磁共振彌散張量成像在脊髓腫瘤的臨床應(yīng)用研究
發(fā)布時(shí)間：2018-07-30 07:11
【摘要】：第一部分健康人脊髓磁共振彌散張量成像的初步研究 目的：利用磁共振彌散張量成像(DTI)的方法,對(duì)健康志愿者進(jìn)行脊髓掃描,探討脊髓DTI掃描技術(shù)的臨床應(yīng)用。 方法：對(duì)24例健康志愿者(平均年齡34.08±12.63歲)分段進(jìn)行脊髓DTI掃描,其中頸段、上胸段、下胸段各8例。利用MedINRIA軟件對(duì)掃描后所得的數(shù)據(jù)進(jìn)行分析。根據(jù)手動(dòng)勾勒的感興趣區(qū)(ROI),將脊髓橫截面整體納入ROI范圍內(nèi)。逐個(gè)節(jié)段計(jì)算FA值、ADC值和FT值,計(jì)算各節(jié)段FT值與該次掃描的最高節(jié)段FT值的比值,即FTR。觀察健康人脊髓DTI圖像及彌散張量纖維束成像(DTT)的圖像特點(diǎn),分析DTI掃描分?jǐn)?shù)各向異性(FA)、表觀彌散系數(shù)(ADC)、纖維束數(shù)量(FT)及纖維束比值(FTR)在不同節(jié)段、性別及年齡間的特點(diǎn)。 結(jié)果：掃描后計(jì)算獲得整體脊髓的FA值為0.647±0.065,ADC值為1.175±0.170,FT值為1998±620.9,FTR值為0.789±0.177。DTI圖像顯示脊髓形態(tài)正常,FA圖像顯示脊髓以藍(lán)色(脊髓縱軸方向)信號(hào)為主,ADC圖像顯示脊髓呈稍低信號(hào),DTT圖像顯示脊髓纖維走行自然,主要沿脊髓縱軸方向排列。頸段、上胸段、下胸段脊髓間DTI掃描FA值無顯著差異(P0.05),ADC值、FT值及FTR之間的差異有統(tǒng)計(jì)學(xué)意義(P0.05),脊髓各節(jié)段間FA值、ADC值、FT值和FTR存在差異(P0.05)。不同性別間脊髓DTI參數(shù)無顯著差異(P0.05)。年齡(23-58歲)與脊髓DTI各參數(shù)值間無直線相關(guān)關(guān)系(P0.05)。 結(jié)論：脊髓DTI及DTT圖像能夠較好地顯示脊髓形態(tài)、結(jié)構(gòu)和各向異性信息。脊髓DTI掃描參數(shù)值在各節(jié)段的之間存在差異,性別與年齡對(duì)脊髓DTI掃描各參數(shù)無明顯影響。DTI掃描能夠直觀、定量地為脊髓的臨床研究提供參考信息。 第二部分磁共振彌散張量成像在脊髓腫瘤的臨床應(yīng)用 目的：利用磁共振彌散張量成像(DTI)的方法,對(duì)脊髓腫瘤患者及對(duì)照組受檢者進(jìn)行掃描,探討DTI技術(shù)在脊髓腫瘤的臨床應(yīng)用。 方法：分別對(duì)20例脊髓腫瘤組患者和20例對(duì)照組受檢者的相應(yīng)節(jié)段進(jìn)行脊髓DTI掃描。利用MedINRIA軟件對(duì)掃描后所得的數(shù)據(jù)進(jìn)行分析。根據(jù)手動(dòng)勾勒的感興趣區(qū)(ROI),將脊髓橫截面整體納入ROI范圍內(nèi)。逐層計(jì)算FA值、ADC值和FT值,計(jì)算脊髓腫瘤組病灶層FT值與病灶上層和病灶下層FT值的比值,以及對(duì)照組中層FT值與上層和下層FT值的比值(FTR1、FTR2)。脊髓腫瘤組患者進(jìn)行McCormik分級(jí)、脊髓獨(dú)立測(cè)量(SCIM)評(píng)分、美國(guó)脊髓損傷協(xié)會(huì)脊髓殘損分級(jí)(AIS)和脊髓損傷神經(jīng)學(xué)分類國(guó)際標(biāo)準(zhǔn)評(píng)分(ISNCSCI),包括評(píng)分總分、運(yùn)動(dòng)評(píng)分、感覺評(píng)分。