本文關(guān)鍵詞： 海馬硬化 顳葉癲癇 彌散張量成像 基于纖維束的空間統(tǒng)計　出處：《廣西醫(yī)科大學》2014年碩士論文　論文類型：學位論文

【摘要】：【目的】磁共振彌散張量成像（diffusion tensor imaging, DTI）是近年來發(fā)展比較迅速的一種可以在活體無創(chuàng)地測量生物組織結(jié)構(gòu)中水分子擴散速率的新的成像方法。本文旨在利用DTI技術(shù)研究伴有海馬硬化（hippocampal sclerosis, HS）的顳葉癲癇(temporal lobe epilepsy, TLE)患者全腦白質(zhì)微結(jié)構(gòu)損害的特點,并探索其與患者發(fā)病年齡、病程的相關(guān)關(guān)系，以期對伴有HS的TLE患者腦部病變的早期發(fā)現(xiàn)和早期干預(yù)等提供客觀有效的形態(tài)學指標。 【對象及方法】所選患者來自2009年至2012年在我院門診或住院治療的伴有海馬硬化的顳葉癲癇病人，共30名，其中13名為左側(cè)海馬硬化（lefthippocampal sclerosis, LHS）患者,17名為右側(cè)海馬硬化（righthippocampal sclerosis, RHS）患者,同時選擇23名年齡及性別匹配的健康志愿者作為對照。對30名伴有HS的TLE患者以及23名正常被試進行全腦DTI掃描。DTI數(shù)據(jù)由FMRIB software library提供的軟件工具包處理，通過基于纖維束的空間統(tǒng)計（track-based spatial statistics，TBSS）方法分別比較左側(cè)HS組與健康對照組、右側(cè)HS組與健康對照組腦白質(zhì)圖像的各向異性分數(shù)（fractional anisotropy, FA）值，尋找有顯著性差異的腦白質(zhì)區(qū)域，并將其作為感興趣區(qū)域（region of interest, ROI），采用雙變量spearman相關(guān)分析方法，研究伴有HS的TLE患者發(fā)病年齡及病程與ROI的FA值的相關(guān)性。所有統(tǒng)計學處理均采用SPSS16.0統(tǒng)計分析軟件包，統(tǒng)計結(jié)果用P表示，p0.05時認為有統(tǒng)計學意義。 【結(jié)果】1.與健康對照組相比，伴有左側(cè)HS的TLE患者FA值降低的區(qū)域主要為雙側(cè)放射冠、左側(cè)胼胝體膝部、右側(cè)胼胝體體、胼胝體壓部、后丘腦輻射、外囊及上縱束，未發(fā)現(xiàn)FA值升高的腦白質(zhì)區(qū)域；2.與健康對照相比，伴有右側(cè)HS的TLE患者FA值降低的區(qū)域主要為雙側(cè)胼胝體、放射冠、丘腦后輻射、扣帶、上縱束，右側(cè)內(nèi)囊前肢、內(nèi)囊的晶狀體后部、外囊，未發(fā)現(xiàn)FA值升高的腦白質(zhì)區(qū)域；3.左側(cè)HS組右側(cè)放射冠前部的FA值與起病年齡正相關(guān)；左側(cè)HS組左側(cè)的胼胝體膝部的FA值與病程呈負相關(guān)，右側(cè)HS組雙側(cè)放射冠上部的FA值均與病程正相關(guān)，余受損區(qū)域的FA值改變與病程無顯著線性相關(guān)關(guān)系�！窘Y(jié)論】1.DTI可以無創(chuàng)有效地研究海馬硬化型TLE患者全腦白質(zhì)微結(jié)構(gòu)的改變。2.海馬硬化型TLE可以產(chǎn)生較廣泛的大腦雙側(cè)半球白質(zhì)結(jié)構(gòu)的異常，而不僅僅局限于顳葉或患側(cè)大腦半球。3.左側(cè)HS的TLE患者的發(fā)病年齡對放射冠前部的改變存在影響,這個區(qū)域可能易受到早期癇性發(fā)作的損傷，或受到致癇因素的影響；4.左側(cè)HS的癲癇患者左側(cè)的胼胝體膝部的FA值與病程呈負相關(guān)，，右側(cè)HS組雙側(cè)放射冠上部的FA值均與病程呈正相關(guān)，提示白質(zhì)纖維受癇性放電的損害與病程長短有關(guān)。
[Abstract]:[objective] diffusion-diffusion Zhang Liang imaging (DTI) is a new imaging method which can be used to measure diffusion rate of water molecules in living tissue structures in vivo. The purpose of this paper is to use DTI technique to measure the diffusion rate of water molecules in living tissues. To study the characteristics of global white matter structure damage in patients with temporal lobe epilepsy with hippocampal sclerosis (HSS) and temporal lobe epilepsys. In order to provide objective and effective morphological indicators for early detection and early intervention of brain lesions in TLE patients with HS, the correlation between the age of onset and the course of disease was explored. [participants and methods] Thirty patients with temporal lobe epilepsy with hippocampal sclerosis were selected from 2009 to 2012. 13 of them were left hippocampus sclerosis (LHS) and 17 were right hippocampal sclerosis (RHS). Meanwhile, 23 healthy volunteers with age and gender matched were selected as control. The whole brain DTI scanning. DTI data were processed by FMRIB software library software kit in 30 TLE patients with HS and 23 normal subjects. The anisotropic fraction of white matter images in left HS group and healthy control group, right HS group and healthy control group were compared by using the spatial statistics based on fiber bundle spatial statistics (TBS) to find the white matter areas with significant differences. Using bivariate spearman correlation analysis method, the correlation between onset age and duration of TLE with HS and FA value of ROI was studied. All statistics were processed by SPSS16.0 statistical analysis software package. The statistical results showed that there was statistical significance when P 0.05 was used. [results] 1.Compared with the healthy control group, the decreased FA values of TLE patients with left HS were mainly bilateral coronas, the genu of the left corpus callosum, the right corpus callosum, the splenium of the corpus callosum, the posterior thalamus radiation, the external capsule and the superior longitudinal bundle. Compared with healthy controls, the decrease of FA in TLE patients with right HS was mainly bilateral corpus callosum, coronal radiosurgery, retrothalamic radiation, cingulate band, superior longitudinal bundle, right anterior limb of internal capsule. In the posterior part of the lens and the outer capsule of the internal capsule, no increase in FA value was found in the white matter region of the brain. There was a positive correlation between the FA value of the right anterior part of the coronal radiography in the left HS group and the onset age, and there was a negative correlation between the FA value of the left corpus callosum knee and the course of disease in the left HS group. The FA values of bilateral upper coronas in the right HS group were positively correlated with the course of disease. There is no significant linear correlation between FA changes and course of disease. [conclusion] 1. DTI can effectively and noninvasively study the changes of white matter microstructure in hippocampal sclerosing TLE patients. 2. Hippocampal sclerosing TLE can produce a wide range of brain. 2. Abnormal white matter structure in both hemispheres, It is not confined to the temporal lobe or the affected hemisphere.3.The age of TLE patients with left HS has an effect on the changes in the anterior part of the radiographic corona. This area may be vulnerable to early epileptic seizures. The FA value of left corpus callosum genu was negatively correlated with the course of disease in the left HS group, and the FA value of the upper part of the bilateral radiographic corona in the right HS group was positively correlated with the course of the disease. The results suggest that the damage of white matter fiber caused by epileptic discharge is related to the duration of disease.
【學位授予單位】：廣西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R742.1

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