本文關(guān)鍵詞： 磁共振 腦動(dòng)脈閉塞 灌注加權(quán)成像 磁共振 腦動(dòng)脈閉塞 彌散張量成像 磁共振 腦動(dòng)脈閉塞 磁共振波譜　出處：《山東大學(xué)》2014年博士論文　論文類型：學(xué)位論文

【摘要】：前言常規(guī)影像學(xué)檢查(如CT、MRI)陰性的腦動(dòng)脈閉塞或狹窄的腦血管病與腦卒中、白質(zhì)疏松、腦萎縮、血管性癡呆有明顯關(guān)系,采用有效的無創(chuàng)檢查方法評(píng)價(jià)狹窄或閉塞動(dòng)脈供血區(qū)腦組織的缺血損害程度尤為重要。本研究擬采用3.0T磁共振PWI、DTI及MRS研究常規(guī)影像學(xué)檢查陰性的腦動(dòng)脈閉塞或重度狹窄患者的腦組織血流灌注、彌散及代謝改變,為臨床提供有效診斷信息。研究分為三部分,第一部分：3.0T磁共振PWI在單側(cè)大腦中動(dòng)脈閉塞的應(yīng)用；第二部分：3.OT磁共振DTI在單側(cè)大腦中動(dòng)脈閉塞的應(yīng)用；第三部分3.0T磁共振MRS在單側(cè)大腦中動(dòng)脈閉塞的應(yīng)用。 第一部分3.0T磁共振PWI在單側(cè)大腦中動(dòng)脈閉塞中的應(yīng)用摘要 目的：利用3.0T磁共振PWI對(duì)常規(guī)MRI腦實(shí)質(zhì)無異常信號(hào)的單側(cè)大腦中動(dòng)脈閉塞或重度狹窄患者進(jìn)行研究,以評(píng)價(jià)其供血區(qū)腦組織及遠(yuǎn)端腦白質(zhì)灌注改變。 方法：采用GE EXCITE Ⅱ3. OT雙梯度超導(dǎo)磁共振儀,對(duì)腦實(shí)質(zhì)無異常信號(hào)的34例單側(cè)大腦中動(dòng)脈M1段閉塞或重度狹窄("g75%)患者進(jìn)行PWI研究,PWI采用T2*梯度回波EPI (T2*-GRE-EPI)成像序列,采用正交頭線圈,掃描范圍包括全腦,對(duì)比劑采用馬根維顯(Gd-DTPA),注射劑量0.2mmol/kg,流速4m1/s。采用GE functool4.2軟件對(duì)受檢者灌注數(shù)據(jù)進(jìn)行后處理,對(duì)患、健側(cè)放射冠區(qū)、顳葉皮質(zhì)、丘腦、豆?fàn)詈�、�?nèi)囊前肢、內(nèi)囊后肢、大腦腳rCBF、rCBV、MTT、TTP進(jìn)行分析,統(tǒng)計(jì)學(xué)方法利用SPSS13.0軟件,采用配對(duì)t檢驗(yàn)或秩和檢驗(yàn)方法,按α=0.05水準(zhǔn),PO.05為差異具有統(tǒng)計(jì)學(xué)意義。 結(jié)果：患側(cè)放射冠區(qū)較鏡像健側(cè)平均MTT及TTP延長(zhǎng)(P0.01),平均rCBF降低(P0.01),平均rCBV無統(tǒng)計(jì)學(xué)差異；患側(cè)顳葉皮質(zhì)較健側(cè)鏡像區(qū)平均MTT及TTP延長(zhǎng)(P0.01),平均rCBF、rCBV無統(tǒng)計(jì)學(xué)差異；患側(cè)豆?fàn)詈溯^健側(cè)鏡像區(qū)平均TTP延長(zhǎng)(P0.01),平均MTT、rCBF、rCBV無統(tǒng)計(jì)學(xué)差異；患側(cè)內(nèi)囊前肢及后肢較鏡像健側(cè)區(qū)平均TTP延長(zhǎng)(P0.01),平均MTT、rCBF及rCBV無統(tǒng)計(jì)學(xué)差異；患側(cè)丘腦、大腦腳MTT、rCBF、rCBV及TTP較鏡像健側(cè)無統(tǒng)計(jì)學(xué)差異。 結(jié)論：利用MTT、rCBF、rCBV及TTP可快速、無創(chuàng)地評(píng)價(jià)常規(guī)MRI腦實(shí)質(zhì)無異常的腦動(dòng)脈閉塞或重度狹窄供血區(qū)腦組織血流灌注異常改變,其供血區(qū)遠(yuǎn)端腦白質(zhì)無灌注異常發(fā)生,其中以MTT及TTP兩參數(shù)最為敏感。 目的：利用3.0T磁共振DTI對(duì)常規(guī)MRI腦實(shí)質(zhì)無異常信號(hào)的單側(cè)大腦中動(dòng)脈Ml段閉塞或重度狹窄患者進(jìn)行研究,以評(píng)價(jià)供血區(qū)及其遠(yuǎn)端腦組織彌散改變。 方法：采用GE EXCITE Ⅱ3.0T雙梯度超導(dǎo)磁共振儀,對(duì)腦實(shí)質(zhì)無異常信號(hào)的34例單側(cè)大腦中動(dòng)脈閉塞或重度狹窄("g75%)患者進(jìn)行DTI研究。DTI采用單次激勵(lì)自旋回波EPI序列：(TR,6000ms;TE,90ms;NEX,4;thickness,5mm),擴(kuò)散敏感梯度取15個(gè)方向,通過預(yù)實(shí)驗(yàn)b值取2200s/mm2。采用GE functool4.2軟件對(duì)受檢者DTI數(shù)據(jù)進(jìn)行后處理,測(cè)量受檢者患、健側(cè)放射冠區(qū)、顳葉皮質(zhì)、丘腦、豆?fàn)詈�、�?nèi)囊前肢、內(nèi)囊后肢、大腦腳及腦橋FA值、ADC值、平行彌散方向本征值λ1及垂直彌散方向本征值λ23。