本文關(guān)鍵詞： 腦癱 磁共振成像 基于體素的形態(tài)測(cè)量學(xué) 基于纖維束示蹤的空間統(tǒng)計(jì)分析 靜息態(tài)腦功能成像　出處：《中國(guó)人民解放軍醫(yī)學(xué)院》2014年博士論文　論文類型：學(xué)位論文

【摘要】：目的：通過(guò)基于體素的形態(tài)測(cè)量學(xué)（voxel-based morphometry, VBM）、纖維束示蹤的空間統(tǒng)計(jì)分析（tract-based spatial statistics，TBSS）和靜息態(tài)腦功能成像（restingstate functional magnetic resonance imaging, resting state fMRI）分析隱匿性痙攣雙癱(spastic diplegic cerebral palsy, SDCP)的全腦結(jié)構(gòu)和功能的改變，探討隱匿性SDCP的腦損傷模式。 方法：我們選用16例隱匿性SDCP患者和16例年齡、性別與之相匹配的正常對(duì)照組，磁共振常規(guī)掃描均未見異常。所有患者均行粗大運(yùn)動(dòng)功能評(píng)分（Gross MotorFunction Classification System, GMFCS）。所有受試者進(jìn)行磁共振掃描,獲取三維磁化準(zhǔn)備快速梯度回波（3D magnetization prepared rapid gradient echo,3D MP-RAGE）T1加權(quán)像（T1weighted imanging, T1WI）、彌散張量成像（diffusion tensor imaging,DTI）數(shù)據(jù)，其中12例隱匿性SDCP患者和14例正常對(duì)照組行靜息態(tài)腦功能成像掃描，掃描范圍包括全部大腦。采用VBM技術(shù)比較隱匿性SDCP與健康志愿者腦灰白質(zhì)體積差異，采用兩獨(dú)立樣本t檢驗(yàn)進(jìn)行統(tǒng)計(jì)學(xué)分析。采用TBSS技術(shù)比較隱匿性SDCP與健康志愿者腦各向異性分?jǐn)?shù)(fractional anisotropy, FA)值變化，尋找有顯著性差異的腦白質(zhì)纖維。并對(duì)隱匿性SDCP患者的灰白質(zhì)差異點(diǎn)與GMFCS進(jìn)行相關(guān)性分析。評(píng)估隱匿性SDCP患者靜息狀態(tài)下腦局部一致性（regionalhomogeneity, ReHo）、低頻振幅（amplitude of low frequency fluctuation，ALFF）以及關(guān)鍵腦區(qū)包括中央前回和丘腦的功能連接（functional connectivity, FC）改變。 結(jié)果：與正常對(duì)照組相比，隱匿性SDCP雙側(cè)基底節(jié)區(qū)、丘腦、島葉和左側(cè)中腦灰質(zhì)體積減少，胼胝體后部和右側(cè)放射冠白質(zhì)體積減少，全腦灰白質(zhì)未見體積增加。隱匿性SDCP腦灰質(zhì)與白質(zhì)的體積減少與患者的GMFCS均無(wú)顯著相關(guān)性。隱匿性SDCP的多個(gè)纖維束FA值顯著低于正常對(duì)照組，主要包括雙側(cè)皮質(zhì)脊髓束、中央前后回及旁中央小葉、前額葉、顳葉、內(nèi)囊和外囊、胼胝體、扣帶回、丘腦、腦干和小腦等部位的纖維束。其中雙側(cè)前額葉、丘腦、內(nèi)囊、胼胝體和腦干的纖維束與GMFCS呈顯著負(fù)相關(guān)。 相對(duì)于正常對(duì)照組，隱匿性SDCP患者腦ReHo值減低區(qū)域主要包括雙側(cè)額頂顳葉、小腦、右側(cè)扣帶回和右側(cè)豆?fàn)詈耍黾訁^(qū)域包括左側(cè)楔前葉、距狀回、梭狀回和右側(cè)楔前葉。 隱匿性SDCP組全腦ALFF未見明顯增高或減低區(qū)域。 功能連接分析顯示與雙側(cè)中央前回功能連接減低區(qū)域主要位于左側(cè)的顳葉和雙側(cè)的顳枕葉，包括雙側(cè)梭狀回和舌回；功能連接增強(qiáng)區(qū)域主要位于對(duì)側(cè)中央前后回和運(yùn)動(dòng)輔助區(qū)以及同側(cè)的中央后回。雙側(cè)丘腦功能連接減低的區(qū)域主要包括雙側(cè)基底節(jié)區(qū)、扣帶回和前額葉；連接增強(qiáng)的區(qū)域主要包括雙側(cè)的中央前回、對(duì)側(cè)小腦。 結(jié)論：隱匿性SDCP的腦結(jié)構(gòu)和功能改變存在特定的空間分布模式，，其特定的分布可能與該病的病理基礎(chǔ)有關(guān)。這些異常有助于理解隱匿性SDCP的發(fā)病機(jī)制，從而提供早期診斷的潛在影像學(xué)指標(biāo)。
[Abstract]:Objective: through voxel based morphometry (voxel-based morphometry, VBM), spatial statistical analysis tractography (tract-based spatial statistics, TBSS) and resting state functional brain imaging (restingstate functional magnetic resonance imaging, resting state fMRI) analysis of occult spastic diplegia (spastic diplegic cerebral palsy, SDCP) - the change of structure and function of brain, brain injury model of occult SDCP.
Methods: We selected 16 cases of occult SDCP patients and 16 age, gender matched normal control group with the routine MRI scan were normal. All patients underwent gross motor function score (Gross MotorFunction, Classification System, GMFCS). MRI scans of all subjects, obtaining three-dimensional magnetization prepared rapid gradient echo (3D magnetization prepared rapid gradient echo, 3D MP-RAGE T1 (T1weighted) Imanging, T1WI weighted imaging, diffusion tensor imaging (diffusion), tensor imaging, DTI) data, including 12 cases of occult SDCP patients and 14 cases of normal control group underwent resting state fMRI scanning, the scanning range includes all the brain. VBM technology