IVIM與DCE-MRI對RRMS病灶及NAWM區(qū)的研究
發(fā)布時間：2018-12-14 10:40
【摘要】：目的多發(fā)性硬化(Multiple sclerosis,MS)是最常見的一種中樞神經(jīng)系統(tǒng)慢性炎性脫髓鞘疾病,具有病灶多發(fā)、病程反復(fù)發(fā)作的特征,是造成青少年致殘的最主要原因。磁共振體素內(nèi)不相干運動(Intravoxel incoherent motion,IVIM)擴散成像是近年來快速發(fā)展的一種能無創(chuàng)、定量評估人體內(nèi)體素規(guī)模運動的成像方法,可準確反映組織微環(huán)境的擴散及灌注特點,目前此方法已得到廣泛應(yīng)用。動態(tài)增強磁共振成像(Dynamic contrast-enhanced magnetic resonance imaging,DCE-MRI)是近年來發(fā)展迅速并得到廣泛應(yīng)用的一種定量灌注成像方法,而目前用此方法對MS擴散及灌注特點的研究較少。本研究旨在探討運用IVIM和DCE-MRI定量分析MS患者病灶及看似正常白質(zhì)(normal-appearing white matter,NAWM)區(qū)微血管滲透性、灌注及分子擴散狀態(tài)的可行性,以期進一步研究MS微循環(huán)的病理生理及血流動力學(xué)改變。材料與方法27例復(fù)發(fā)-緩解型多發(fā)性硬化(RRMS)患者行常規(guī)MRI和IVIM掃描,取多個b值(10,20,30,40,50,100,150,200,350,500,650,800,1000 s/mm2),獲取反映RRMS患者病灶及NAWM區(qū)組織擴散特點的表觀擴散系數(shù)(apparent diffusion coefficient,ADC)、ADCslow、ADCfast及組織微血管灌注f值。23例RRMS患者行常規(guī)MRI和DCE-MRI檢查并應(yīng)用單室Patlak模型后處理,定量分析MS患者病灶及NAWM區(qū)反映微血管滲透性的標記物即容積轉(zhuǎn)移常數(shù)Ktrans、血漿內(nèi)對比劑百分比Vp及灌注參數(shù):腦血流量(CBF)和腦血容量(CBV)值。結(jié)果1)非強化病灶區(qū)的ADC、ADCslow、ADCfast明顯高于病灶旁及遠離病灶的NAWM區(qū)(H1=46.16,H2=27.32,H3=8.93,P0.05)。而非強化病灶區(qū)的f值明顯低于病灶旁及遠離病灶的NAWM區(qū)(H=17.99,P0.05)。病灶旁NAWM區(qū)與遠離病灶的NAWM區(qū)均無統(tǒng)計學(xué)意義(P0.05)。2)非強化病灶、病灶旁NAWM區(qū)及遠離病灶的NAWM區(qū)之間兩兩比較,MS患者非強化病灶的Ktrans明顯高于遠離病灶的NAWM區(qū)(χ2=7.58,P0.05)。其余兩組間的Ktrans值差異無統(tǒng)計學(xué)意義(P0.05)。3)非強化病灶CBV明顯高于遠離病灶的NAWM區(qū),差異有統(tǒng)計學(xué)意義(χ2=6.39,P0.05)。非強化病灶的CBV略高于病灶旁NAWM區(qū),但均無統(tǒng)計學(xué)意義(P0.05)。4)非強化病灶、病灶旁NAWM區(qū)及遠離病灶的NAWM區(qū)三組之間的Vp、CBF值差異均無統(tǒng)計學(xué)意義(P0.05)。結(jié)論磁共振IVIM成像能定量分析RRMS患者病灶與NAWM區(qū)組織的擴散及灌注特點,有助于推測病灶的病理改變,對損傷分類及鑒別提供幫助。DCE-MRI采用Patlak模型能定量分析MS患者病灶及NAWM區(qū)的微血管滲透及灌注特點,準確地反應(yīng)MS的血流動力學(xué)改變。
[Abstract]:Objective multiple sclerosis (Multiple sclerosis,MS) is the most common chronic inflammatory demyelinating disease of central nervous system. (Intravoxel incoherent motion,IVIM diffusion imaging is a kind of noninvasive imaging method which can be developed rapidly in recent years. It can accurately reflect the diffusion and perfusion characteristics of tissue microenvironment by quantitatively evaluating the size motion of human voxel. At present, this method has been widely used. Dynamic enhanced magnetic resonance imaging (Dynamic contrast-enhanced magnetic resonance imaging,DCE-MRI) is a rapidly developed and widely used quantitative perfusion imaging method in recent years, but it is seldom used to study the diffusion and perfusion characteristics of MS. The purpose of this study was to investigate the feasibility of quantitative analysis of microvascular permeability, perfusion and molecular diffusion in patients with MS and in the seemingly normal white matter (normal-appearing white matter,NAWM) area by IVIM and DCE-MRI. To further study the pathophysiological and hemodynamic changes of MS microcirculation. Materials and methods 27 patients with relapsed and remitting multiple sclerosis (RRMS) underwent routine MRI and IVIM scans, and multiple b values (10 ~ 20 ~ 30 ~ 4050 ~ 50 ~ 100 ~ 150 ~ 150 ~ 100 ~ 200 ~ 350 ~ 500 ~ 650 ~ 800 ~ 1000 s/mm2) were taken to obtain the apparent diffusion coefficient (apparent diffusion coefficient,ADC), which could reflect the characteristics of the lesions and the tissue diffusion in the NAWM area of RRMS patients. ADCslow,ADCfast and tissue microvascular perfusion f value. 23 patients with RRMS were examined by routine MRI and DCE-MRI and treated with single compartment Patlak model. Quantitative analysis of the lesion and NAWM marker reflecting microvascular permeability in MS patients, I. e., volume transfer constant Ktrans, Vp and perfusion parameters: cerebral blood flow (CBF) and cerebral blood volume (CBV). Results 1) the ADC,ADCslow,ADCfast in the unenhanced lesion area was significantly higher than that in the NAWM region near the lesion and far away from the lesion (H1 46.16H _ 2H _ (27.32) H _ (3) P _ (8.93) P _ (0.05). The f value of the unenhanced focus area was significantly lower than that of the NAWM region (P 0.05). There was no significant difference between the adjacent NAWM area and the NAWM region away from the lesion (P0.05). There was no significant difference between the adjacent NAWM area and the NAWM region away from the lesion. The Ktrans of unenhanced lesions in MS patients was significantly higher than that in NAWM areas far away from the lesions (蠂 2 7.58 P 0.05). There was no significant difference in Ktrans between the other two groups (P0.05). 