本文選題：輕度創(chuàng)傷性腦損傷 + 基于纖維束示蹤空間統(tǒng)計(jì)分析��； 參考：《天津醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的采用擴(kuò)散峰度成像技術(shù)(Diffusion Kurtosis Imaging,DKI)及脈沖式動(dòng)脈自旋標(biāo)記技術(shù)(Pulsed Arterial Spin Labeling,PASL)對(duì)輕度創(chuàng)傷性腦損傷(Mild Traumatic Brain Injury,m TBI)患者的腦組織結(jié)構(gòu)及腦血流量的變化進(jìn)行分析,并研究影像學(xué)上這些變化與腦震蕩后綜合癥嚴(yán)重程度的相關(guān)關(guān)系。對(duì)象和方法本研究納入m TBI組患者20例(男性11例、女性9例,年齡23-45歲,平均年齡為30.5±7.4歲),格拉斯哥昏迷指數(shù)(Glasgow Coma Scale,GCS)評(píng)分均為15分;對(duì)照組(Normal Control,NC)正常志愿者15例(男性7例、女性8例,年齡22-50歲,平均年齡為32.7±9.9歲)。另外,本研究根據(jù)磁敏感加權(quán)成像(Susceptibility Weighted Imaging,SWI)的圖像上有無軸索損傷對(duì)m TBI組患者進(jìn)一步分組,分為有軸索損傷組[SWI(+)]8例和無軸索損傷組[SWI(-)]12例。所有圖像均懫用Siemens公司Magnetom Trio Tim 3.0T MR掃描儀進(jìn)行采集,采用8通道頭線圈。所有受試者進(jìn)行T1 MPRAGE序列、T2WI序列、SWI序列、DKI序列及PASL序列掃描。在進(jìn)行掃描前對(duì)m TBI組患者進(jìn)行Rivermead腦震蕩后綜合征問卷調(diào)查表(Rivermead Postconcussion Symptom Questionnaire,RPSQ)評(píng)分。DKI數(shù)據(jù)分析:(1)腦白質(zhì)纖維束分析:通過Diffusional Kurtosis Estimator(DKE)軟件得到各參數(shù)圖(FA、MD、MK、AK、RK);采用FSL軟件對(duì)NC組、SWI(-)組、SWI(+)組3組進(jìn)行基于纖維束示蹤空間統(tǒng)計(jì)(Tract Based Spatial Statistics,TBSS)分析和FA、MD、MK、AK、RK各參數(shù)與RPSQ評(píng)分的相關(guān)性分析。以年齡作為協(xié)變量。p0.05時(shí)認(rèn)為結(jié)果存在統(tǒng)計(jì)學(xué)差異。(2)雙側(cè)丘腦分析:應(yīng)用(1)中TBSS分析過程中已進(jìn)行渦流校正、標(biāo)準(zhǔn)空間配準(zhǔn)的各參數(shù)(FA、MD、MK、AK、RK)數(shù)據(jù),對(duì)雙側(cè)丘腦進(jìn)行感興趣區(qū)(Region of interest,ROI)分析。統(tǒng)計(jì)分析應(yīng)用SPSS21.0軟件包進(jìn)行,對(duì)NC組、SWI(-)組及SWI(+)組3組間左、右側(cè)丘腦的FA、MD、MK、AK、RK值進(jìn)行方差分析,兩兩組比較檢驗(yàn)應(yīng)用Bonferroni法;對(duì)各參數(shù)值與RPSQ量表評(píng)分進(jìn)行Spearman相關(guān)性分析。以年齡作為協(xié)變量。p0.05時(shí)認(rèn)為結(jié)果存在統(tǒng)計(jì)學(xué)差異。PASL數(shù)據(jù)分析:r CBF參數(shù)圖通過MRI掃描儀自動(dòng)得到,對(duì)腦組織的r CBF值進(jìn)行ROI分析,感興趣區(qū)域取雙側(cè)額葉、雙側(cè)頂葉、雙側(cè)枕葉、雙側(cè)顳葉及雙側(cè)丘腦。統(tǒng)計(jì)分析應(yīng)用SPSS21.0軟件包進(jìn)行,對(duì)NC組、SWI(-)組及SWI(+)組3組間各個(gè)ROI區(qū)域的r CBF值進(jìn)行方差分析,兩兩組比較檢驗(yàn)應(yīng)用Bonferroni法;對(duì)r CBF參數(shù)值與RPSQ量表評(píng)分進(jìn)行Spearman相關(guān)性分析。年齡作為協(xié)變量。p0.05時(shí)認(rèn)為結(jié)果存在統(tǒng)計(jì)學(xué)差異。結(jié)果DKI數(shù)據(jù)結(jié)果:(1)腦白質(zhì)纖維束各參數(shù)值分析結(jié)果:SWI(-)組與NC組相比:SWI(-)組多個(gè)腦白質(zhì)區(qū)域FA值升高、MD值降低、MK值升高、AK值升高及RK值升高;且DKI參數(shù)(AK)顯示異常區(qū)域較DTI(FA、MD)廣泛。SWI(+)組與NC組相比:SWI(+)組多個(gè)腦白質(zhì)區(qū)域FA值降低、MD值升高、MK值降低、AK值降低及RK值降低。SWI(+)組與SWI(-)組相比:SWI(+)組多個(gè)腦白質(zhì)區(qū)域FA值降低,、MD值升高、MK值降低、AK值降低及RK值降低。本研究未發(fā)現(xiàn)與RPSQ評(píng)分相關(guān)的白質(zhì)區(qū)域。(2)雙側(cè)丘腦各參數(shù)值分析結(jié)果:SWI(+)組右側(cè)丘腦MK值明顯升高(兩兩組比較非Bonferroni法檢驗(yàn),p=0.043),余參數(shù)值均未出現(xiàn)明顯變化。丘腦各參數(shù)值與RPSQ評(píng)分無明顯相關(guān)性。PASL數(shù)據(jù)結(jié)果:SWI(-)組與NC組相比:SWI(-)組左側(cè)枕葉r CBF值明顯降低(p=0.021)。SWI(+)組與NC組相比:SWI(+)組左側(cè)額葉、右側(cè)頂葉、右側(cè)枕葉、右側(cè)顳葉的r CBF值均明顯降低(左側(cè)額葉:p=0.047,右側(cè)頂葉:p=0.020,右側(cè)枕葉:p=0.011,右側(cè)顳葉:p=0.033)。SWI(+)組與SWI(-)組相比:SWI(+)組右側(cè)顳葉的r CBF值明顯降低(p=0.028)。左側(cè)額葉r CBF值與RPSQ評(píng)分存在明顯負(fù)相關(guān)(r=-0.598,p=0.007)。結(jié)論1.利用DKI技術(shù)對(duì)急性期輕度創(chuàng)傷性腦損傷患者進(jìn)行研究,發(fā)現(xiàn)急性m TBI患者腦白質(zhì)MK、AK、RK各參數(shù)值發(fā)生了異常變化,且參數(shù)AK在SWI(-)組發(fā)現(xiàn)的腦白質(zhì)微結(jié)構(gòu)異常范圍較DTI參數(shù)(FA、MD)廣泛,提示對(duì)于m TBI所致的腦白質(zhì)的損傷,DKI對(duì)m TBI患者腦白質(zhì)微結(jié)構(gòu)損傷的評(píng)估較DTI敏感,同時(shí)提供了與DTI不同的微觀變化信息,使我們能夠更好地理解m TBI所致的腦白質(zhì)的病理生理變化。2.利用DKI技術(shù)對(duì)急性期輕度創(chuàng)傷性腦損傷患者進(jìn)行研究,發(fā)現(xiàn)急性m TBI患者丘腦的MK值發(fā)生變化,而DTI參數(shù)(FA、MD)未發(fā)生明顯變化,說明DKI較DTI能敏感地發(fā)現(xiàn)m TBI患者腦灰質(zhì)的異常,丘腦損傷也可能參與到m TBI患者神經(jīng)功能障礙的發(fā)生發(fā)展過程中。3.利用PASL技術(shù)對(duì)急性期輕度創(chuàng)傷性腦損傷患者進(jìn)行研究,發(fā)現(xiàn)急性m TBI患者腦組織血流量減低,而且一些區(qū)域的腦血流量與腦震蕩后綜合征的嚴(yán)重程度存在相關(guān)性,提示m TBI患者腦組織血流動(dòng)力學(xué)的異常可能參與了臨床癥狀產(chǎn)生。
