本文選題：功能磁共振成像 + 腦震蕩綜合征　； 參考：《安徽醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的采用靜息態(tài)功能磁共振腦功能顯像技術(shù),構(gòu)建腦震蕩綜合征患者(Post-concussion syndrome,PCS)的腦結(jié)構(gòu)網(wǎng)絡(luò),通過(guò)研究其網(wǎng)絡(luò)屬性的變化探討腦震蕩綜合征的病理生理機(jī)制:(1)應(yīng)用功能磁共振彌散張量成像技術(shù)(diffusion tensor imaging,DTI)觀察腦震蕩綜合征患者大腦白質(zhì)纖維網(wǎng)絡(luò)細(xì)微結(jié)構(gòu)的損傷并探討其改變的意義;(2)應(yīng)用功能磁共振成像中的基于體素的形態(tài)學(xué)測(cè)量(Voxel based morphometry,VBM)和計(jì)算機(jī)圖形輔助處理技術(shù),探討腦震蕩后綜合征患者大腦灰質(zhì)體積的變化及其意義。方法(1)選取18例腦震蕩綜合征被試均招募于安徽醫(yī)科大學(xué)附屬省立醫(yī)院神經(jīng)外科門診2015年4月至2015年9月接診的輕度腦外傷患者組成患者組,同期在社會(huì)上招募性別、年齡、教育程度與輕度顱腦損傷組患者均匹配的18名健康人組成正常對(duì)照組,所有受試者均在受傷后3個(gè)月接受相同參數(shù)的靜息態(tài)磁共振成像數(shù)據(jù)采集,數(shù)據(jù)使用FSL軟件經(jīng)渦流矯正、張量計(jì)算、空間標(biāo)準(zhǔn)化、計(jì)算FA值,通過(guò)與正常對(duì)照組隨機(jī)化統(tǒng)計(jì)比較并校正后得到腦白質(zhì)纖維束網(wǎng)絡(luò)發(fā)生損傷的區(qū)域;(2)以2015年4月至2016年1月期間安徽醫(yī)科大學(xué)附屬省立醫(yī)院神經(jīng)外科收治的23例腦震蕩綜合征患者為患者組,以及同期招募的25名健康人為對(duì)照組,經(jīng)靜息態(tài)功能磁共振檢查后獲得數(shù)據(jù),使用SPM8中VBM軟件包經(jīng)過(guò)圖像標(biāo)準(zhǔn)化變換、配準(zhǔn)、圖像成分分割、平滑及統(tǒng)計(jì)分析后,發(fā)現(xiàn)兩組灰質(zhì)體積存在差異的部位,提取差異有統(tǒng)計(jì)學(xué)意義的結(jié)果并直觀顯示。結(jié)果(1)使用約翰霍普金斯大學(xué)腦白質(zhì)模板(JHUWM)進(jìn)行定位發(fā)現(xiàn):相對(duì)于正常組,患者組的FA值降低區(qū)域包括:胼胝體膝部和體部、雙側(cè)前放射冠、左側(cè)丘腦后輻射(包括視輻射束)和右側(cè)外囊;未發(fā)現(xiàn)FA值增高的區(qū)域。(2)基于VBM研究方法可見(jiàn):與對(duì)照組相比,腦震蕩綜合征患者組的大腦灰質(zhì)體積減小的腦區(qū)包括額葉(左側(cè)額下回、右側(cè)額直回)、顳葉(左側(cè)顳下回)、左側(cè)島蓋和左側(cè)殼核;與對(duì)照組相比,未發(fā)現(xiàn)灰質(zhì)體積明顯增大的腦區(qū)。結(jié)論(1)TBSS方法發(fā)現(xiàn)輕度顱腦損傷患者大腦白質(zhì)纖維束的細(xì)微結(jié)構(gòu)異常,可能與腦震蕩綜合征患者傷后出現(xiàn)癥狀的病理生理機(jī)制及臨床表現(xiàn)密切相關(guān)。(2)腦震蕩后綜合征患者的大腦灰質(zhì)體積存在結(jié)構(gòu)性異常改變,主要表現(xiàn)為局部萎縮性變化,推測(cè)這種變化可能與腦震蕩后綜合征所產(chǎn)生的多種遷延不愈的臨床表現(xiàn)的病理機(jī)制有關(guān)。綜上,本研究采用靜息態(tài)功能磁共振的腦功能成像技術(shù),能夠顯示出腦震蕩綜合征患者傷后大腦白質(zhì)及灰質(zhì)組成的結(jié)構(gòu)網(wǎng)絡(luò)均出現(xiàn)了細(xì)微的異常變化,為對(duì)于PCS的致病機(jī)制的研究提供新的方向,為腦創(chuàng)傷的診治提供了新的理論依據(jù)。
[Abstract]:Objective to construct a brain structure network of Post-discussion syndrome (PCS) in patients with concussion syndrome by resting functional magnetic resonance imaging (fMRI).Study on the pathophysiological mechanism of concussion syndrome by studying the changes of its network properties: 1) use functional magnetic resonance diffusion Zhang Liang imaging technique to observe the fine structure of cerebral white matter fiber network in patients with concussion syndromeApplication of Voxel based morphometry and computer Graphics in functional Magnetic Resonance Imaging.To investigate the changes and significance of gray matter volume in patients with postconcussion syndrome.Methods 18 patients with concussion syndrome were recruited from the Department of Neurosurgery, Anhui Medical University, from April 2015 to September 2015.Eighteen healthy persons with education level matched with those of mild craniocerebral injury group constituted a normal control group. All subjects received the same parameters of resting magnetic resonance imaging data at 3 months after injury, and the data were corrected by eddy current using FSL software.Zhang Liang calculation, spatial standardization, calculation of FA value,23 cases of neurosurgery in Provincial Hospital affiliated to Anhui Medical University between April 2015 and January 2016 were obtained by comparing and correcting the randomization statistics of the white matter bundle network in the normal control group from April 2015 to January 2016.Concussion syndrome patient group,The data were obtained by resting functional magnetic resonance imaging (fMRI) and 25 healthy persons recruited in the same period. The VBM software package in SPM8 was used for image standardization transformation, registration, image component segmentation, smoothing and statistical analysis.The difference of gray matter volume between the two groups was found.Results using Johns Hopkins White matter template (JHUWM), we found that the decreased FA values in the patients group included the genu and body of corpus callosum, bilateral anterior radiographic corona.The left posterior thalamic radiation (including the visual radiation beam) and the right outer capsule; the area where FA value was not found to be increased was observed based on the VBM method: compared with the control group,In concussion syndrome group, the areas of reduced gray matter volume included frontal lobe (left inferior frontal gyrus, right frontal gyrus, temporal lobe (left infratemporal gyrus, left insular cap and left putamen nucleus), compared with control group.No significant increase in gray matter volume was found in the brain.Conclusion the fine structure of white matter fiber bundle in patients with mild craniocerebral injury was found by TBSS method.It may be closely related to the pathophysiological mechanism and clinical manifestation of posttraumatic symptoms in patients with concussion syndrome. (2) there are structural abnormal changes in gray matter volume in the brain of patients with postconcussion syndrome, mainly manifested as local atrophic changes.It is speculated that this change may be related to the pathological mechanism of many delayed clinical manifestations of postconcussion syndrome.In conclusion, using resting functional magnetic resonance imaging technique, this study can show slight abnormal changes in white matter and gray matter structure network in patients with concussion syndrome.It provides a new direction for the study of the pathogenesis of PCS and a new theoretical basis for the diagnosis and treatment of brain trauma.
【學(xué)位授予單位】：安徽醫(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;R651.15

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