP(rs=0.301,P=0.341)和m NCV(rs=0.078,P=0.81)均無顯著相關(guān)性。SN FA值與腓總神經(jīng)CMAP(rs=-0.16,P=0.618)無顯著相關(guān)性,與腓總神經(jīng)m NCV之間存在顯著相關(guān)性(rs=0.846,P0.01)。實(shí)驗(yàn)亞組B L4-SN FA值與雙下肢脛神經(jīng)和腓總神經(jīng)的CMAP及m NCV均無顯著相關(guān)性(|rs|0.4,P0.01)。6對(duì)照組、實(shí)驗(yàn)亞組A及實(shí)驗(yàn)亞組B Kruskal-Wallis H檢驗(yàn)(表6)示,L4-SN三組之間FA值存在總體分布差異(P0.05);L4、S1-SN三組之間ADC值存在總體分布差異(P0.05),L5 ADC值不存在總體分布差異(P0.05);λ⊥值三組之間存在總體分布差異。Nemenyi檢驗(yàn)(表6)兩兩比較示,對(duì)照組與實(shí)驗(yàn)亞組B FA值、ADC值和λ⊥值存在總體分布差異(P0.05),L5實(shí)驗(yàn)亞組A與實(shí)驗(yàn)亞組B及S1對(duì)照組與實(shí)驗(yàn)亞組A FA值存在總體分布差異(P0.05),余對(duì)照組與實(shí)驗(yàn)亞組A、實(shí)驗(yàn)亞組A與實(shí)驗(yàn)亞組B同節(jié)段神經(jīng)FA值、ADC值和λ⊥值均不存在總體分布差異(P0.05)。結(jié)論:DTI具有評(píng)估腰骶神經(jīng)病變的能力,能夠?qū)】嫡吲c軸索損傷伴脫髓鞘患者進(jìn)行鑒別,因此有望實(shí)現(xiàn)臨床無創(chuàng)定量定性診斷腰骶神經(jīng)病的可能。但本研究未發(fā)現(xiàn)腰骶神經(jīng)DTI與神經(jīng)電生理學(xué)存在顯著線性相關(guān)性。
[Abstract]:Objective : To evaluate the feasibility of using diffusion tensor imaging ( DTI ) technique to evaluate the feasibility of diagnosis of lumbar sacral neuropathy and to investigate the correlation between the DTI and neurophysiology in the lumbar sacral neuropathy . Methods : 18 cases were selected as experimental group ( 11 males and 7 females , aged 21 - 84 years , mean age 56.49 years ) . 20 healthy volunteers were selected as control group ( male 9 , female 11 , age 21 - 32 years , average age 25.59 years ) . The experimental group was divided into experimental subgroups A ( demyelination group , 6 cases , including 2 cases of neurileitis , 4 cases of idiopathic lumbar sacral neuropathy ) and experimental subgroup B ( axial cord injury with demyelination group , 12 cases , including 2 cases of Guillain ' s syndrome , 7 cases with idiopathic multiple peripheral neuropathy , 2 cases of idiopathic lumbar sacral nerve and 1 case of syphilis ) . In the experimental group and the control group , the 3D STIR SPACE sequence and DTI sequence of the sacral plexus nerve and sciatic nerve were carried out respectively . The two images were transferred to the Neuro3D workstation , and the two groups of images were fused , and the two groups of L4 , L5 , S1 , S2 and sciatic nerves ( SN ) ( hereinafter referred to as " L4 - SN " nerve ) DTI were quantified and analyzed . There was no significant statistical difference between the experimental group and the control group ( P0.05 ) . There was no significant correlation between the values of the two groups ( P = 0.301 , P = 0.618 ) and the difference of the total distribution between the three groups ( P0.05 ) .

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R445.2;R681.5

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本文編號(hào)：1478088