DTI聯(lián)合~1H-MRS對(duì)肝豆?fàn)詈俗冃阅X組織微觀結(jié)構(gòu)損害的定量研究
發(fā)布時(shí)間：2018-03-20 06:15
本文選題：肝豆?fàn)詈俗冃?/strong> 切入點(diǎn)：磁共振波譜學(xué) 出處：《安徽醫(yī)科大學(xué)》2017年碩士論文 論文類型：學(xué)位論文
【摘要】：背景肝豆?fàn)詈俗冃?Hepatolenticular degeneration,HLD)是一種少見且為數(shù)不多可以治療的遺傳代謝障礙疾病,又稱Wilson disease(WD)。HLD診斷主要基于臨床表現(xiàn)、實(shí)驗(yàn)室檢查及眼角膜K-F環(huán)。一旦患者出現(xiàn)失代償期肝硬化和或嚴(yán)重的神經(jīng)系統(tǒng)癥狀則預(yù)后不佳,早發(fā)現(xiàn)早治療對(duì)患者預(yù)后有極大幫助,然而HLD的臨床表現(xiàn)多樣,早期診斷尤為困難。常規(guī)MRI對(duì)HLD的診斷、治療及隨訪評(píng)估有重要價(jià)值。彌散張量成像(Diffusion tensor imaging,DTI)及磁共振氫質(zhì)子波譜成像(~1H-Magnetic Resonance Spectroscopy,~1H-MRS)是一種基于磁共振原理的新技術(shù),較常規(guī)MRI更為敏感。MRS能反應(yīng)潛在病變的生化指標(biāo),DTI能敏感的反應(yīng)微觀結(jié)構(gòu)改變。目前國(guó)內(nèi)外學(xué)者運(yùn)用MRS或DTI技術(shù)對(duì)HLD報(bào)道較少,并且研究結(jié)果存在爭(zhēng)議。目的應(yīng)用DTI和~1H-MRS評(píng)估肝豆?fàn)詈俗冃曰颊吣X灰質(zhì)核團(tuán)及白質(zhì)的微觀結(jié)構(gòu)損害。探討HLD患者平掃示之腦白質(zhì)正常區(qū)是否存在微觀結(jié)構(gòu)損害;研究HLD組與健康對(duì)照組平均彌散系數(shù)(Average diffusion coefficient,ADC)、部分各向異性值(Fractional anisotropy,FA)、彌散張量本征值(Eigenvalue,E1、E2、E3)及NAA/Cr、NAA/Cho、NAA/Cho比值的差異;分析FA值與NAA/Cr比值的相關(guān)性;通過(guò)DT I與MRS定量數(shù)據(jù)繪制受試者操作特征曲線(Receiver operating characteristic,R OC),評(píng)價(jià)其診斷效能。方法選取HLD患者26例及正常對(duì)照組20例行DTI及~1H-MRS成像,感興趣區(qū)(Region of interest,ROI)置于受試者大腦兩側(cè)殼核、丘腦、額葉及胼胝體壓部,比較兩組不同腦區(qū)FA、ADC、E1、E2、E3值及NAA/Cr、Cho/Cr、NAA/Cho比值的差異,應(yīng)用Pearson等級(jí)相關(guān)進(jìn)行相關(guān)分析,以臨床確診結(jié)果為金標(biāo)準(zhǔn)繪制ROC曲線,P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果HLD患者雙側(cè)殼核及丘腦的FA及ADC值高于正常組,其中殼核差異有統(tǒng)計(jì)學(xué)意義(P0.05),而雙側(cè)丘腦差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);雙側(cè)額葉白質(zhì)及胼胝體壓部FA值降低,ADC值升高,與正常組對(duì)比差異均有統(tǒng)計(jì)學(xué)意義(P0.05);HLD組各興趣區(qū)本征值均高于對(duì)照組,其中雙側(cè)殼核E1、E2、E3值、雙側(cè)丘腦E1值、雙側(cè)額葉白質(zhì)及胼胝體壓部E2、E3值差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。HL D組雙側(cè)殼核、雙側(cè)丘腦及胼胝體壓部的NAA/Cr比值低于正常對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。雙側(cè)丘腦、額葉白質(zhì)及胼胝體FA值與NAA/Cr比值呈中等正相關(guān)(P0.05)。右側(cè)殼核FA值診斷效能較高,診斷取值0.160(10-3mm2/s),敏感度76.9%、特異度80%,FA值和NAA/Cr比值串聯(lián)特異度達(dá)90%,二者并聯(lián)敏感度達(dá)96.2%。結(jié)論DTI能發(fā)現(xiàn)HLD患者平掃示之腦白質(zhì)正常區(qū)存在微觀結(jié)構(gòu)損害,較常規(guī)MR顯示腦實(shí)質(zhì)損傷更為敏感;殼核的FA值反向升高,可能與HLD患者鐵異常過(guò)量沉積于該部位有關(guān);MRS能無(wú)創(chuàng)檢測(cè)HLD患者腦組織損害的代謝異常;部分感興趣區(qū)FA值與NAA/Cr比值存在中等程度的正相關(guān);DTI與MRS兩者結(jié)合可以反應(yīng)真實(shí)的腦組織損害并提供定量數(shù)據(jù),有一定的診斷效能,為應(yīng)用臨床奠定基礎(chǔ)。
[Abstract]:Background Hepatolenticular degeneration (HLD) is a rare and rarely treatable disorder of genetic metabolism, also known as Wilson disease(WD).HLD diagnosis based on clinical manifestations. Laboratory examination and corneal K-F ring. Once patients have decompensated cirrhosis and severe nervous system symptoms, the prognosis is not good. Early detection of early treatment is of great help to the prognosis of patients. However, the clinical manifestations of HLD are diverse. Early diagnosis is particularly difficult. Conventional MRI is of great value in the diagnosis, treatment and follow-up evaluation of HLD. Diffusion Zhang Liang imaging tensor imaging and magnetic resonance proton spectroscopy imaging are a new technique based on the principle of magnetic resonance. It is more sensitive than conventional MRI. Mrs can reflect the changes of