觀察脊髓腫瘤患者脊髓DTI圖像及彌散張量纖維束成像(DTT)的圖像特點(diǎn),分析脊髓腫瘤的DTI掃描分?jǐn)?shù)各向異性(FA)、表觀彌散系數(shù)(ADC)、纖維束數(shù)量(FT)及纖維束比值(FTR)的特點(diǎn),分析髓外腫瘤與髓內(nèi)腫瘤DTI掃描參數(shù)的特征,研究脊髓腫瘤DTI掃描參數(shù)值與臨床評(píng)分間的相關(guān)性。 結(jié)果：掃描后計(jì)算獲得脊髓腫瘤組受檢者脊髓平均FA值為0.607±0.104,ADC值為1.405±0.294,FT值為1746±554.4,FTR2為0.739±0.173,FTR2為0.808±0.198。對(duì)照組受檢者脊髓的平均FA值為0.649±0.048,ADC值為1.161±0.132,FT值為2005.6±403.8,FTR2值為0.998±0.034,FTR2為1.011±0.049。圖像上髓外腫瘤以脊髓受壓移位為主要表現(xiàn)；髓內(nèi)腫瘤相應(yīng)部位脊髓外形增粗,髓內(nèi)信號(hào)異常。在FA圖上,髓外腫瘤患者脊髓以藍(lán)色信號(hào)為主,瘤體內(nèi)呈混雜信號(hào)；髓內(nèi)腫瘤患者脊髓信號(hào)混雜。ADC圖顯示,髓外腫瘤患者脊髓受壓部位信號(hào)稍高,髓內(nèi)腫瘤患者脊髓信號(hào)呈點(diǎn)片狀升高。DTT圖上顯示,髓外腫瘤生長(zhǎng)部位脊髓纖維束受壓變形,髓內(nèi)腫瘤生長(zhǎng)部位可見脊髓纖維束結(jié)構(gòu)破壞。脊髓腫瘤組與對(duì)照組DTI掃描FA值、ADC值、FT值和FTR之間的差異有統(tǒng)計(jì)學(xué)意義(P0.05),脊髓腫瘤組病灶上層DTI參數(shù)值與對(duì)照組比較無明顯差異(P0.05),病灶層和病灶下層與對(duì)照組比較有明顯差異(P0.05)。脊髓腫瘤組各層面的DTI參數(shù)值之間存在顯著差異(P0.05)。髓外腫瘤與髓內(nèi)腫瘤患者脊髓的FA值、ADC值、FT值以及FTR之間差異有統(tǒng)計(jì)學(xué)意義(P0.05)。脊髓腫瘤病灶層的FA值、ADC值、FT值和FTR與患者臨床評(píng)分除ADC值與AIS分級(jí)之間無明顯直線相關(guān)關(guān)系(P0.05)外,其他各參數(shù)值與評(píng)分值之間均存在直線相關(guān)關(guān)系(P0.05)。 結(jié)論：脊髓腫瘤DTI掃描能夠顯示脊髓形態(tài)、結(jié)構(gòu)及各向異性改變,DTT圖像能夠顯示脊髓纖維束的移位和損傷情況。脊髓腫瘤的DTI掃描參數(shù)值出現(xiàn)異常,髓外腫瘤與髓內(nèi)腫瘤患者脊髓的DTI參數(shù)值亦存在差異,脊髓腫瘤DTI掃描的參數(shù)值與臨床評(píng)分所反映的脊髓功能缺失基本一致。DTI掃描參數(shù)值能夠較好地反映脊髓腫瘤患者的脊髓損傷和神經(jīng)功能情況。
[Abstract]:Part I preliminary study of diffusion tensor imaging in healthy human spinal cord
Objective: To investigate the clinical application of DTI scanning technique in healthy volunteers by magnetic resonance diffusion tensor imaging (DTI).
