本文選題：三叉神經(jīng)痛 + 彌散張量成像　； 參考：《昆明醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：對健康志愿者和TN患者行3.OT磁共振彌散張量成像(diffusion tensor imaging, DTI)序列檢查,通過對正常對照組(control subjects)雙側(cè)三叉神經(jīng)(trigeminal nerve, TGN)腦池段(cisternal segment)、三叉神經(jīng)痛(trigeminal neuralgia, TN)組責(zé)任血管(Responsible Vessel, RV)壓迫點(diǎn)以及TN組健側(cè)對應(yīng)位置三叉神經(jīng)的表觀擴(kuò)散系數(shù)(apparent diffusion coefficient, ADC)值和部分各向異性(Fractional Anisotrop, FA)值測量,比較三組ADC值及FA值的差異,并研究ADC值的變化與FA值的變化是否存在相關(guān)性；測量TN組患側(cè)責(zé)任血管壓迫點(diǎn)及相應(yīng)位置健側(cè)TGN的橫斷面面積(cross-sectional area, CSA),觀察CSA的變化與ADC值、FA值是否存在相關(guān)性。嘗試通過測量DTI的相關(guān)參數(shù)FA值、ADC值以及形態(tài)學(xué)參數(shù)CSA,并了解各參數(shù)與TN的相關(guān)性,嘗試建立一種無創(chuàng)性的對TN病理微結(jié)構(gòu)變化的磁共振診斷模式。 材料與方法： 1.一般資料 1.1健康對照組 對40例正常志愿者(檢查前均取得志愿者同意并簽訂知情同意書)行MRI的DTI序列掃描,所有志愿者臨床均無與三叉神經(jīng)相關(guān)的癥狀和體征。男性20例,女性20例,年齡20-83歲,平均51.2歲。 1.2TN組 收集2012年9月--2013年12月本院神經(jīng)外科診斷為原發(fā)性TN患者40例,其中男性16例,女性24例,年齡21-74歲,平均年齡53.3歲,病程范圍從3年-20年不等,平均為5.7年,均為單側(cè)面部疼痛,右側(cè)19例,左側(cè)21例。TN組按照疼痛與否分為患側(cè)(ipsilateral TN)與健側(cè)(contralateral TN)組。 2.設(shè)備與檢查方法 運(yùn)用PHILIPS Achieve3.0T MR超導(dǎo)掃描儀,選用8通道相陣頭顱專用線圈,成像序列分別為：①對正常對照組及TN組首先行常規(guī)序列掃描：橫斷面T2WI(TR/TE=3300ms/100ms)、T1WI (TR/TE=550ms/15ms)及T2FLAIR序列(TR/TE=6000ms/120ms)。②對TN組行形態(tài)學(xué)序列：3D-FIESTA (TR=5.0ms, TE=1.9ms);3D-TOF-MRA平掃及增強(qiáng)序列(TR=16.0ms,TE=3.5ms)③對正常對照組及TN組行T1WI-3D-TFE序列(TR/TE=7.5ms/3.5ms)及DTI序列(TR/TE=7687ms/76.6ms). 3.病例分組及圖像分析 全部數(shù)據(jù)在EWS(Extended MR WorkSpace)工作站內(nèi)應(yīng)用Fibertrack和Diffusion軟件進(jìn)行后處理。在所得圖像上選擇感興趣區(qū)(region of interest,ROI),ROI為圓形或點(diǎn)狀,分別測量其FA值和ADC值；另外對TN組患者分別測量患側(cè)責(zé)任血管壓迫點(diǎn)及相應(yīng)位置健側(cè)TGN的CSA。 3.1正常對照組 在FA彩圖與T1WI-3D-TFE解剖像的融合圖上,將正常對照組雙側(cè)TGN的腦池段按照距離分成四個點(diǎn),分別在TGN腦干發(fā)出點(diǎn)起點(diǎn)、出Meckel's腔的終點(diǎn)以及這兩個點(diǎn)(橋池段起點(diǎn)到終點(diǎn))之間的1/3處、2/3處,對這四個點(diǎn)的ADC值和FA值進(jìn)行采集,進(jìn)行雙側(cè)對比。再將正常志愿者按照年齡分成六組,30歲以下7例,30-40歲8例,40-50歲12例,50-60歲6例,60歲以上5例,分別對這四個點(diǎn)測量的ADC值及FA值進(jìn)行雙側(cè)對比。最后再分別將單側(cè)的四個點(diǎn)兩兩進(jìn)行縱向?qū)Ρ取?3.2TN組 利用Diffusion軟件生成的ADC圖及FA圖,分別在患側(cè)責(zé)任血管壓迫點(diǎn)測量FA值及ADC值,并且測量相應(yīng)對側(cè)無癥狀側(cè)的值。