本文選題：視神經(jīng)脊髓炎　切入點(diǎn)：磁共振成像　出處：《大連醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:本研究運(yùn)用擴(kuò)散峰度成像技術(shù)(diffusionkurtosis imaging,DKI)對視神經(jīng)脊髓炎(Neuromyelitisoptica,NMO)患者及健康對照人群的腦實(shí)質(zhì)進(jìn)行檢測,比較分析視神經(jīng)脊髓炎患者顱內(nèi)細(xì)微組織結(jié)構(gòu)的變化情況,探討擴(kuò)散峰度成像技術(shù)對視神經(jīng)脊髓炎的臨床診斷及預(yù)后評價的應(yīng)用價值。材料與方法:收集從2014年11月到2016年12月之間于大連醫(yī)科大學(xué)附屬第一醫(yī)院神經(jīng)內(nèi)科住院的NMO患者10名作為病例組。病例組中包括男患者1人,女患者9人,年齡28～53歲,平均年齡(41.1±8.49)歲,并由研究脫髓鞘病的神經(jīng)內(nèi)科醫(yī)師根據(jù)其臨床癥狀對其進(jìn)行EDSS評分。收集本市同期10名健康志愿者作為健康對照組,要求其年齡性別與病例組相匹配。在所有參與人員知情同意的情況下,采用3.0TMRI進(jìn)行常規(guī)及DKI序列的檢測。將掃描后獲得圖像利用ADW4.4工作站中Functool軟件進(jìn)行分析,然后即可獲得本研究應(yīng)用的相關(guān)參數(shù),包括徑向峰度(radial kurtosis,RK)、軸向峰度(axial kurtosis,AK)、平均擴(kuò)散峰度(mean kurtosis,MK)、徑向彌散率(radial diffusion ratio,RD)、軸向彌散率(axial diffusion ratio,AD)、平均彌散率(medial diffusion ratio,MD)對應(yīng)圖像,分別對常規(guī)MRI表現(xiàn)正常的頂葉、枕葉、顳葉、額葉區(qū)白質(zhì),內(nèi)囊(前肢、后肢)、胼胝體(壓部、膝部)白質(zhì)纖維束的感興趣區(qū)進(jìn)行RK、AK、MK、RD、AD、MD的測量。因為灰質(zhì)具有高度各向同性,方向性參數(shù)在灰質(zhì)具有明顯誤差,因此對殼核、蒼白球、尾狀核、丘腦腦深部灰質(zhì)核團(tuán)僅測量MD及MK值。每一部位的感興趣區(qū)在同一層面左右兩側(cè)各測量3次,取平均值作為最后結(jié)果。采用SPSS 21.0統(tǒng)計學(xué)應(yīng)用軟件對所有檢測區(qū)獲得的數(shù)據(jù)進(jìn)行分析。對視神經(jīng)脊髓炎組與健康對照組各檢測區(qū)所獲得的DKI參數(shù)均值進(jìn)行兩獨(dú)立樣本t檢驗,比較兩組數(shù)據(jù)間是否存在差異;應(yīng)用Spearmans相關(guān)分析視神經(jīng)脊髓炎組各部位DKI參數(shù)與EDSS評分量表之間的相關(guān)性。將P0.05作為具有統(tǒng)計學(xué)差異的標(biāo)準(zhǔn)。結(jié)果:1.視神經(jīng)脊髓炎患者所有檢測的白質(zhì)及纖維束區(qū)AK、MK值均升高,但只有顳葉的AK值明顯升高(P0.05)。額葉、頂葉、枕葉區(qū)白質(zhì),內(nèi)囊(前肢、后肢)、肼胝體部(壓部、膝部)白質(zhì)纖維束的RK值略上升,顳葉RK值略降低(P0.05)。2.視神經(jīng)脊髓炎患者顳葉、枕葉區(qū)白質(zhì)及內(nèi)囊后肢RD值明顯下降,頂葉、枕葉、顳葉、額葉區(qū)白質(zhì),內(nèi)囊(前肢、后肢)、胼胝體壓部的白質(zhì)纖維束的MD值明顯下降,頂葉、顳葉、額葉區(qū)、內(nèi)囊部(前肢、后肢)、胼胝體部(壓部、膝部)的AD值下降明顯(P0.05)。3.視神經(jīng)脊髓炎患者蒼白球部MK值升高明顯,所檢測的灰質(zhì)核團(tuán)MD值均明顯下降(P0.05)。4.NMO患者殼核、額葉的MK值,頂葉和胼胝體壓部的AK值與EDSS評分成負(fù)相關(guān)(P0.05)。結(jié)論:1.DKI是一項能夠量化人體內(nèi)水分子非高斯分布方式擴(kuò)散的MRI新技術(shù),能夠更加真實(shí)、敏銳發(fā)現(xiàn)組織細(xì)微結(jié)構(gòu)改變。2.與常規(guī)MRI相比,DKI可早期發(fā)現(xiàn)NMO顱內(nèi)組織的細(xì)微損傷,有助于疾病的早期診斷。3.DKI的MK及AK值可以評估NMO患者的預(yù)后情況。
[Abstract]:Objective: in this study, diffusion kurtosis imaging (DKI) was used to detect the brain parenchyma in patients with neuromyelitis optica NMOA (NMOA) and healthy controls, and to compare and analyze the changes of intracranial fine tissue structure in patients with optic neuromyelitis. To explore the value of diffusion kurtosis imaging in the clinical diagnosis and prognosis evaluation of optic neuromyelitis. Materials and methods: collected from November 2014 to December 2016, Department of Neurology, first affiliated Hospital, Dalian Medical University. Ten hospitalized NMO patients as case groups. The case group included a male patient. Nine female patients, aged 28 to 53 years, with an average age of 41.1 鹵8.49 years, were assessed by neurologists for demyelinating disease according to their clinical symptoms. Ten healthy volunteers in the same period were collected as healthy control group. With the informed consent of all the participants, the routine and DKI sequences were detected by 3.0TMRI. The images were scanned and analyzed by Functool software in ADW4.4 workstation. Then the relevant parameters used in this study were