本文選題：非癡呆型血管性認(rèn)知障礙 + 氫質(zhì)子磁共振波譜�。� 參考：《華中科技大學(xué)》2013年碩士論文

【摘要】：本研究分為兩個部分，分別采用氫質(zhì)子磁共振波譜（Proton Magnetic ResonanceSpectroscopy，~1H-MRS）技術(shù)、擴(kuò)散張量成像（Diffusion Tensor Imaging，DTI）技術(shù)了解非癡呆型血管性認(rèn)知障礙（vascular cognitive impairment no dementia，VCIND）患者腦灰質(zhì)代謝變化和腦白質(zhì)隱匿性損傷特點，分析VCIND組各感興趣區(qū)~1H-MRS、DTI指標(biāo)與蒙特利埃認(rèn)知評估量表（Montreal Cognitive Assessment，MoCA）評分之間的相關(guān)性，評價腦灰質(zhì)~1H-MRS檢測及腦白質(zhì)DTI檢查在VCIND早期診斷和病情評價中的應(yīng)用價值。 第一部分非癡呆型血管性認(rèn)知障礙的氫質(zhì)子磁共振波譜研究 目的：通過單體素~1H-MRS技術(shù)來探討VCIND患者腦灰質(zhì)的代謝變化特點，評價腦灰質(zhì)~1H-MRS檢測在VCIND早期診斷、病情評價中的應(yīng)用價值。 材料和方法：收集34名VCIND患者和26名條件匹配的志愿者，所有研究對象均接受頭部單體素~1H-MRS技術(shù)掃描，檢測雙側(cè)丘腦的N-乙酰天門冬氨酸（N-acetylaspartate，NAA）、膽堿化合物(Choline，Cho)、肌酸/磷酸肌酸(Creatine,Cr)，采用相對定量法得出NAA/Cr、Cho/Cr，比較VCIND組與對照組兩側(cè)丘腦NAA/Cr、Cho/Cr的差異，并分析VCIND組兩側(cè)丘腦NAA/Cr、Cho/Cr與MoCA評分間的相關(guān)性。 結(jié)果：1.VCIND組兩側(cè)丘腦NAA/Cr較對照組降低，差異有統(tǒng)計學(xué)意義（P0.05），Cho/Cr較對照組無明顯差異(P0.05）；2.VCIND組內(nèi)，兩側(cè)丘腦NAA/Cr與MoCA評分呈正相關(guān)（P0.05），Cho/Cr與MoCA評分無相關(guān)性(P0.05）。 結(jié)論：1.VCIND患者兩側(cè)丘腦存在神經(jīng)元損傷，兩側(cè)丘腦代謝異�？赡苁菍�(dǎo)致 VCIND患者認(rèn)知損害的重要因素；2.~1H-MRS技術(shù)可以敏感地檢測出VCIND患者腦灰質(zhì)代謝異常；3. VCIND患者丘腦NAA/Cr的變化在一定程度上可以反映認(rèn)知損害的程 度；4.丘腦的~1H-MRS檢測有助于VCIND的早期診斷和病情評價。 第二部分非癡呆型血管性認(rèn)知障礙磁共振擴(kuò)散張量成像研究 目的：利用DTI技術(shù)了解VCIND患者腦白質(zhì)隱匿性損傷特點，探討腦白質(zhì)的DTI檢查在VCIND早期診斷、病情評價中的價值。 材料和方法：收集27例VCIND患者和24例志愿者，所有研究對象均接受DTI技術(shù)掃描。掃描完成后，將圖像傳至后處理工作站，測量兩側(cè)額葉白質(zhì)、胼胝體膝部和壓部的各向異性分?jǐn)?shù)（Fractional anisotropy，F(xiàn)A）和表觀擴(kuò)散系數(shù)（Apparent diffusioncoefficient，ADC）。比較VCIND組與對照組感興趣區(qū)FA值、ADC值的差異，分析VCIND組各感興趣區(qū)FA值、ADC值與MoCA評分之間的相關(guān)性。 結(jié)果：1.VCIND組兩側(cè)額葉白質(zhì)FA值較對照組降低，ADC值較對照組升高，，差異具有統(tǒng)計學(xué)意義（P 0.05），胼胝體膝部、壓部FA、ADC值較對照組均無明顯差異（P0.05）；2. VCIND組內(nèi)，兩側(cè)額葉白質(zhì)FA值與MoCA評分呈正相關(guān)（P 0.05），ADC值與MoCA評分呈負(fù)相關(guān)性（P 0.05），胼胝體膝部、壓部FA值、ADC值與MoCA評分均無顯著相關(guān)性（P0.05）。 結(jié)論：1.VCIND患者兩側(cè)額葉白質(zhì)纖維存在隱匿性損傷，這可能是導(dǎo)致VCIND患者認(rèn)知損害的重要原因；2. DTI指標(biāo)可以敏感地反映VCIND患者腦白質(zhì)存在的隱匿性損傷；3. VCIND患者額葉白質(zhì)FA值、ADC值變化在一定程度上可以反映認(rèn)知損害的程度；4.額葉白質(zhì)的DTI檢查有助于VCIND的早期診斷和病情評價。
[Abstract]:This study was divided into two parts , using proton magnetic resonance spectroscopy ( ~ 1H - MRS ) and diffusion tensor imaging ( DTI ) . The correlation between ~ 1H - MRS , DTI and Montreal Cognitive Assessment ( MoCA ) was used to evaluate the correlation between ~ 1H - MRS , DTI and Montreal Cognitive Assessment ( MoCA ) .

