本文選題：擴散峰度成像 + 腦梗死��； 參考：《天津醫(yī)科大學》2017年碩士論文

【摘要】：目的:觀察擴散峰度成像(diffusion kurtosis imaging,DKI)在腦梗死急性期的變化特點,對比DKI與擴散加權(quán)成像(diffusion weighted imaging,DWI)評價梗死核心區(qū)的能力,探索DKI與DWI不同表現(xiàn)區(qū)域的血流灌注情況,從而揭示DKI在急性腦梗死患者早期診斷及評估預后中的價值,并探討其可能機制。對象與方法:(1)選取急性腦梗死患者共60例,所有患者除常規(guī)MRI掃描外,還進行DWI、DKI、MRA、DSC-PWI(dynamic susceptibility contrast enhanced perfusion weighted imaging,DSC-PWI)掃描。分別獲得ADC、平均擴散系數(shù)(mean diffusivity,MD)、平均峰度系數(shù)(mean kurtosis,MK)、軸向峰度系數(shù)(axial kurtosis,AK)和徑向峰度系數(shù)(radial kurtosis,RK)參數(shù)圖,測量患側(cè)與健側(cè)相應的參數(shù)值,并計算各參數(shù)值的變化率。(2)其中37例急性腦梗死患者完成縱向隨訪研究,MRI檢查時間分別為24小時內(nèi)、5-7天、30天后,將所有病灶按照大小分為小病灶(Dmax1cm)和大病灶(Dmax≥1cm)兩組,小病灶組進行計數(shù)比較,大病組測量病灶的體積大小。(3)其中25例急性腦梗死患者,共包含32個大病灶,根據(jù)MD與MK參數(shù)圖所示異常范圍的一致程度,分為MD/MK匹配與MD/MK錯配兩組,錯配組病灶由內(nèi)向外依次分為病灶中心區(qū)、錯配區(qū)及邊緣區(qū),而匹配組無錯配區(qū),由內(nèi)向外依次為病灶中心區(qū)、邊緣區(qū),分別測量兩組患者不同區(qū)域腦組織內(nèi)各灌注血流動力學參數(shù)值(MTT、TTP、CBF、CBV值),以對側(cè)腦組織作為正常對照。統(tǒng)計學分析采用SPSS 19.0軟件包:分析腦梗死急性期各擴散、峰度參數(shù)值患側(cè)與健側(cè)的差異,并比較各參數(shù)值變化率間的差異;分析大病灶組急性期各擴散、峰度參數(shù)圖所示病灶體積的差異,并比較急性期各參數(shù)圖病灶體積與隨訪最終體積的相關(guān)性,分析小病灶組急性期各參數(shù)圖與隨訪最終陽性病灶數(shù)目的一致性;分析急性期腦梗死患者MD/MK匹配與錯配兩組間不同區(qū)域各灌注血流動力學參數(shù)值的差異,并比較各組內(nèi)不同區(qū)域間各灌注參數(shù)值間的差異。結(jié)果:(1)急性期腦梗死患者病灶內(nèi)各擴散參數(shù)ADC、MD值減低,而各峰度參數(shù)MK、AK、RK值增高(P值均0.001),且各峰度參數(shù)的變化率大于各擴散參數(shù)的變化率(P值均0.001),同類參數(shù)的變化率相比,擴散參數(shù)ADC與MD值的變化率無統(tǒng)計學差異,峰度參數(shù)除AK與RK之間具有統(tǒng)計學差異(P0.005),余峰度參數(shù)之間差異均無統(tǒng)計學意義。大病灶組急性期各擴散、峰度參數(shù)圖所示的病灶體積無統(tǒng)計學差異(H=8.506,P0.05),復查T2WI顯示的病灶體積與急性期各擴散、峰度參數(shù)顯示的病灶體積均呈正相關(guān)(P值均0.001),其中與擴散參數(shù)ADC、MD圖的體積呈中度相關(guān),相關(guān)系數(shù)r分別為0.761、0.775,與峰度參數(shù)MK、AK、RK圖的體積呈高度相關(guān),相關(guān)系數(shù)分別為0.880、0.869、0.870;小病灶組急性期各峰度參數(shù)圖較各擴散參數(shù)圖與最終T2WI圖顯示的陽性病灶數(shù)具有更好的一致性,前者無統(tǒng)計學差異(P值均0.05)。(3)急性期MD、MK異常范圍劃分的不同區(qū)域的腦組織較對側(cè)均表現(xiàn)為MTT、TTP值延長,CBF、CBV值減低(P值均0.05),病灶中心區(qū)與錯配區(qū)之間,僅CBF值存在差異,表現(xiàn)為前者較后者減低(P值0.05);病灶中心區(qū)與邊緣區(qū)之間,TTP、CBF、CBV值均存在差異,分別表現(xiàn)為前者較后者延長、減低、減低(P值均0.05);病灶錯配區(qū)與邊緣區(qū)之間,僅CBV值存在差異,表現(xiàn)為前者較后者減低(P值0.05)。結(jié)論:急性腦梗死患者DKI較傳統(tǒng)DWI可以提供更豐富的病灶信息,有助于對病灶的早期診斷,尤其是MK參數(shù)圖;急性腦梗死患者峰度參數(shù)較擴散參數(shù)能更準確的評價梗死核心區(qū),更易于腦梗死早期預測病灶的最終轉(zhuǎn)變;急性腦梗死患者MD異常范圍內(nèi),MK異常的中心區(qū)較MK正常的錯配區(qū)具有更低的CBF值,提示MK可以分級MD內(nèi)部處于不同代謝狀態(tài)的組織結(jié)構(gòu)改變,為DKI能夠準確地評價梗死核心區(qū)提供了依據(jù),同時也為IP的準確定義提供了補充。
[Abstract]:Objective: To observe the diffusion kurtosis imaging (diffusion kurtosis, imaging, DKI) changes in patients with acute cerebral infarction, compared with DKI and diffusion weighted imaging (diffusion weighted, imaging, DWI) to evaluate the ability of the infarct core area, explore the perfusion of DKI and DWI showed different areas, so as to reveal the diagnosis and evaluation of prognosis of DKI in patients with early acute the value of cerebral infarction, and to explore its possible mechanism. Subjects and methods: (1) from patients with acute cerebral infarction were 60 cases, all patients in addition to routine MRI scan, but also DWI, DKI, MRA, DSC-PWI (dynamic susceptibility contrast enhanced perfusion weighted imaging, DSC-PWI). ADC scan respectively, average diffusion coefficient (mean diffusivity, MD), the average coefficient of kurtosis (mean kurtosis, MK (axial), axial kurtosis coefficient kurtosis, AK) and radial (radial kurtosis, RK kurtosis parameter) map, measure the ipsilateral and The parameters of the corresponding contralateral values, and calculate the parameter values of the rate of change. (2) including 37 cases of acute cerebral infarction patients completed longitudinal follow-up study, MRI examination time was 24 hours, 5-7 days, 30 days later, all lesions were small lesions according to size (Dmax1cm) and large lesions (Dmax = 1cm two) group, small size group were counted, the volume of illness group lesion. (3) including 25 cases of acute cerebral infarction patients, including 32 lesions, according to the degree of uniform MD and MK parameters shown abnormal range, divided into MD/MK, MD/MK and mismatch mismatch group two groups. Focus from the inside to the outside is divided into the central area of the lesion, the mismatch area and the edge area, and the