本文選題：MRI + 彌散張量成像　； 參考：《福建中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:檢測健康成人前視路DTI指標(biāo)的正常值范圍,分析其分布特點及影響因素。探討鞍區(qū)腫瘤患者前視路DTI指標(biāo)、DTT圖形態(tài)結(jié)構(gòu)的變化特征,并分析其與手術(shù)后視覺功能改變和預(yù)后的關(guān)系。方法:選取健康成年志愿者38例,女20例,男18例,年齡18～80歲,平均(38.2± 15.9)歲。既往無眼科、糖尿病等病史,現(xiàn)無陽性視覺傳導(dǎo)系統(tǒng)癥狀和體征,并能配合完成視力、視野檢查及MRI掃描。使用3.0TMRSkyra掃描儀(Siemens公司,柏林,德國),對檢查者除常規(guī)序列掃描外,還采用分段讀出平面回波成像序列(RS-EPI)進(jìn)行前視路軸位DTI掃描(薄層掃描找到適宜定位片的傾斜角,以能清晰看到前視路形態(tài)結(jié)構(gòu)為準(zhǔn)),9個分段數(shù),30個彌散梯度方向。由同一名影像科高年資技師進(jìn)行圖像掃描,采用3.0T MR Skyra掃描儀自帶的后處理工作站軟件,由兩名高年資的影像科醫(yī)生進(jìn)行DTI指標(biāo)采集和DTT影像重建。軸位上檢測雙側(cè)視神經(jīng)中點、視交叉正中點及雙側(cè)視束中點的FA、ADC值,以其代表前視路各部位的FA值和ADC值。經(jīng)后處理在DTT圖上重建出前視路纖維束,觀察其形態(tài)結(jié)構(gòu)情況。選取福州總醫(yī)院診斷為鞍區(qū)腫瘤并接受手術(shù)治療的成年患者,為鞍區(qū)腫瘤組。排除標(biāo)準(zhǔn):合并有鞍區(qū)之外的顱內(nèi)腫瘤,術(shù)前接受過放療或腫瘤復(fù)發(fā)或殘留而再次手術(shù),術(shù)后免疫組化結(jié)果為非腫瘤性疾病,有MRI掃描禁忌的,或依從性差不能完成術(shù)后檢查隨訪的患者。鞍區(qū)腫瘤組共入選21例。同時配對選取與鞍區(qū)腫瘤組匹配的健康成人21例作為對照組。鞍區(qū)腫瘤組與健康成人對照組在鞍區(qū)腫瘤組手術(shù)前1周內(nèi)同時行軸位前視路DTI掃描。鞍區(qū)腫瘤組在手術(shù)后4個月時復(fù)查前視路DTI。運(yùn)用VIS(visual impairment score)評分分級表進(jìn)行視覺功能的評估。將前視路分為腫瘤前方的視神經(jīng)、腫瘤區(qū)的視交叉及腫瘤后方視束3個部位,測量方法同健康成人對照組。測定兩組前視路中每個部位的FA值、ADC值,并據(jù)此計算以上3個部位的值。對比分析研究這些值的差異及其與VIS分級的關(guān)系。統(tǒng)計分析采用SPSS20.0版本軟件進(jìn)行,P0.05認(rèn)為差異有統(tǒng)計學(xué)意義。結(jié)果:前視路DTI的彩色編碼FA圖像表現(xiàn):正常前視路呈較均勻的綠色信號。ADC圖像表現(xiàn):正常前視路呈灰色,與正常腦組織灰度可區(qū)分,腦脊液呈白色信號。DTT圖可三維顯示正常前視路纖維束形態(tài),且后處理軟件界面可任意角度旋轉(zhuǎn)DTT圖對前視路纖維束進(jìn)行觀察。前視路DTI的定量指標(biāo)FA與ADC值呈顯著負(fù)相關(guān),r =-0.693,P0.001。整個前視路的FA、ADC值與性別、年齡無關(guān)(P0.05)。不同前視路部位的FA值、ADC值存在顯著差異(P0.05),視交叉與視神經(jīng)、視束之間有顯著差別(P0.05),視神經(jīng)與視束之間無明顯差別(P0.05),視交叉處FA值最低ADC值最高。鞍區(qū)腫瘤組,DTT圖中可三維觀察前視路纖維束形態(tài)結(jié)構(gòu)(連續(xù)、中斷、飽滿或稀疏);并且可觀察前視路纖維束與腫瘤之間的空間位置關(guān)系:前視路神經(jīng)纖維束是受腫瘤擠壓變形移位,還是被腫瘤組織包繞。鞍區(qū)腫瘤組的前視路纖維束形態(tài)與視覺功能的VIS評分分級無關(guān)(P0.05),但與預(yù)后關(guān)系顯著(P0.05),依據(jù)視覺功能VIS評分預(yù)后分組,術(shù)前前視路纖維束形態(tài)結(jié)構(gòu)連續(xù)型的患者,在術(shù)后4個月時,視覺功能恢復(fù)要好于中斷型(P0.05)。鞍區(qū)腫瘤組在腫瘤前方的視神經(jīng)、腫瘤區(qū)的視交叉及腫瘤后方的視束這3個區(qū)域的FA值均顯著低于健康成人對照組(P0.05),而ADC值均顯著高于健康成人對照組(P0.05)。FA、ADC值在前視路各部位之間存在顯著性差異(P0.001),視神經(jīng)與視束無明顯差異(P0.05),視交叉FA值顯著低于視神經(jīng)、視束(P0.001),視交叉ADC值顯著高于視神經(jīng)、視束(P0.001)。對照組FA值在3個部位之間存在顯著性差異(P0.001),而視神經(jīng)與視束無明顯差異(P=0.998);視交叉顯著低于視神經(jīng)、視束(P0.001);對照組ADC值在3個部位之間存在顯著性差異(P0.001),而視神經(jīng)與視束無明顯差異(P=0.122);視交叉顯著高于視神經(jīng)、視束(P0.001)。鞍區(qū)腫瘤組術(shù)后4個月整個前視路FA值較術(shù)前明顯上升(P0.05),ADC值明顯下降(P0.05)。其中,腫瘤前方視神經(jīng)、腫瘤部位的視交叉及腫瘤后視束術(shù)后4個月的FA值均較術(shù)前顯著上升(P0.05),且腫瘤視交叉部位的回升程度大于視神經(jīng)、視束(P0.05)。而術(shù)后4個月的ADC值也發(fā)生了類似FA值的恢復(fù)情況。鞍區(qū)腫瘤組術(shù)前FA、ADC值與VIS評分及分級無關(guān)(P0.05)。鞍區(qū)腫瘤組術(shù)后視交叉部位FA值升高組的病情改善率為92.99%,顯著高于FA值下降組的28.6%(P=0.006)。由此,鞍區(qū)腫瘤術(shù)后視交叉部位FA值的變化是視覺功能預(yù)后的良好預(yù)測指標(biāo),其敏感度、特異度、陽性預(yù)測值及陰性預(yù)測值分別為 86.7%、83.3%、92.9%、71.4%。結(jié)論FA值和ADC值是DTI的敏感且可靠的指標(biāo),可用于前視路的定量分析。DTT圖可三維顯示前視路神經(jīng)纖維束的形態(tài)結(jié)構(gòu),可將其用來判斷鞍區(qū)腫瘤病人的預(yù)后,DTT圖上前視路形態(tài)結(jié)構(gòu)連續(xù)型的患者,其預(yù)后要好于中斷型。鞍區(qū)腫瘤患者的前視路DTI指標(biāo)可在整個前視路發(fā)生不同程度變化,視交叉處尤為顯著。手術(shù)后這些變化在前視路不同部位出現(xiàn)不同程度的恢復(fù),并與視覺功能的改善相關(guān),鞍區(qū)腫瘤術(shù)后視交叉部位FA值上升與視覺功能預(yù)后成正相關(guān)。
[Abstract]:Objective: to detect the normal range of DTI index in healthy adults, analyze its distribution characteristics and influence factors. To explore the DTI index of the anterior vision and the morphological changes of the DTT map in the sellar tumor patients, and to analyze the relationship between the changes of the visual function and the prognosis after the operation. Methods: 38 healthy adult volunteers, 20 women, 18 men, and a year were selected. The average age of 18~80 years (38.2 + 15.9) years old. The history of non Ophthalmology, diabetes and other diseases, there is no positive visual conduction system symptoms and signs, and can cooperate with the completion of visual