將TN組患側(cè)、TN組健側(cè)分別與正常對照組雙側(cè)TGN的FA值及ADC值進(jìn)行對比分析,研究三組上述測量值是否存在差異性,對TN組患側(cè)分析ADC值的變化與FA值的變化是否具有相關(guān)性；另外,對比分析TN患者雙側(cè)TGN的CSA是否存在差異性,以及患側(cè)CSA的變化與FA值、ADC值的相關(guān)性。 4.統(tǒng)計方法 采用SPSS18.0進(jìn)行統(tǒng)計學(xué)分析,以P0.05(雙側(cè))為差異有統(tǒng)計學(xué)意義。計量資料用x±s表示。 ①首先對各組統(tǒng)計量進(jìn)行正態(tài)性檢驗,如為正態(tài)分布,選用t檢驗(t-test)或單因素方差分析(1-way analysis of variance,ANOVA)；不符合正態(tài)分布選用非參數(shù)檢驗法(non-parametric test)。②對40例正常志愿者雙側(cè)三叉神經(jīng)距腦干發(fā)出點(diǎn)不同位置點(diǎn)的FA及ADC值進(jìn)行配對t檢驗(pair T test)；按照年齡分組,分別對各組年齡段的雙側(cè)TGN橋池段不同距離的FA值及ADC值進(jìn)行配對t檢驗；最后,再將橋池段相鄰距離之間的FA值及ADC值進(jìn)行單因素方差分析,并且分別對四個點(diǎn)之間的任意兩個點(diǎn)的FA值及ADC值差異性進(jìn)行統(tǒng)計分析。③先將TN組患側(cè)與健側(cè)TGN的FA值及ADC值進(jìn)行配對t檢驗,再用獨(dú)立樣本t檢驗(independent samples T test)將TN組患側(cè)、健側(cè)分別與正常對照組雙側(cè)的FA值和ADC值進(jìn)行對比；最后,通過線性回歸(Linear regression)分析,研究FA值的變化與ADC的變化是否存在相關(guān)性,并繪制散點(diǎn)圖及線性趨勢線。④通過配對t檢驗對TN患者雙側(cè)TGN的CSA進(jìn)行對比分析,并通過線性回歸分析研究CSA的變化與ADC值、FA值的變化是否有相關(guān)性。 結(jié)果： 1.各組數(shù)據(jù)均符合正態(tài)分布。 2.正常對照組 ①雙側(cè)三叉神經(jīng)的平均ADC值為(1.431±0.308)×10-3mm2/s,其中左側(cè)為(1.493±0.341)×10-3mm2/s,右側(cè)為(1.369±0.258)×10-3mm2/s;平均FA值為0.423±0.057,其中左側(cè)為0.416±0.058,右側(cè)為0.431±0.055。②按照年齡分組,在40-50歲組,橋池段的2/3處FA值及ADC值出現(xiàn)了左右不對稱的特點(diǎn)。 ③FA值及ADC值在單側(cè)任意兩點(diǎn)水平間均無顯著統(tǒng)計學(xué)差異。 3.TN組 ①TN組患側(cè)的平均FA值(0.330±0.056)顯著低于TN組健側(cè)(0.408±0.054)(t=-8.448,P0.05)以及正常對照組雙側(cè)(0.423±0.057)(t=8.432,P0.05)；TN組健側(cè)和正常對照組雙側(cè)FA值并沒有差異性(t=1.433,P0.05)。TN組患側(cè)的AI)C值(2.052±0.473)×10-3mm2/s則顯著高于TN組健側(cè)(1.541±0.266)×10-3mm2/s(t=8.830,P0.05)以及正常對照組雙側(cè)(1.431±0.308)×10-3mm2/s(t=8.432,P0.05)；TN組健側(cè)和正常對照組雙側(cè)ADC值并沒有明顯差異性(t=1.433,P0.05)。進(jìn)一步研究發(fā)現(xiàn)FA值的降低與ADC的增高呈負(fù)相關(guān)(r=-0.613,P0.001)。 TN組患側(cè)的CSA(3.75±0.35)mm2顯著低于(t=-27.313,P0.001)TN組健側(cè)(5.21±0.33)m2,進(jìn)一步將CSA分別與FA值及ADC值做相關(guān)分析,選用通過線性回歸(Linear regression)分析,發(fā)現(xiàn)其存在線性關(guān)系,進(jìn)一步做相關(guān)分析,Pearson相關(guān)系數(shù)顯示：FA值的下降與CSA的減小呈正相關(guān)(r=0.526,P0.001):ADC的增加與CSA的減小呈負(fù)相關(guān)(r=-0.867,P0.001)。 結(jié)論： 正常對照組 1.DT I圖像能夠清晰分辨雙側(cè)三又神經(jīng)腦池段,可實現(xiàn)各項導(dǎo)出量的測量。 2.三叉神經(jīng)腦池段左右側(cè)各導(dǎo)出量的差異與年齡有著一定的關(guān)系。 