match was no mismatch, from inside to outside for the center of the lesion area, the edge area, respectively. The brain tissue was measured in two groups in different regions of the perfusion hemodynamic parameters (MTT, TTP, CBF, CBV) the contralateral brain tissue. As the normal control group. Statistical analysis using SPSS 19 software: analysis of the diffusion of acute cerebral infarction, the difference and the contralateral side of the kurtosis parameter values, and compare the difference between the parameter values of the diffusion rate; analysis of large lesion group in acute stage, the difference shown in the kurtosis parameter of lesion, and to compare the correlation between acute the parameter maps of lesion volume and follow-up final volume, consistency analysis of minor lesions in acute stage of map and follow-up parameters eventually positive number of lesions; analysis of MD/MK patients in acute stage of cerebral infarction, the difference between the two groups in different regions of the perfusion blood flow mechanics parameters and mismatch, and compare the perfusion parameters in different regions the difference between the values between the groups. Results: (1) in patients with acute cerebral infarction lesions by diffusion parameters ADC, MD value decreased, and the kurtosis parameter MK, AK, RK value increased (P 0.001), and the change rate of large kurtosis parameter The change in the rate of diffusion parameter (P value 0.001), change the same parameters than on the rate of diffusion parameters ADC and MD value was no significant difference, except the kurtosis parameter with statistical difference between AK and RK (P0.005), the difference between more than peak parameters were not statistically significant. The diffusion of large lesion group in acute period, there was no significant difference in kurtosis parameters shown in the lesion volume (H=8.506, P0.05), the diffusion lesion volume and acute phase T2WI scan show, the kurtosis parameter display the lesion volume were positively correlated (P = 0.001), and the diffusion parameters ADC, MD graph volume showed a moderate correlation, correlation the coefficient of R were 0.761,0.775, AK, MK and kurtosis parameters, RK was highly correlated with graph volume, the correlation coefficient was 0.880,0.869,0.870; the number of positive lesions in small lesions in acute stage of the kurtosis parameter map is the diffusion parameter map and final T2WI display has better Consistency, no significant difference between the former (P 0.05). (3) the acute phase of MD, MK anomaly range in different regions of the brain than the other side are represented as MTT, CBF, TTP value increased, CBV value decreased (P = 0.05), between the center of the lesion area and the mismatch area. There is only the difference in CBF value is lower in the former than in the latter (P = 0.05); between the center of the lesion area and the edge area of TTP, CBF, CBV values were different, respectively for the performance of the former than the latter to extend, reduce, decrease (P 0.05); mismatch between the lesion area and the edge area, there are only the difference in CBV value is lower in the former than in the latter (P = 0.05). Conclusion: DKI in patients with acute cerebral infarction than conventional DWI can provide more abundant information focus, is helpful to early diagnosis of the lesions, especially MK parameters; acute cerebral infarction with diffusion parameters kurtosis parameters can be more accurate assessment of infarct core area indeed, more prone to cerebral infarction early The final change measuring lesions in patients with acute cerebral infarction; MD anomaly range, central area of abnormal MK than in normal MK mismatch region with lower CBF values, suggesting that MK may be classified in MD internal changes of tissue structure of different metabolic state, DKI can accurately estimate the infarct core area provides the basis, but also provides the supplement for the accurate definition of IP.

【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R445.2;R743.33

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