本文選題：急性期彌漫性軸索損傷 + 磁共振��； 參考：《中南大學(xué)》2014年碩士論文

【摘要】：目的：探討磁共振彌散張量成像(diffusion tensor imaging,DTI)在急性期彌漫性軸索損傷中的診斷價(jià)值,并評(píng)估DTI對(duì)急性期彌漫性軸索損傷的嚴(yán)重程度以及預(yù)后的意義。 材料和方法：研究對(duì)象分為DAI組及正常對(duì)照組,DAI組為符合彌漫性診斷診斷標(biāo)準(zhǔn)的21例急性期(4.05±1.63d)彌漫性軸索損傷患者,男性15例,女性6例,年齡19-57歲,平均37.2歲。對(duì)照組選擇與DAI組年齡、性別匹配的健康自愿者(對(duì)照組)21例。均進(jìn)行常規(guī)磁共振T1加權(quán)(T1weighted imaging, T1WI)、T2加權(quán)(T2weighted imaging,T2WI)、液體衰減反轉(zhuǎn)恢復(fù)序列(Fluid attenuated inversion recovery, FLAIR)序列及DTI。使用思創(chuàng)(CreaLife) DTI分析軟件對(duì)圖像進(jìn)行處理,選取包括胼胝體膝部、胼胝體體部、胼胝體壓部、內(nèi)囊前肢、內(nèi)囊后肢、大腦腳感興趣區(qū),得到不同感興趣區(qū)的各項(xiàng)異性分?jǐn)?shù)(fractional anisotropy, FA),相對(duì)各項(xiàng)異性指數(shù)(relative anisotropy, RA),表觀彌散系數(shù)(apparent diffusion coefficient,ADC)。然后比較DAI組與對(duì)照組相應(yīng)區(qū)域的FA值,RA值,ADC值。 用思創(chuàng)DTT軟件用選取感興趣區(qū)法在矢狀位FA圖勾勒胼胝體、內(nèi)囊及大腦腳,進(jìn)行纖維束追蹤,重建出所通過的纖維束三維圖像,請(qǐng)三位有經(jīng)驗(yàn)的醫(yī)師對(duì)重建的纖維束進(jìn)行分析。 在DAI患者急性期(4.05±1.63d)與恢復(fù)期(7.86±1.49m)分別進(jìn)行GCS (Glasgow Coma Scale)評(píng)分及GOS (Glasgow Outcome Scale)評(píng)分,并與DAI組不同感興趣區(qū)FA值,RA值,ADC值進(jìn)行相關(guān)性分析。 結(jié)果： 1、急性期DAI與正常對(duì)照的DTI成像比較： 急性期DAI胼胝體壓部(0.59±0.07)、胼胝體膝部(0.68±0.05)、內(nèi)囊后肢(0.64±0.03)、大腦腳(0.58±0.05)FA值與對(duì)照組比較,差異有統(tǒng)計(jì)學(xué)意義(P0.05)；急性期DAI胼胝體壓部(0.58±0.03)、胼胝體體部(0.60±0.02)、內(nèi)囊后肢(0.52±0.03)、大腦腳(0.49±0.04)RA值與對(duì)照組比較,差異有統(tǒng)計(jì)學(xué)意義(P0.05);急性期DAI胼胝體壓部(0.73±0.04)、內(nèi)囊后肢(0.65±0.03)ADC值與對(duì)照組比較,差異有統(tǒng)計(jì)學(xué)意義；兩組間胼胝體體部、內(nèi)囊前肢FA值的差異無統(tǒng)計(jì)學(xué)意義(P0.05)。 2、急性期DAI的DTI改變與DAI嚴(yán)重程度的相關(guān)性分析： 急性期DAI組胼胝體壓部、內(nèi)囊后肢、大腦腳FA值與GCS評(píng)分有相關(guān)性(P0.05),胼胝體壓部、大腦腳RA值與GCS評(píng)分有相關(guān)性(P0.05),胼胝體壓部ADC值與GCS評(píng)分有相關(guān)性(P0.05)。 3、急性期DAI組的DTI改變與DAI預(yù)后的相關(guān)性分析： 急性期DAI組的胼胝體壓部、大腦腳FA值與GOS評(píng)分有相關(guān)性(P0.05),胼胝體壓部RA值與GOS評(píng)分有相關(guān)性,各感興趣區(qū)ADC值與GOS評(píng)分無相關(guān)性(P0.05)。 4、急性期DAI組的彌散張量纖維束成像：其中12例表現(xiàn)為受損部位白質(zhì)纖維束略稀疏,4例表現(xiàn)為損傷部位纖維束中斷,5例未見明顯異常。 結(jié)論： 1.急性期DAI組患者的腦深部白質(zhì)纖維束的DTI的FA、RA、ADC值與正常對(duì)照組比較有差異,提示DTI能反映DAI白質(zhì)纖維束損傷的異常彌散改變,DTI可成為早期診斷DAI的手段。 2.急性期DAI組患者腦深部白質(zhì)纖維束的DTI的FA,RA、ADC值與GCS評(píng)分有相關(guān)性,DTI可作為評(píng)估DAI患者嚴(yán)重程度的方法。 3、急性期DAI組患者腦深部白質(zhì)纖維束的DTI的FA、RA值與GOS評(píng)分有相關(guān)性,ADC值與GOS評(píng)分無相關(guān)性。DTI可在一定程度上判斷DAI患者預(yù)后。 4、DTT能提供白質(zhì)纖維束受損的可視化依據(jù)。
[Abstract]:Objective: To evaluate the diagnostic value of diffusion tensor imaging (DTI) in acute diffuse axonal injury and to evaluate the significance of DTI for the severity and prognosis of acute diffuse axonal injury.
Materials and methods: the subjects were divided into DAI group and normal control group. Group DAI was 21 patients with diffuse axonal injury (4.05 + 1.63d) with diffuse diagnostic criteria, 15 men, 6 women, 19-57 years old and 37.2 years old. The control group was selected with the age of DAI and 21 cases of sex matched healthy volunteers (control group). Routine magnetic resonance T1 weighted (T1weighted imaging, T1WI), T2 weighted (T2weighted imaging, T2WI), liquid attenuation inversion recovery sequence (Fluid attenuated inversion recovery) sequence and processing software were used to deal with the image, including the corpus callosum, corpus callosum, corpus callosum pressure part. The capsular forelimb, the inner capsule hind limbs, the cerebrum sense of interest, the fractional anisotropy, FA, the relative heterosexual index (relative anisotropy, RA), the apparent dispersion coefficient (apparent diffusion coefficient, ADC). Then the FA value, the value, and the value of the DAI group and the control group are compared.
Using the selected DTT software, the corpus callosum, the inner capsule and the cerebrum foot were outlined in the sagittal FA map with the selected region of interest method. The fiber bundle was tracked and the three-dimensional image of the fiber bundle was reconstructed. Three experienced doctors were asked to analyze the reconstructed fiber bundle.
The scores of GCS (Glasgow Coma Scale) and GOS (Glasgow Outcome Scale) were scored in the acute phase (4.05 + 1.63d) and the recovery period (7.86 + 1.49M) of the patients with DAI, and the correlation analysis was carried out with the values, values and values of the different regions of interest in the DAI group.
Result錛，

本文編號(hào)：1919793