3.隨著距腦干發(fā)出點(diǎn)距離水平的不同,TGN的FA值及ADC值存在相關(guān)變化,這種變化與三叉神經(jīng)腦池段的解剖有一定關(guān)系。TN組 1.DTI技術(shù)顯示,TN患者患側(cè)較其健側(cè)及正常人雙側(cè)平均FA值顯著性減低,ADC值顯著性增高,并且TN患者患側(cè)FA值的降低和ADC的增高呈負(fù)相關(guān),提示TN患者患側(cè)由于血管壓迫導(dǎo)致明顯脫髓鞘改變,為診斷三叉神經(jīng)痛提供了非常有價值的信息。 2.TN患者患側(cè)較健側(cè)CSA顯著性減小,且CSA的減小與FA值的降低呈正相關(guān),與ADC值的增高呈負(fù)相關(guān),提示TN組患側(cè)血管神經(jīng)壓迫點(diǎn)有明顯萎縮(橫斷面面積減小),且這種形態(tài)學(xué)改變與脫髓鞘改變有相關(guān)性,脫髓鞘程度越重神經(jīng)萎縮越嚴(yán)重。 3.DTI技術(shù)可以顯示血管壓迫性三叉神經(jīng)痛的神經(jīng)萎縮及脫髓鞘改變,可以進(jìn)一步指導(dǎo)TN的診斷和治療。
[Abstract]:Objective: to examine the 3.OT magnetic resonance diffusion tensor imaging (diffusion tensor imaging, DTI) sequence of healthy volunteers and TN patients, and to pass to the normal control group (control subjects) of the bilateral trigeminal nerve (trigeminal nerve, TGN) brain pool, and the three fork neuralgia group. Ssel, RV) the apparent diffusion coefficient (apparent diffusion coefficient, ADC) values and the partial anisotropy (Fractional Anisotrop, FA) values of the contralateral trigeminal nerve of the TN group were measured to compare the difference between the ADC values and the FA values of the three groups, and to investigate whether there was a correlation between the variation of the values and the changes of the values. The cross-sectional area (cross-sectional area, CSA) of the vascular compression point and the corresponding position TGN was observed. The correlation between the changes of CSA and the value of ADC and the value of FA was observed. By measuring the FA value, ADC value and the CSA of the morphological parameters of DTI, the correlation between the parameters and the TN was investigated, and a noninvasive pathological micro knot was established. A diagnostic model of magnetic resonance (MRI).
Materials and methods:
1. general information
1.1 healthy control group
40 normal volunteers (all volunteers who received consent before the examination and signed informed consent) were scanned with DTI sequence of MRI. All the volunteers had no symptoms and signs related to trigeminal nerve. 20 men, 20 women, 20-83 years old and 51.2 years old.
