本文選題：磁共振波譜成像　切入點(diǎn)：磁共振擴(kuò)散張量成像　出處：《新鄉(xiāng)醫(yī)學(xué)院》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：背景小兒腦性癱瘓是由各種原因所致的非進(jìn)行性腦損傷綜合征,給家庭和社會(huì)造成沉重精神和經(jīng)濟(jì)的負(fù)擔(dān)。大量的研究證實(shí)對(duì)腦癱高危兒進(jìn)行早期干預(yù)(康復(fù)治療)的效果是肯定的。目前多模態(tài)磁共振技術(shù)在許多方面有著廣泛的運(yùn)用,但國內(nèi)外將多模態(tài)磁共振成像技術(shù)用于小兒腦癱的研究尚未見報(bào)道。目的本研究旨在探討磁共振多模態(tài)成像在小兒腦性癱瘓(腦癱)中的臨床應(yīng)用價(jià)值。方法選取經(jīng)臨床診斷為腦癱的患兒50例為試驗(yàn)組(A組),其中男28例,女22例,年齡0~6個(gè)月,主要為新生兒缺氧缺血性腦病的患兒。選取50例正常的新生兒作為對(duì)照組(B組),男27例,女23例,對(duì)照組納入標(biāo)準(zhǔn):新生兒無圍生期窒息及宮內(nèi)窘迫表現(xiàn),出生后1min、7min的Apgar評(píng)分均≥8分;無中樞系統(tǒng)傳染和畸形;無顯著代謝障礙和染色體病癥;無神經(jīng)系統(tǒng)疾病癥狀。A組、B組均行核磁共振常規(guī)序列(T1WI、T2WI等)及多模態(tài)功能磁共振檢查(MRS、DTI、SWI),其中兩組均采用MRS及DTI掃描檢查,并比較兩組影像學(xué)圖像,測定兩組膽堿復(fù)合物(Cho)、N-乙�；扉T冬氨酸(NAA)、肌酸復(fù)合物(Cr)、乳酸(LAC)、肌醇(ml)等代謝產(chǎn)物,然后進(jìn)行比較;對(duì)比分析SWI與常規(guī)序列對(duì)腦實(shí)質(zhì)、腦室及蛛網(wǎng)膜下腔和硬膜下出血檢出數(shù)目;比較常規(guī)磁共振檢查與多模態(tài)磁共振檢查對(duì)患兒大腦不同興趣區(qū)的敏感度及多模態(tài)磁共振成像技術(shù)對(duì)腦癱患兒檢查的有效率其差異有無統(tǒng)計(jì)學(xué)意義,采用t檢驗(yàn)及X2檢驗(yàn)分析。結(jié)果相比于常規(guī)的磁共振檢查,多模態(tài)磁共振檢查在對(duì)患兒大腦不同區(qū)的敏感度相對(duì)較高;SWI與常規(guī)MR序列對(duì)顱內(nèi)出血檢出數(shù)目比較統(tǒng)計(jì),可見SWI對(duì)顱腦出血灶的診斷優(yōu)于常規(guī)MRI;DTI與常規(guī)MRI檢測情況通過我們的研究發(fā)現(xiàn),對(duì)照組未見DTI的異常信號(hào);而試驗(yàn)組中,使用DTI序列檢出病灶者為43例,診斷準(zhǔn)確率為86.0%;普通MRI序列檢出21例,占42.0%,可見DTI的診斷準(zhǔn)確率明顯高于常規(guī)MR,其差異具有統(tǒng)計(jì)學(xué)意義,P0.05;試驗(yàn)組NAA/Cr低于對(duì)照組,而Cho/Cr、Lac/Cr及ml/Cr高于對(duì)照組,差異具有統(tǒng)計(jì)學(xué)意義,P0.05。結(jié)論SWI與常規(guī)序列聯(lián)合應(yīng)用能夠提高新生兒顱內(nèi)出血的診斷;臨床應(yīng)用DTI可于HIE早期檢測中有效顯示其病灶范圍及數(shù)目,同時(shí)采用MRS可無創(chuàng)地測量患兒腦部組織缺氧、缺血過程中所產(chǎn)生的代謝產(chǎn)物,三者結(jié)合可提高患兒臨床診斷準(zhǔn)確性,為患者預(yù)后評(píng)估提供有力價(jià)值。目的研究磁共振成象技術(shù)(MRI)多序列掃描在小兒腦癱康復(fù)治療期間的應(yīng)用價(jià)值。方法選取我院2015年12月至2016年5月65例小兒腦癱患者為研究對(duì)象,所有患兒均進(jìn)行MRI多序列掃描,以小兒腦癱患兒康復(fù)治療后的康復(fù)程度為參考標(biāo)準(zhǔn),計(jì)算MRI檢查的靈敏度、特異度、陽性預(yù)測值、陰性預(yù)測值、準(zhǔn)確性、Kappa值。結(jié)果MRI檢查的靈敏度為87.9%,特異度為93.75%,陽性預(yù)測值為93.5%,陰性預(yù)測值為88.2%,診斷符合率為90.8%,Kappa值為0.82。結(jié)論小兒腦癱患兒的病灶改善情況和患兒康復(fù)程度存在一定的相關(guān)性。MRI多序列掃描對(duì)小兒腦癱患兒的病情診斷、治療指導(dǎo)、預(yù)后評(píng)估具有重要價(jià)值。
[Abstract]:Background cerebral palsy is non progressive brain damage syndrome caused by various reasons, caused heavy mental and economic burden to families and society. Many studies have confirmed that early intervention for high-risk infants with cerebral palsy (rehabilitation) the effect is positive. The multi modality magnetic resonance imaging technology in many areas has been widely use, but domestic and international multimodal magnetic resonance imaging technology for children with cerebral palsy is unclear. Objective this study aimed to investigate the paralysis in children with cerebral magnetic resonance multi modality imaging (CP) in clinical application. Methods the clinical diagnosis of cerebral palsy in 50 cases as experimental group (group A), which male 28 cases, female 22 cases, aged 0~6 months, mainly for neonatal HIE. Selected 50 cases of normal newborns as control group (B group), male 27 cases, female 23 cases, the control group included in the standards: newborn Without perinatal asphyxia and fetal distress, after the birth of 1min, the 7min Apgar scores were more than 8 points; no central nervous system infection and deformity; no significant metabolic disorders and chromosomal disorders; no neurological symptoms of the disease in.A group, B group underwent conventional MRI sequences (T1WI, T2WI) and multi