Methods: 24 healthy volunteers (the average age of 34.08 + 12.63 years) were divided into the spinal cord DTI scans, including the cervical, upper thoracic and lower thoracic segments in 8 cases. The MedINRIA software was used to analyze the scanned data. The spinal cord cross section was integrated into the ROI range according to the manually outlined region of interest (ROI). The FA value was calculated one by one, ADC. Value and FT value, calculate the ratio of the FT value of each segment to the maximum segment FT of the scan, that is, the image characteristics of the DTI image of the spinal cord and the diffusion tensor fiber beam imaging (DTT) in healthy people, and the analysis of the DTI scan fractional anisotropy (FA), the apparent dispersion coefficient (ADC), the number of fiber bundles (FT) and the fiber bundle ratio (FTR) in different segments, sex and year. The characteristics of the age.
Results: after scanning, the FA value of the whole spinal cord was 0.647 + 0.065, the ADC value was 1.175 + 0.170, the FT value was 1998 + 620.9, the FTR value was 0.789 + 0.177.DTI, the spinal cord was normal, the FA image showed the spinal cord in blue (the longitudinal axis of the spinal cord) signal, the ADC image showed a slightly lower signal in the spinal cord and the DTT image showed the spinal fiber walking self. However, there was no significant difference in the FA value of DTI scan between the cervical segment, the upper thoracic segment and the lower thoracic segment of the spinal cord (P0.05), and the difference between the ADC value, the FT value and the FTR was statistically significant (P0.05). There was a difference between the FA values, ADC values, FT values and FTR (P0.05) between the segments of the spinal cord (P0.05). The age (23-58 years old). There was no linear correlation between DTI values and spinal cord parameters (P0.05).
Conclusion: the DTI and DTT images of spinal cord can better display the morphological, structural and anisotropic information of spinal cord. There is a difference between the parameters of the spinal cord DTI scanning parameters between the segments. There is no obvious influence of sex and age on the parameters of the spinal cord DTI scan, and the.DTI scan can be intuitionistic and provide reference information for the clinical study of spinal cord.
The second part of magnetic resonance diffusion tensor imaging in the clinical application of spinal cord tumors
Objective: to scan the patients of spinal cord tumor and control group by using the method of magnetic resonance diffusion tensor imaging (DTI) to explore the clinical application of DTI in the spinal cord tumor.
Methods: the spinal cord DTI scan was performed on the corresponding segments of 20 patients with spinal cord tumor and 20 control groups. The data were analyzed by MedINRIA software. The spinal cord cross section was integrated into the ROI range according to the manual intramedullary region of interest (ROI). The FA value, ADC value and FT value were calculated by layer by layer, and the spinal swelling was calculated. The ratio of the FT value of the tumor layer to the upper layer and the lower FT value of the lesion, and the ratio of the middle layer FT to the upper and lower FT values (FTR1, FTR2) in the control group. The patients in the spinal cord tumor group were graded by McCormik, independent of the spinal cord (SCIM) score, the spinal cord damage classification (AIS) and the international standard of Neurology for spinal cord injury. Score (ISNCSCI), including score total score, exercise score, sensory score. The characteristics of the spinal cord tumor patients' spinal cord DTI image and diffusion tensor fiber bundle imaging (DTT) were observed, and the DTI scan score anisotropy (FA), apparent diffusion coefficient (ADC), the quantity of fiber bundle (FT) and fiber bundle ratio (FTR) of spinal tumors were analyzed, and the extramedullary tumors were analyzed. And the characteristics of DTI scanning parameters in intramedullary tumors, and to study the correlation between DTI scan parameters and clinical scores.