Proton magnetic resonance spectroscopy of the first part of non - dementia vascular cognitive disorder

Objective : To evaluate the changes of cerebral gray matter metabolism in patients with VCIND , and to evaluate the value of brain gray ~ 1H - MRS in early diagnosis and evaluation of VCIND in patients with VCIND .

Materials and Methods : 34 volunteers with VCIND and 26 matched conditions were collected . All the subjects received N - acetylaspartate ( NAA ) , choline compound ( Choline , Cho ) , creatine / creatine phosphocreatine ( Creatine , Cr ) . The differences of NAA / Cr and Cho / Cr were determined by relative quantitative method , and the correlation between NAA / Cr , Cho / Cr and MoCA scores on both sides of VCIND group was analyzed .

Results : 1 . The NAA / Cr of the thalamus on both sides of the VCIND group was lower than that of the control group ( P0.05 ) . Cho / Cr had no significant difference compared with the control group ( P0.05 ) .
2 . There was positive correlation between NAA / Cr and MoCA scores on both sides of the VCIND group ( P0.05 ) . Cho / Cr had no correlation with MoCA score ( P0.05 ) .

Conclusion : 1 . There are neuronal damage in the thalamus of both sides of VCIND patients , and the abnormal metabolism of the thalamus in both sides may be caused .

The important factors of cognitive impairment in patients with VCIND ;
2 . The abnormality of gray matter metabolism in patients with VCIND can be detected sensitively by 1H - MRS technique .
3 . The changes of NAA / Cr in the thalamus of VCIND patients can reflect the course of cognitive impairment to some extent

Degree ;
4 . The detection of ~ 1H - MRS in thalamus contributes to the early diagnosis and evaluation of VCIND .

Magnetic resonance diffusion tensor imaging in the second part of non - dementia vascular cognitive impairment

Objective : To investigate the characteristics of brain white matter ( VCIND ) in patients with VCIND ( VCIND ) and to explore the value of DTI in early diagnosis and evaluation of VCIND .

Materials and Methods : Twenty - seven patients with VCIND and 24 volunteers were collected . All the subjects were scanned by DTI . After the scan was completed , the images were transferred to the post - processing workstation to measure the anisotropy fraction ( FA ) and apparent diffusion coefficient ( ADC ) of frontal white matter , corpus callosal knee and pressure part on both sides . The FA values and ADC values were compared between VCIND group and control group . The correlation between FA value , ADC value and MoCA score in VCIND group was analyzed .

Results : The FA values of frontal lobes on both sides of the VCIND group were lower than those in the control group , and the ADC values were significantly higher than those in the control group ( P0.05 ) .
2 . In VCIND group , the FA value of frontal lobes on both sides was positively correlated with MoCA score ( P 0.05 ) . The ADC value was negatively correlated with MoCA score ( P 0.05 ) . There was no significant correlation between ADC value and MoCA score ( P0.05 ) .

Conclusion : 1 . There is hidden injury of frontal white matter fibers on both sides of VCIND patients , which may be an important cause of cognitive impairment in patients with VCIND .
2 . DTI can sensitively reflect the latent damage of brain white matter in VCIND patients .
3 . The change of ADC value can reflect the degree of cognitive impairment to some extent in VCIND patients .
4 . DTI of frontal white matter contributes to early diagnosis and evaluation of VCIND .
【學(xué)位授予單位】：華中科技大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R749.13;R445.2

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