統(tǒng)計(jì)學(xué)方法利用SPSS13.0軟件,采用配對(duì)t檢驗(yàn)或秩和檢驗(yàn),按α=0.05水準(zhǔn),P0.05為差異具有統(tǒng)計(jì)學(xué)意義。 結(jié)果：患側(cè)放射冠區(qū)較鏡像健側(cè)FA值減小(P0.05),ADC、λ1及λ23值增大(P0.05)；患側(cè)顳葉皮質(zhì)λ23值較健側(cè)增大(P0.05),而FA、ADC、λ1值無統(tǒng)計(jì)學(xué)差異；患側(cè)豆?fàn)詈溯^健側(cè)λ23值增大(P0.05),而患、健側(cè)FA、ADC及λ1值無統(tǒng)計(jì)學(xué)差異；患側(cè)內(nèi)囊前肢及后肢較健側(cè)FA值減小(P0.05),λ23值增大(P0.05),而ADC及λ1值與健側(cè)無統(tǒng)計(jì)學(xué)差異�；�、健側(cè)丘腦、大腦腳及腦橋FA、ADC、λ1及λ23值無統(tǒng)計(jì)學(xué)差異。 結(jié)論：采用高b值DTI能夠敏感探測(cè)常規(guī)MRI無異常信號(hào)的慢性腦動(dòng)脈閉塞或重度狹窄供血區(qū)腦組織彌散異常,而缺血區(qū)遠(yuǎn)端腦白質(zhì)無彌散異常改變。 目的：利用3.0T磁共振MRS對(duì)常規(guī)MRI腦實(shí)質(zhì)無異常信號(hào)的單側(cè)大腦中動(dòng)脈閉塞或重度狹窄患者進(jìn)行研究,以評(píng)價(jià)供血區(qū)腦組織代謝改變。 方法：采用GE EXCITE Ⅱ3.0T雙梯度超導(dǎo)磁共振儀,對(duì)腦實(shí)質(zhì)無異常信號(hào)的34例單側(cè)大腦中動(dòng)脈M1段閉塞或重度狹窄("g75%)患者進(jìn)行MRS研究。MRS采用化學(xué)位移成像(Chemical Shift Imaging, CSI)進(jìn)行多體素采集,點(diǎn)解析波譜(Point Resolved Spectroscopy, PRESS)序列掃描,TR1500ms, TE135ms,采集時(shí)間5.6min。應(yīng)用GE EXCITE Ⅱ3.0T MR儀自帶MRS分析軟件,測(cè)量患、健側(cè)放射冠區(qū)、丘腦、豆?fàn)詈薔AA、Cr、Cho及NAA/Cho、NAA/Cr、Cho/Cr值,并觀察Lac峰。統(tǒng)計(jì)學(xué)方法利用SPSS13.0軟件,采用配對(duì)t檢驗(yàn)或秩和檢驗(yàn),按α=0.05水準(zhǔn),P0.05為差異有統(tǒng)計(jì)學(xué)意義。 結(jié)果：患側(cè)放射冠區(qū)較鏡像健側(cè)平均NAA、Cr、NAA/Cr及NAA/Cho減小(P0.01), Cho及Cho/Cr增大(P0.05)；患側(cè)丘腦平均Cho、NAA、Cr、NAA/Cr、 NAA/Cho及Cho/Cr與鏡像健側(cè)無統(tǒng)計(jì)學(xué)差異；患側(cè)豆?fàn)詈溯^鏡像健側(cè)平均NAA、NAA/Cho降低降低(P0.05), Cho及Cho/Cr升高(P0.05),患側(cè)豆?fàn)詈薈r及NAA/Cr與鏡像健側(cè)無統(tǒng)計(jì)學(xué)差異,所有患者患側(cè)各測(cè)量部位未觀察到Lac峰。 結(jié)論：MRS可敏感檢測(cè)慢性腦動(dòng)脈重度狹窄或閉塞所致供血區(qū)腦組織的代謝改變,彌補(bǔ)了常規(guī)MRI的不足。
[Abstract]:The conventional imaging (such as CT, MRI) negative cerebral artery occlusion or stenosis of cerebral vascular disease and stroke, leukoaraiosis, cerebral atrophy was related to vascular dementia, the effective evaluation of non invasive examination methods of artery stenosis or occlusion of cerebral ischemia, the extent of damage is particularly important. The study of 3.0T magnetic resonance PWI, DTI and MRS on routine examination negative imaging of cerebral artery occlusion or severe stenosis in patients with cerebral perfusion, diffusion and metabolic changes, to provide effective information for clinical diagnosis. The research is divided into three parts, the first part: occlusion by 3.0T magnetic resonance PWI in unilateral cerebral artery in the second part; occlusion by 3.OT magnetic resonance DTI artery in unilateral middle cerebral artery in the brain; the application of unilateral occlusion of the third part of the 3.0T magnetic resonance MRS.