acuity, visual field examination and MRI scan. Using the 3.0TMRSkyra scanner (Siemens, Berlin, Germany), in addition to the routine sequence scan, the inspector also uses segmented readout plane echo. Image sequence (RS-EPI) scan the front optic axis position DTI scan (TLC scan to find the inclined angle of the suitable location plate, to clearly see the shape and structure of the forward view), 9 segments and 30 dispersion gradient directions. The image scanning of the same image technician, and the software of the post processing workstation with the 3.0T MR Skyra scanner. Two senior imaging doctors performed DTI index collection and DTT image reconstruction. On the axis, the midpoint of bilateral optic nerve, the FA, ADC value of the midpoint of the optic intersecting and bilateral optic tract were measured to represent the FA and ADC values of the various parts of the anterior vision. After the post-processing, the fibrous bundles of the anterior vision were rebuilt on the DTT map, and the morphological structure of the anterior optic pathway was observed. The State General Hospital, diagnosed as a sellar tumor and undergoing surgical treatment, is a sellar tumor group. The exclusion criteria: intracranial tumors outside the saddle area, the preoperative radiotherapy or tumor recurrence or residual reoperation, the postoperative immunohistochemical result is a non tumor disease, the MRI scan is taboo, or the compliance is not complete. 21 cases in the sellar region tumor group were selected and 21 healthy adults matched with the sellar region tumor group were selected as the control group. The saddle area tumor group and the healthy adult control group underwent DTI scan at the same time in the sellar region tumor group 1 weeks before the operation. The saddle area tumor group rechecked the DTI. transport of the preoptic route at 4 months after the operation. The VIS (visual impairment score) grading scale was used to evaluate the visual function. The anterior optic pathway was divided into the optic nerve in front of the tumor, the optic chiasma in the tumor area and the posterior optic tract of the tumor in 3 parts. The measurement method was compared with the healthy adult control group. The FA value and the value of each part of the two groups were measured, and the values of the above 3 parts were calculated. Comparative analysis and analysis of the differences in these values and the relationship with the VIS classification. Statistical analysis was carried out with the SPSS20.0 version software, and P0.05 thought the difference was statistically significant. Results: the color coded FA image of the front view road DTI: the normal front road showed a more uniform green signal.ADC image, the normal front view was gray, and the normal brain tissue was grey. The degree can be distinguished, the cerebrospinal fluid is white signal.DTT map can display the normal anterior optic tract fiber bundle form, and the post-processing software interface can rotate DTT map to observe the anterior optic tract. The quantitative index of DTI of the anterior vision FA is negatively correlated with the ADC value, R =-0.693, P0.001. the whole anterior vision FA, ADC value is independent of sex and age. P0.05). There was a significant difference (P0.05) in the value of ADC in different preoptic pathways. There was a significant difference between optic and optic nerve (P0.05), there was no significant difference between optic and optic tract (P0.05), and the lowest ADC value at the optic intersection (P0.05). In the sellar tumor group, the morphological structure of the fibrous bundle of the anterior vision was observed in the DTT map (continuous, interruption, satiety). The spatial relationship between the anterior optic fiber bundle and the tumor can be observed: the anterior optic nerve fiber bundle is shifted by the tumor and is wrapped around the tumor tissue. The VIS score of the anterior optic tract of the sellar tumor group has no correlation with the visual function (P0.05), but it has a significant relationship with the prognosis (P0.05), depending on the view. The visual function recovery was better than that of interruption (P0.05) at 4 months after operation. The FA values in the 3 regions of the sellar tumor group in front of the tumor were significantly lower than those in the healthy control group (P0. 