[Abstract]:Objective to analyze the changes of brain tissue structure and cerebral blood flow in patients with mild traumatic brain injury (Mild Traumatic Brain) (Pulsed Arterial Spin Labeling, PASL) by Diffusion Kurtosis Imaging (DKI) and pulse arterial spin labeling (PASL), and to study these changes in imaging and imaging. The correlation of the severity of post concussion syndrome. Subjects and methods included 20 patients in group M TBI (male 11, female 9, age 23-45, average age 30.5 + 7.4 years old), and Glasgow coma index (Glasgow Coma Scale, GCS) scores were 15; Normal Control, NC (Normal Control, NC) normal volunteers were 15 cases (male 7 cases, female 8). For example, the age of 22-50 years, the average age of 32.7 + 9.9 years old. In addition, the study based on the Susceptibility Weighted Imaging (SWI) image without axonal injury to the m TBI group patients further divided into [SWI (+)]8 cases and the non axonal injury group [SWI (-)]12 cases. All images are Siemens company Mag. The netom Trio Tim 3.0T MR scanner was collected with 8 channel head coils. All subjects performed T1 MPRAGE sequence, T2WI sequence, SWI sequence, DKI sequence and PASL sequence scan. (1) the analysis of white matter fiber bundle: through Diffusional Kurtosis Estimator (DKE) software, each parameter diagram (FA, MD, MK, AK, RK) is obtained. Correlation analysis. There was a statistical difference between the results of age as a covariate.P0.05. (2) bilateral thalamus analysis: application (1) in the process of TBSS analysis in the process of eddy current correction, the parameters of the standard space registration (FA, MD, MK, AK, RK), the region of interest (Region of interest, ROI) analysis of bilateral thalamus (Region of interest, ROI). Statistical analysis applied SPSS21 .0 software package was carried out to analyze the FA, MD, MK, AK, RK values of the 3 groups between groups NC, SWI (-) and SWI (+) group. The 22 groups of comparison tests were applied to the Bonferroni method, and the Spearman correlation analysis was carried out for the values of the parameters and the RPSQ scale. R CBF parameters were automatically obtained by MRI scanner, ROI analysis of R CBF value of brain tissue, bilateral frontal lobe, bilateral parietal lobe, bilateral occipital lobe, bilateral temporal lobe and bilateral thalamus in the region of interest. Statistical analysis and analysis were carried out with SPSS21.0 software package, and the variance analysis of R values of each ROI region between the 3 groups of SWI (-) group and SWI (+) group was analyzed in NC group, 22 Group comparative test using Bonferroni method; Spearman correlation analysis of R CBF parameter value and RPSQ scale score. Age as a covariate.P0.05, the results were statistically different. Results DKI data results: (1) the results of each parameter value analysis of white matter fiber bundle: SWI (-) group compared with the NC group: SWI (-) group of multiple brain white matter region FA value increased, The MD