The application of 3.0T MRI PWI in unilateral middle cerebral artery occlusion in the first part
Objective: To investigate the changes of white matter perfusion in blood supply area and distal brain by using 3.0T magnetic resonance PWI in patients with unilateral middle cerebral artery occlusion or severe stenosis without abnormal signal in routine MRI.
Methods: the GE EXCITE II 3. OT dual gradientsuperconducting MRI, 34 cases of unilateral brain no abnormal signal of brain parenchyma in M1 segment artery occlusion or severe stenosis (g75%) patients with PWI research, PWI by T2* EPI (T2*-GRE-EPI) gradient echo imaging sequence, orthogonal head coil, including full scan range the brain, by contrast agent Magnevist injection (Gd-DTPA), 0.2mmol/kg, 4m1/s. using GE functool4.2 software flow for subjects with perfusion data postprocessing, the patients with contralateral corona radiata, temporal lobe cortex, thalamus, lentiform nucleus, anterior limb of the internal capsule, posterior limb of the internal capsule, cerebral peduncle rCBF, rCBV, MTT TTP, analysis, statistical methods using SPSS13.0 software, using the paired t test or rank sum test method, according to a =0.05 level for PO.05, the difference was statistically significant.
Results: the ipsilateral contralateral mirror regions than radiata average MTT and TTP extension (P0.01), a lower average rCBF (P0.01), there was no significant difference in the average rCBV; the ipsilateral temporal lobe cortex than the healthy side mirror area and average MTT TTP extension (P0.01), average rCBF, rCBV had no statistical difference; the average side TTP the lentiform nucleus than the contralateral mirror area (P0.01), prolong the average MTT, rCBF, rCBV had no significant difference; the average TTP lateral anterior limb of the internal capsule and hindlimb compared with contralateral mirror extension (P0.01), average MTT, no significant difference between rCBF and rCBV; the ipsilateral thalamus, cerebral peduncle MTT, rCBF, no significant difference rCBV and TTP compared with the contralateral mirror.