of SDCP compared with healthy volunteers gray matter volume differences in hiding, using two independent sample t test was used for statistical analysis. Using TBSS technology is the occult SDCP and health Kang volunteers (fractional anisotropy, fractional anisotropy value change, FA) for cerebral white matter fiber had significant difference. And the difference of gray matter in patients with occult SDCP and GMFCS correlation analysis. The assessment of occult SDCP patients in resting state brain regional homogeneity (regionalhomogeneity, ReHo), low frequency (amplitude amplitude of low frequency fluctuation, ALFF) and the key brain regions including the precentral gyrus and thalamus functional connectivity (functional connectivity, FC).
Results: compared with normal control group, thalamus occult SDCP in bilateral basal ganglia, and insula and left midbrain decreased gray matter volume, corpus callosum and right coronaradiata posterior white matter volume decreased, whole brain gray matter volume was increased. The occult SDCP of brain gray matter and white matter volume reduction had no significant correlation with patients GMFCS. A plurality of fiber bundle FA occult SDCP was significantly lower than that of the normal control group, including bilateral corticospinal tract, and posterior central gyrus and paracentral lobule, prefrontal cortex, temporal lobe, internal capsule and external capsule, corpus callosum, cingulate gyrus, thalamus, cerebellum and brainstem fibers and other parts of the prefrontal cortex. Among them, the internal capsule, thalamus, corpus callosum and brainstem fiber bundle was negatively correlated with GMFCS.
Compared with the normal control group, the areas of ReHo decrease in patients with occult SDCP mainly include bilateral fronto fronto temporal lobe, cerebellum, right cingulate gyrus and right lenticular nucleus, and the increased areas include the left anterior cingulate lobe, the distance like gyrus, the fusiform gyrus and the right anterior cingulate lobe.
In the occult SDCP group, the whole brain ALFF did not significantly increase or decrease.
The functional connectivity analysis showed temporal and occipital lobe and bilateral precentral gyrus decreased functional connectivity areas were mainly located in the left temporal lobe and bilateral, bilateral fusiform gyrus and lingual gyrus; functional connectivity areas were mainly located in the contralateral supplementary motor area and posterior central gyrus and ipsilateral postcentral gyrus and bilateral thalamus decreased functional connectivity. Regions including bilateral basal ganglia, cingulate and prefrontal cortex; link enhancement region mainly include bilateral precentral gyrus, contralateral cerebellum.
Conclusion: there is a specific spatial distribution pattern of occult SDCP in brain structure and function. Its specific distribution may be related to the pathological basis of the disease. These abnormalities help to understand the pathogenesis of occult SDCP and provide potential imaging indicators for early diagnosis.

【學(xué)位授予單位】：中國(guó)人民解放軍醫(yī)學(xué)院
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2014
【分類號(hào)】：R445.2;R742.3

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