value decreased, the MK value increased, the AK value increased and the RK value increased, and the DKI parameter (AK) showed that the abnormal region was more than DTI (FA, MD) and the broad.SWI (+) group was lower than the NC group. High MK value decreased, AK value decreased and RK value decreased. The study did not find the white matter area related to the RPSQ score. (2) the analysis of the values of each parameter in the bilateral thalamus: the MK value of the right thalamus in the SWI (+) group was significantly higher (22 groups compared with non Bonferroni test, p=0.043), and the values of the residual ginseng were not obviously changed. The parameters of the thalamus and the RPSQ score were not obvious. Compared with the NC group, the SWI (-) group compared with the NC group: the R CBF value of the left occipital lobe in the SWI (-) group was significantly lower (p=0.021).SWI (+) group compared with the NC group: the left frontal lobe of the SWI (+) group, the right parietal lobe, the right occipital lobe and the right temporal lobe decreased significantly (left frontal lobe: right parietal lobe: right right occipital lobe: right temporal lobe) The WI (+) group was compared with the SWI (-) group: the R CBF value of the right temporal lobe in the SWI (+) group was significantly lower (p=0.028). The left frontal lobe R CBF value was negatively correlated with the RPSQ score (r=-0.598, p=0.007). Conclusion 1., the DKI technique was used to study the patients with mild traumatic brain injury. Changes, and the parameters AK found in the SWI (-) group are more extensive than the DTI parameters (FA, MD). It is suggested that DKI is more sensitive to the damage of white matter in the cerebral white matter caused by M TBI than that in M TBI, and provides a different microview change information that is different from that of DTI, so that we can better understand the brain of the brain. The pathophysiological changes of white matter.2. used DKI technique to study the patients with mild traumatic brain injury in acute stage. It was found that the MK value of the thalamus in the acute m TBI patients changed, and the DTI parameter (FA, MD) did not change obviously. It shows that DKI is more sensitive than DTI to find the abnormality of the gray matter in the m TBI patients. The thalamic injury may also be involved in the patient God. In the process of dysfunctional development,.3. used PASL technology to study the patients with mild traumatic brain injury in acute phase, and found that the blood flow of brain tissue in acute m TBI patients decreased, and the cerebral blood flow in some regions was correlated with the severity of postconcussion syndrome, suggesting the abnormal hemodynamics of brain tissue in M TBI patients. It may be involved in the emergence of clinical symptoms.
【學(xué)位授予單位】：天津醫(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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相關(guān)期刊論文 前1條

1 Shu-ping Peng;Yi-ning Li;Jun Liu;Zhi-yuan Wang;Zi-shu Zhang;Shun-ke Zhou;Fang-xu Tao;Zhi-xue Zhang;;Pulsed arterial spin labeling effectively and dynamically observes changes in cerebral blood flow after mild traumatic brain injury[J];Neural Regeneration Research;2016年02期

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本文編號(hào)：1899467