microstructures of potential lesions. At present, there are few reports on HLD by using MRS or DTI techniques at home and abroad. Objective to evaluate the microstructural damage of gray matter and white matter in patients with hepatolenticular degeneration by DTI and 1H-MRS. To study the difference of average diffusion coefficient and fractional anisotropy between HLD group and healthy control group, and to analyze the correlation between FA value and NAA/Cr ratio. DTI and MRS quantitative data were used to draw the receiver operating characteristic curve and evaluate its diagnostic efficacy. Methods 26 patients with HLD and 20 normal controls underwent DTI and 1H-MRS imaging. The region of interest ROI was placed in the bilateral putamen nucleus of the brain. The thalamus, frontal lobe and corpus callosum were compared between the two groups. The difference of E _ (2) E _ (3) and the ratio of NAA / Cr Cho-r / Cr ~ (2 +) NAA / Cho were compared between the two groups. The correlation between the two groups was analyzed by Pearson grade correlation. Results the FA and ADC values of bilateral putamen and thalamus in patients with HLD were higher than those in normal controls. There was significant difference in putamen nucleus (P 0.05), but no significant difference in bilateral thalamus (P 0.05), and the FA value of bilateral frontal white matter and corpus callosum decreased. Compared with the normal group, the difference was statistically significant (P 0.05). The intrinsic values of each region of interest in the HLD group were higher than those in the control group, including the E _ (1) E _ (2) E _ (3) of the bilateral putamen nucleus and the E _ (1) E _ (1) value of the bilateral thalamus. The NAA/Cr ratio of bilateral putamen nucleus, bilateral thalamus and corpus callosum in group HL-D was lower than that in control group (P 0.05), and the difference was statistically significant (P 0.05) between the two sides of the white matter of frontal lobe and the splenium of corpus callosum (P 0.05), and the ratio of NAA/Cr in bilateral thalamus was significantly lower than that in the control group (P < 0.05). The ratio of FA and NAA/Cr in the white matter of frontal lobe and corpus callosum showed a moderate positive correlation (P 0.05). The diagnostic value was 0.160 ~ 10 ~ (-3) mm ~ (-2) / s, sensitivity was 76.9, the specificity of FA value and NAA/Cr ratio was 90, and the sensitivity of parallel connection between them was 96.2.Conclusion DTI can detect the microstructural damage in normal white matter area of HLD patients on plain scan. The increased FA value of putamen nucleus may be related to the excessive deposition of iron in HLD patients and the noninvasive detection of metabolic abnormalities in brain tissue damage in patients with HLD by magnetic resonance spectroscopy (Mrs). The moderate positive correlation between FA value and NAA/Cr ratio in some regions of interest can reflect the real brain tissue damage and provide quantitative data. It has certain diagnostic efficacy and lays a foundation for clinical application.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R445.2;R742.4
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本文編號(hào)：1637842
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