3) the CBV of unenhanced focus was significantly higher than that of far away NAWM (蠂 2 + 6.39% P 0.05). The CBV of the unenhanced lesions was slightly higher than that of the adjacent NAWM areas, but there was no statistical significance (P0.05). There was no significant difference in Vp,CBF values between the three groups in the NAWM region adjacent to the lesion and the NAWM area away from the lesion (P0.05). Conclusion IVIM imaging can quantitatively analyze the characteristics of diffusion and perfusion between the lesions and the NAWM area in RRMS patients, and is helpful to speculate the pathological changes of the lesions. DCE-MRI with Patlak model can quantitatively analyze the characteristics of microvascular permeability and perfusion in the lesion and NAWM area of MS patients, and accurately reflect the hemodynamic changes of MS.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R445.2;R744.51
本文編號：2378471
[Abstract]:Objective multiple sclerosis (Multiple sclerosis,MS) is the most common chronic inflammatory demyelinating disease of central nervous system. (Intravoxel incoherent motion,IVIM diffusion imaging is a kind of noninvasive imaging method which can be developed rapidly in recent years. It can accurately reflect the diffusion and perfusion characteristics of tissue microenvironment by quantitatively evaluating the size motion of human voxel. At present, this method has been widely used. Dynamic enhanced magnetic resonance imaging (Dynamic contrast-enhanced magnetic resonance imaging,DCE-MRI) is a rapidly developed and widely used quantitative perfusion imaging method in recent years, but it is seldom used to study the diffusion and perfusion characteristics of MS. The purpose of this study was to investigate the feasibility of quantitative analysis of microvascular permeability, perfusion and molecular diffusion in patients with MS and in the seemingly normal white matter (normal-appearing white matter,NAWM) area by IVIM and DCE-MRI. To further study the pathophysiological and hemodynamic changes of MS microcirculation. Materials and methods 27 patients with relapsed and remitting multiple sclerosis (RRMS) underwent routine MRI and IVIM scans, and multiple b values (10 ~ 20 ~ 30 ~ 4050 ~ 50 ~ 100 ~ 150 ~ 150 ~ 100 ~ 200 ~ 350 ~ 500 ~ 650 ~ 800 ~ 1000 s/mm2) were taken to obtain the apparent diffusion coefficient (apparent diffusion coefficient,ADC), which could reflect the characteristics of the lesions and the tissue diffusion in the NAWM area of RRMS patients. ADCslow,ADCfast and tissue microvascular perfusion f value. 23 patients with RRMS were examined by routine MRI and DCE-MRI and treated with single compartment Patlak model. Quantitative analysis of the lesion and NAWM marker reflecting microvascular permeability in MS patients, I. e., volume transfer constant Ktrans, Vp and perfusion parameters: cerebral blood flow (CBF) and cerebral blood volume (CBV). Results 1) the ADC,ADCslow,ADCfast in the unenhanced lesion area was significantly higher than that in the NAWM region near the lesion and far away from the lesion (H1 46.16H _ 2H _ (27.32) H _ (3) P _ (8.93) P _ (0.05). The f value of the unenhanced focus area was significantly lower than that of the NAWM region (P 0.05). There was no significant difference between the adjacent NAWM area and the NAWM region away from the lesion (P0.05). There was no significant difference between the adjacent NAWM area and the NAWM region away from the lesion. The Ktrans of unenhanced lesions in MS patients was significantly higher than that in NAWM areas far away from the lesions (蠂 2 7.58 P 0.05). There was no significant difference in Ktrans between the other two groups (P0.05). 3) the CBV of unenhanced focus was significantly higher than that of far away NAWM (蠂 2 + 6.39% P 0.05). The CBV of the unenhanced lesions was slightly higher than that of the adjacent NAWM areas, but there was no statistical significance (P0.05). There was no significant difference in Vp,CBF values between the three groups in the NAWM region adjacent to the lesion and the NAWM area away from the lesion (P0.05). Conclusion IVIM imaging can quantitatively analyze the characteristics of diffusion and perfusion between the lesions and the NAWM area in RRMS patients, and is helpful to speculate the pathological changes of the lesions. DCE-MRI with Patlak model can quantitatively analyze the characteristics of microvascular permeability and perfusion in the lesion and NAWM area of MS patients, and accurately reflect the hemodynamic changes of MS.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R445.2;R744.51
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