05), the value of ADC was significantly higher than that of the healthy adult control group (P0.05).FA, and the value of ADC was significantly different between the various parts of the anterior vision (P0.001). There was no significant difference between the optic nerve and the optic tract (P0.05). The optic cross FA value was significantly lower than the optic nerve, the optic tract (P0.001), and the optic intersecting ADC was significantly higher than the optic nerve and the optic tract (P0.001). The FA value of the control group was in the 3 parts. There was significant difference (P0.001) between the optic nerve and the optic tract (P=0.998); the optic chiasma was significantly lower than the optic nerve and the optic tract (P0.001); the ADC value of the control group was significantly different between the 3 sites (P0.001), but the optic nerve was not significantly different from the optic tract (P =0.122); the optic chiasm was significantly higher than the optic nerve, the optic tract (P0.001) and the sellar tumor group operation. The FA value of the whole anterior approach increased significantly (P0.05) in the first 4 months (P0.05), and the ADC value decreased significantly (P0.05). Among them, the FA value of the optic nerve in front of the tumor, the optic chiasma at the tumor site and the postoperative posterior optic tract of the tumor were significantly higher than that before the operation (P0.05), and the recovery of the optic intersections of the tumor was greater than that of the optic nerve and the optic tract (P0.05). And the AD of the 4 months after the operation. The C value also occurred similar to the recovery of the FA value. The preoperative FA, ADC value of the sellar tumor group was not related to the VIS score and classification (P0.05). The improvement rate of the FA value group in the optic cross section of the sellar tumor group was 92.99%, significantly higher than the 28.6% (P=0.006) in the FA value reduction group. Thus, the change of the FA value of the optic cross site after the sellar tumor operation was the visual function. A good predictor of prognosis, its sensitivity, specificity, positive predictive value and negative predictive value were 86.7%, 83.3%, and 92.9%, respectively. 71.4%. conclusion FA and ADC values are sensitive and reliable indicators of DTI, which can be used in the quantitative analysis of the anterior optic pathway for the three-dimensional display of the morphological structure of the anterior optic nerve fiber bundle, which can be used to judge the sella swollen. The prognosis of the patients with tumor is better than that of interruption. The DTI index of the anterior vision of the patients with sellar region tumor can be changed to varying degrees in the whole anterior vision, especially in the optic intersection. These changes have been recovered at different levels in the anterior vision and the visual function after the operation. Correlation between the FA value of the optic cross area and the prognosis of visual function after sellar tumor operation was positively correlated.

【學(xué)位授予單位】：福建中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R445.2;R739.41

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