modal function magnetic resonance imaging (MRS, DTI, SWI), the two groups were treated with MRS and DTI scan, and compare the two groups of images, determination of two groups of choline (Cho), N- acetylaspartate (NAA), creatine compounds (Cr), lactic acid (LAC), inositol (ML) and other metabolites, and compared with conventional SWI; sequence of brain parenchyma compared to that of the ventricle and subarachnoid and subdural hemorrhage detected number; compared with conventional magnetic resonance imaging and magnetic resonance imaging in children with multi modality in different brain region of interest sensitivity and multimodal magnetic resonance imaging examination of children with cerebral palsy The effective rate had no significant difference, with the t test and X2 test analysis. Results compared to the conventional magnetic resonance imaging, multi modality magnetic resonance imaging in children with relatively high sensitivity in different brain regions; SWI sequence and conventional MR for intracranial hemorrhage detected the number of statistics, showing that SWI diagnosis of cerebral hemorrhage foci better than the conventional MRI; DTI and conventional MRI detection through our research found that the control group had no abnormal signal of DTI; while in the experimental group, using DTI sequence detected lesions in 43 cases, the diagnostic accuracy rate was 86%; the common MRI sequence detected 21 cases, accounting for 42%, the accuracy rate of diagnosis showed that DTI was significantly higher than that of conventional MR, the difference was statistically significant, P0.05; experimental group than in control group. NAA/Cr, Cho/Cr, Lac/Cr and ml/Cr higher than the control group, the difference was statistically significant. Conclusion P0.05. SWI and conventional sequences combined with can improve the freshmen Fetal diagnosis of intracranial hemorrhage; clinical application of DTI HIE in early detection of the lesions showed the effective range and number, and the MRS can be used for noninvasive measurement of children with brain tissue hypoxia, metabolites produced during ischemia, the combination of the three can improve the clinical diagnostic accuracy, provide value for prognosis as. Objective to study the technology of magnetic resonance (MRI) application value of multi sequence scan during the rehabilitation of children with cerebral palsy. Methods in our hospital from December 2015 to May 2016, 65 cases of cerebral palsy patients as the research object, all the patients were treated with MRI sequence scanning, to the extent of recovery of rehabilitation of infantile cerebral palsy were treated as the reference standard, the sensitivity calculation. MRI check the specificity, positive predictive value, negative predictive value, accuracy and Kappa value. The results of the sensitivity of MRI examination was 87.9%, the specificity was 93.75%, the positive predictive value was 93.5%, The negative predictive value was 88.2%, the diagnostic coincidence rate was 90.8%, Kappa value was 0.82. conclusion infantile cerebral palsy lesion improvement and rehabilitation of children with certain degree of correlation between.MRI sequence scanning of cerebral palsy in children with the disease diagnosis and treatment guidelines, prognosis evaluation has important value.

【學(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R445.2;R742.3

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