Results: after scanning, the average FA value of spinal cord was 0.607 + 0.104, ADC value was 1.405 + 0.294, FT value was 1746 + 554.4, FTR2 was 0.739 + 0.173, FTR2 was 0.808 + 0.198. control group, and the average FA value of spinal cord was 0.649 + 0.048, ADC value was 1.161 + 0.132, FT value was 1.405 011 + 0.049. images of extramedullary tumors were mainly manifested by compression of the spinal cord. The spinal cord of the intramedullary tumor was thickened and the intramedullary signal was abnormal. On the FA map, the spinal cord of the patients with extramedullary tumors was mainly blue signal, and the tumor was mixed signal. The intramedullary tumor patients' spinal cord signal mixed.ADC map showed the spinal cord compression of the extramedullary tumor patients. The signal of the location of the spinal cord was slightly higher, and the spinal cord signal in the intramedullary tumor was raised on the.DTT map. The spinal fiber bundles were compressed and the spinal cord fibrous structural damage was seen in the growth parts of the intramedullary tumor. The FA value, the ADC value, the FT value and the FTR between the spinal tumor group and the control group were statistically significant (P0.05), and the spinal cord was statistically significant (P0.05). There was no significant difference in the DTI parameters between the lesions of the myeloid tumor group and the control group (P0.05). The lesion layer and the lower layer of the lesion were significantly different from the control group (P0.05). There was a significant difference between the parameters of the DTI parameters at various levels of the spinal cord tumor group (P0.05). There were differences between the FA value, the ADC value, FT value and FTR between the extramedullary and intramedullary tumor patients. Statistical significance (P0.05). There was a linear correlation between the FA value, ADC value, FT value and FTR of the lesion layer of the spinal cord tumor and the patient's clinical score except the ADC value and the AIS classification (P0.05), and there was a linear correlation between the values of the other parameters and the score values (P0.05).
Conclusion: DTI scan of spinal cord tumor can show morphological, structural and anisotropic changes in spinal cord. DTT images can show the displacement and damage of spinal cord fibers. The DTI scanning parameters of spinal tumors are abnormal, and the parameters of DTI parameters in the spinal cord of extramedullary and intramedullary tumors are also different. The parameters of the DTI scan of spinal tumors and the presence of the spinal cord tumor The score of the spinal cord is basically consistent with that of the.DTI score. It can better reflect the spinal cord injury and neurological function in patients with spinal cord tumors.
【學(xué)位授予單位】：第二軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2014
【分類號(hào)】：R739.42;R445.2
本文編號(hào)：2154239
[Abstract]:Part I preliminary study of diffusion tensor imaging in healthy human spinal cord
Objective: To investigate the clinical application of DTI scanning technique in healthy volunteers by magnetic resonance diffusion tensor imaging (DTI).
Methods: 24 healthy volunteers (the average age of 34.08 + 12.63 years) were divided into the spinal cord DTI scans, including the cervical, upper thoracic and lower thoracic segments in 8 cases. The MedINRIA software was used to analyze the scanned data. The spinal cord cross section was integrated into the ROI range according to the manually outlined region of interest (ROI). The FA value was calculated one by one, ADC. Value and FT value, calculate the ratio of the FT value of each segment to the maximum segment FT of the scan, that is, the image characteristics of the DTI image of the spinal cord and the diffusion tensor fiber beam imaging (DTT) in healthy people, and the analysis of the DTI scan fractional anisotropy (FA), the apparent dispersion coefficient (ADC), the number of fiber bundles (FT) and the fiber bundle ratio (FTR) in different segments, sex and year. The characteristics of the age.
Results: after scanning, the FA value of the whole spinal cord was 0.647 + 0.065, the ADC value was 1.175 + 0.170, the FT value was 1998 + 620.9, the FTR value was 0.789 + 0.177.DTI, the spinal cord was normal, the FA image showed the spinal cord in blue (the longitudinal axis of the spinal cord) signal, the ADC image showed a slightly lower signal in the spinal cord and the DTT image showed the spinal fiber walking self. However, there was no significant difference in the FA value of DTI scan between the cervical segment, the upper thoracic segment and the lower thoracic segment of the spinal cord (P0.05), and the difference between the ADC value, the FT value and the FTR was statistically significant (P0.05). There was a difference between the FA values, ADC values, FT values and FTR (P0.05) between the segments of the spinal cord (P0.05). The age (23-58 years old). There was no linear correlation between DTI values and spinal cord parameters (P0.05).
Conclusion: the DTI and DTT images of spinal cord can better display the morphological, structural and anisotropic information of spinal cord. There is a difference between the parameters of the spinal cord DTI scanning parameters between the segments. There is no obvious influence of sex and age on the parameters of the spinal cord DTI scan, and the.DTI scan can be intuitionistic and provide reference information for the clinical study of spinal cord.