1.2TN group
40 cases of primary TN diagnosed in the Department of Neurosurgery of our hospital in September 2012 --2013 year were collected, including 16 male and 24 female, 21-74 years old and 53.3 years old. The range of course ranged from 3 years -20 years, averaging 5.7 years. All were unilateral facial pain, the right 19 cases, and the 21.TN group on the left side were divided into the affected side (ipsilateral TN). The contralateral TN group.
2. equipment and inspection methods
Using the PHILIPS Achieve3.0T MR superconducting scanner, the 8 channel phase array head special coils were selected, and the imaging sequences were: first, the normal control group and the TN group were first performed routine sequence scanning: cross section T2WI (TR/TE=3300ms/100ms), T1WI (TR/TE=550ms/15ms) and T2FLAIR sequence (TR/TE=6000ms/120ms). A (TR=5.0ms, TE=1.9ms); 3D-TOF-MRA plain scavenging and enhanced sequence (TR=16.0ms, TE=3.5ms) (TR=16.0ms, TE=3.5ms) (TR=16.0ms, TE=3.5ms) were used for T1WI-3D-TFE sequence (TR/TE=7.5ms/3.5ms) and DTI sequence (TR/TE=7687ms/76.6ms) in the normal control group and the TN group.
3. case grouping and image analysis
All data were processed in the EWS (Extended MR WorkSpace) workstation with Fibertrack and Diffusion software. The region of interest (region of interest, ROI) was selected and the FA value and the value were measured respectively in the region of interest (ROI). CSA. of GN
3.1 normal control group
On the fusion map of FA color map and T1WI-3D-TFE anatomy image, the brain pool section of bilateral TGN in normal control group is divided into four points according to distance, respectively, at the starting point of the TGN brainstem, the end point of the Meckel's cavity and the 1/3 between the two points (the starting point of the bridge section to the end point), and 2/3, to collect the ADC and FA values of the four points, and carry out both sides. The normal volunteers were divided into six groups, 7 cases under 30 years of age, 8 cases of 30-40 years old, 40-50 years and 12 cases, 50-60 years old and 6 cases, and 5 cases over 60 years old, respectively. The ADC and FA values of these six points were compared respectively.
3.2TN group
The values of FA and ADC were measured on the affected vascular compression points of the affected side, and the values of the corresponding contralateral asymptomatic side were measured by the ADC and FA maps generated by the Diffusion software. The FA values and ADC values of the TN group affected side, the healthy side of the TN group and the normal control group were compared with those of the normal control group, and the difference between the three groups was studied and the TN group was found. Whether the changes in the ADC value of the patient's side analysis were related to the changes in the FA value. In addition, the difference in the CSA of the bilateral TGN in TN patients and the correlation between the changes of the CSA and the FA value and the ADC value of the affected side of the affected side were compared.
4. statistical methods
SPSS18.0 was used for statistical analysis, and P0.05 (bilateral) was statistically significant. The measurement data were expressed by X + s.
First, a normal test was carried out for all statistics, such as normal distribution, t test (t-test) or single factor variance analysis (1-way analysis of variance, ANOVA); nonparametric test (non-parametric test) was not conformed to normal distribution (non-parametric test). (2) 40 cases of normal volunteers had different positions of the trigeminal nerve from the brainstem of the bilateral trigeminal nerve. And the ADC value of the paired t test (pair T test). According to age group, the FA value and ADC value of the different distances of the bilateral TGN bridge pool segments of each group are paired t test. Finally, the FA value and ADC value of the adjacent distance between the bridge pool section are analyzed by single factor variance, and the FA between the four points at any two points is respectively. The difference of value and ADC value was statistically analyzed. Third, the FA value and ADC value of the affected side and the healthy side of the TN group were paired t test, and the independent sample t test (independent samples T test) was used to compare the affected side of the TN group with the normal control group. Finally, the linear regression analysis was used to analyze and study the TGN. Whether there is a correlation between the change of FA value and the change of ADC, and draw a scatter plot and linear trend line. (4) a paired t test was used to compare the CSA of the bilateral TGN in TN patients, and the change of CSA and the value of ADC were studied by linear regression analysis, and whether the change of FA value was related.
Result錛，

本文編號：1968321