Conclusion: the use of MTT, rCBF, rCBV and TTP can be rapid, noninvasive evaluation of conventional MRI brain parenchyma abnormal cerebral artery occlusion or severe stenosis of the blood supply area of cerebral perfusion abnormalities, the blood supply area of the distal white matter no perfusion abnormalities occur, with MTT and TTP two was the most sensitive parameter.
Objective: To study the diffusion changes of blood supply area and its distal brain tissue by using 3.0T magnetic resonance DTI in patients with Ml segment occlusion or severe stenosis of the middle cerebral artery in routine MRI without abnormal signal.
Methods: the GE EXCITE II 3.0T dual gradientsuperconducting MRI, 34 cases of unilateral brain no abnormal signal of brain parenchyma in arterial occlusion or severe stenosis (g75%) of DTI.DTI by using single excitation spin echo EPI sequence were: (TR, 6000ms; TE, 90ms; NEX, 4; thickness. 5mm, 15) diffusion sensitive gradient direction, 2200s/mm2. of subjects DTI data postprocessing using GE functool4.2 software through the pre experiment, b value were measured with contralateral corona radiata, temporal lobe cortex, thalamus, lentiform nucleus, anterior limb of the internal capsule, posterior limb of the internal capsule, cerebral peduncle and pons FA value, ADC value, parallel diffusion direction eigenvalue lambda 1 and vertical diffusion direction of the eigenvalues lambda 23. statistical methods by SPSS13.0 software, using the paired t test or rank sum test, according to a =0.05 level for P0.05, the difference was statistically significant.
Results: the ipsilateral contralateral mirror regions than radiata FA decreased (P0.05), ADC, and lambda 1 lambda 23 increased (P0.05); the ipsilateral temporal lobe cortex compared with the contralateral lambda 23 increase (P0.05), FA, ADC, a value of 1. There were no significant differences in the ipsilateral lentiform nucleus; compared with the contralateral lambda 23 (P0.05), and the value increases with the contralateral FA, ADC value and lambda 1 no significant difference; the ipsilateral anterior limb and limb than contralateral FA decreased (P0.05), a 23 increase value (P0.05), and no significant difference between ADC and lambda 1 value and the healthy side. Patients with contralateral thalamus and pons, cerebral peduncle FA, ADC, lambda 1 lambda 23 values and no statistical differences.
Conclusion: high b value DTI can be used to detect abnormal diffusion of brain tissue in chronic cerebral artery occlusion or severe stenosis of normal MRI without abnormal signal, but there is no abnormal change of white matter in ischemic area.
Objective: To study the metabolic changes of cerebral tissue in blood supply area by using 3.0T magnetic resonance MRS in patients with unilateral middle cerebral artery occlusion or severe stenosis without abnormal signal in routine MRI.
Methods: the GE EXCITE II 3.0T dual gradientsuperconducting MRI, 34 cases of unilateral brain no abnormal signal of brain parenchyma in M1 segment artery occlusion or severe stenosis (g75%) of MRS.MRS were analyzed by chemical shift imaging (Chemical Shift Imaging, CSI) multi voxel point resolved spectroscopy (Point Resolved Spectroscopy, PRESS TR1500ms, TE135ms) sequence, MRS analysis software, using GE EXCITE 5.6min. with the acquisition time measuring instrument with MR II 3.0T, thalamus contralateral corona radiata, lenticula, NAA, Cr, Cho and NAA/Cho, NAA, /Cr, Cho/Cr, and observe the Lac statistical method using SPSS13.0 peak. The software, using the paired t test or rank sum test, according to a =0.05 level of P0.05, the difference was statistically significant.
Results: the ipsilateral than the contralateral mirror radiata district average NAA, Cr, NAA/Cr and NAA/Cho decreased (P0.01), Cho and Cho/Cr increased (P0.05); the ipsilateral thalamus was Cho, NAA, Cr, NAA/Cr, NAA/Cho and Cho/Cr had no significant difference with the contralateral mirror; the ipsilateral lentiform nucleus than the contralateral mirror the average NAA, NAA/Cho decreased (P0.05), Cho and Cho/Cr increased (P0.05), ipsilateral lentiform nucleus Cr and NAA/Cr and the contralateral mirror had no statistical difference, all patients with each measurement site was observed Lac peaks.
Conclusion: MRS can detect the metabolic changes of brain tissue in the blood supply area caused by chronic severe cerebral artery stenosis or occlusion, and make up for the deficiency of conventional MRI.

【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2014
【分類號(hào)】：R743;R445.2

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本文編號(hào)：1457664