obtained, including radial kurtosis, axial kurtosis, mean diffusion kurtosism, radial diffusion diffusion, axial kurtosiskurtosis, radial diffusion rate, axial diffusion rate and medial diffusion diffusion. The area of interest in the white matter of the parietal lobe, occipital lobe, temporal lobe, frontal lobe, internal capsule (forelimb, hind limb, corpus callosum (bulbar, knee)) of the normal parietal lobe, occipital lobe, temporal lobe, frontal lobe, and internal capsule (forelimb, hind limb, corpus callosum) was measured respectively by MRI. The directional parameters have obvious errors in gray matter, so the MD and MK values of putamen nucleus, globus pallidus, caudate nucleus and thalamic deep gray nucleus were measured only. The average value was taken as the final result. The data obtained from all the test areas were analyzed by SPSS 21.0 statistical software. Two independent sample t tests were performed on the mean DKI parameters obtained from each test area of the optic neuromyelitis group and the healthy control group. To compare the differences between the two groups of data; Spearmans correlation analysis was used to analyze the correlation between DKI parameters and EDSS score scale in optic neuritis group. P05 was taken as the standard of statistical difference. Results: 1. AK MK values in white matter and fibrous bundles were all increased in all patients with optic neuromyelitis. However, only the AK value of temporal lobe increased significantly (P 0.05). The RK value of white matter in frontal lobe, parietal lobe, occipital area, internal capsule (forelimb, hind limb, hydrazine callus, knee) increased slightly, and the RK value of temporal lobe decreased slightly (P 0.05. 2) in patients with optic neuromyelitis. The Rd value of white matter in occipital lobe and posterior limb of internal capsule decreased significantly, the MD value of white matter fiber bundle in parietal lobe, occipital lobe, temporal lobe, frontal lobe, temporal lobe, frontal lobe, internal capsule (forelimb, posterior limb, corpus callosum) decreased significantly, parietal lobe, temporal lobe, frontal lobe, internal capsule (forelimb). The AD value of the posterior limb, corpus callosum (bulbar, knee) decreased significantly (P0.050.3.The MK value of the globus pallidus increased significantly in the optic neuromyelitis patients, and the MD values of the gray matter nuclei decreased significantly in the putamen and frontal lobes of the patients with NMO, and the MK values in the frontal lobe and the putamen nucleus of the patients with NMO were significantly decreased. The AK value of parietal lobe and corpus callosum was negatively correlated with EDSS score (P 0.05). Conclusion: 1. DKI is a new MRI technique which can quantify the diffusion of water molecules in human body by non-#china_person0# distribution, and can be more realistic. Compared with routine MRI, DKI can detect the slight injury of NMO early, which is helpful to the early diagnosis of disease. 3. The MK and AK values of DKI can evaluate the prognosis of NMO patients.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R445.2;R744.52
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本文編號：1645448