The second part of magnetic resonance diffusion tensor imaging in the clinical application of spinal cord tumors
Objective: to scan the patients of spinal cord tumor and control group by using the method of magnetic resonance diffusion tensor imaging (DTI) to explore the clinical application of DTI in the spinal cord tumor.
Methods: the spinal cord DTI scan was performed on the corresponding segments of 20 patients with spinal cord tumor and 20 control groups. The data were analyzed by MedINRIA software. The spinal cord cross section was integrated into the ROI range according to the manual intramedullary region of interest (ROI). The FA value, ADC value and FT value were calculated by layer by layer, and the spinal swelling was calculated. The ratio of the FT value of the tumor layer to the upper layer and the lower FT value of the lesion, and the ratio of the middle layer FT to the upper and lower FT values (FTR1, FTR2) in the control group. The patients in the spinal cord tumor group were graded by McCormik, independent of the spinal cord (SCIM) score, the spinal cord damage classification (AIS) and the international standard of Neurology for spinal cord injury. Score (ISNCSCI), including score total score, exercise score, sensory score. The characteristics of the spinal cord tumor patients' spinal cord DTI image and diffusion tensor fiber bundle imaging (DTT) were observed, and the DTI scan score anisotropy (FA), apparent diffusion coefficient (ADC), the quantity of fiber bundle (FT) and fiber bundle ratio (FTR) of spinal tumors were analyzed, and the extramedullary tumors were analyzed. And the characteristics of DTI scanning parameters in intramedullary tumors, and to study the correlation between DTI scan parameters and clinical scores.
Results: after scanning, the average FA value of spinal cord was 0.607 + 0.104, ADC value was 1.405 + 0.294, FT value was 1746 + 554.4, FTR2 was 0.739 + 0.173, FTR2 was 0.808 + 0.198. control group, and the average FA value of spinal cord was 0.649 + 0.048, ADC value was 1.161 + 0.132, FT value was 1.405 011 + 0.049. images of extramedullary tumors were mainly manifested by compression of the spinal cord. The spinal cord of the intramedullary tumor was thickened and the intramedullary signal was abnormal. On the FA map, the spinal cord of the patients with extramedullary tumors was mainly blue signal, and the tumor was mixed signal. The intramedullary tumor patients' spinal cord signal mixed.ADC map showed the spinal cord compression of the extramedullary tumor patients. The signal of the location of the spinal cord was slightly higher, and the spinal cord signal in the intramedullary tumor was raised on the.DTT map. The spinal fiber bundles were compressed and the spinal cord fibrous structural damage was seen in the growth parts of the intramedullary tumor. The FA value, the ADC value, the FT value and the FTR between the spinal tumor group and the control group were statistically significant (P0.05), and the spinal cord was statistically significant (P0.05). There was no significant difference in the DTI parameters between the lesions of the myeloid tumor group and the control group (P0.05). The lesion layer and the lower layer of the lesion were significantly different from the control group (P0.05). There was a significant difference between the parameters of the DTI parameters at various levels of the spinal cord tumor group (P0.05). There were differences between the FA value, the ADC value, FT value and FTR between the extramedullary and intramedullary tumor patients. Statistical significance (P0.05). There was a linear correlation between the FA value, ADC value, FT value and FTR of the lesion layer of the spinal cord tumor and the patient's clinical score except the ADC value and the AIS classification (P0.05), and there was a linear correlation between the values of the other parameters and the score values (P0.05).
Conclusion: DTI scan of spinal cord tumor can show morphological, structural and anisotropic changes in spinal cord. DTT images can show the displacement and damage of spinal cord fibers. The DTI scanning parameters of spinal tumors are abnormal, and the parameters of DTI parameters in the spinal cord of extramedullary and intramedullary tumors are also different. The parameters of the DTI scan of spinal tumors and the presence of the spinal cord tumor The score of the spinal cord is basically consistent with that of the.DTI score. It can better reflect the spinal cord injury and neurological function in patients with spinal cord tumors.
【學(xué)位授予單位】：第二軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2014
【分類號(hào)】：R739.42;R445.2
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