發(fā)布時間：2018-04-20 00:07

  本文選題：功能磁共振成像 + 靜息態(tài)�。� 參考：《天津醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:利用靜息態(tài)功能磁共振成像(resting-state functional MRI,rsfMRI),采用功能連接的種子點分析方法,觀察癲癇患者雙側(cè)海馬頭部與腦內(nèi)的功能連接的變化,分析總結(jié)這些變化的病理生理意義,為癲癇的診斷治療提供更多、更可靠的影像學(xué)依據(jù)。對象與方法:收集我院2014～2016診斷為癲癇的患者,根據(jù)患者臨床表現(xiàn)、頭皮腦電圖的放電特點以及相關(guān)的多項影像學(xué)檢查進行綜合評價,將癲癇患者分為兩組,即顳葉內(nèi)側(cè)癲癇(mesial temporal lobe epilepsy,mTLE)17例和伴中央顳區(qū)棘波良性兒童癲癇(benign epilepsy with centrotemporal spikes,BECT)患者12例,另社會招募健康志愿者19例。采用德國西門子Trio Tim 3.0T磁共振掃描儀和32通道頭線圈掃描設(shè)備對結(jié)構(gòu)MRI和功能MRI(functional MRI,fMRI)進行數(shù)據(jù)采集。fMRI數(shù)據(jù)預(yù)處理在MATLAB平臺用SPM8軟件來完成,種子點選在雙側(cè)海馬頭部,以畫小球的方式獲得雙側(cè)海馬頭部的ROI,ROI中心點坐標(biāo)為±27,-12,-17,小球半徑5mm。采用REST1.8軟件對數(shù)據(jù)進行功能連接分析處理得到所有被試的功能連接圖。用REST1.8軟件對mTLE組、BECT組和正常對照組進行統(tǒng)計分析:(1)三組分別做組內(nèi)單樣本t檢驗,觀察各組病例在全腦水平上的功能連接強度差異。(2)對三組兩兩組間分別行兩獨立樣本t檢驗,觀察mTLE組和正常對照組之間海馬頭部與全腦功能連接的改變;BECT組和正常對照組之間海馬頭部與全腦功能連接的變化;最后將mTLE組和BECT組進行比較,觀測兩種不同類型癲癇海馬頭部與全腦功能連接的差異。(3)在海馬外結(jié)構(gòu)選取12個興趣區(qū):雙側(cè)額中回、雙側(cè)中央前回、雙側(cè)中央后回、雙側(cè)枕上回、雙側(cè)丘腦、雙側(cè)尾狀核,分別計算三組被試雙側(cè)海馬頭部與以上這些興趣區(qū)之間的相關(guān)系數(shù),然后對三組相關(guān)系數(shù)采用兩獨立樣本t檢驗進行兩兩組間比較觀察海馬頭部功能連接的變化,認為P0.05具有統(tǒng)計學(xué)意義。(1)、(2)的統(tǒng)計結(jié)果圖在REST1.8上以軟件自帶的標(biāo)準(zhǔn)T1結(jié)構(gòu)像作為底圖模板,將統(tǒng)計圖疊加在底圖上的方式進行顯示,統(tǒng)計結(jié)果經(jīng)AlphaSim矯正,認為P0.05具有統(tǒng)計學(xué)意義。結(jié)果:1.正常對照組、mTLE組和BECT組組內(nèi)分析結(jié)果顯示,海馬頭部與杏仁核及海馬旁回呈正相關(guān)性功能連接,且相關(guān)性最強,其他正相關(guān)性功能連接腦區(qū)還有顳葉外側(cè)皮層、島葉、丘腦、基底節(jié)區(qū)等腦區(qū),三組表現(xiàn)基本一致。海馬頭部與額葉、頂葉、枕葉等皮層區(qū)域表現(xiàn)為負相關(guān),mTLE組和BECT組皮層的負激活區(qū)域范圍比正常對照組縮小,mTLE組更為明顯。2.mTLE組與正常對照組比較:相比正常對照組,mTLE組海馬頭部與全腦功能連接整體顯示為連接強度的減低。減低的腦區(qū)有右側(cè)海馬旁回,右側(cè)海馬,右側(cè)顳上回,右側(cè)顳中回,右側(cè)顳極-顳上回,右側(cè)豆?fàn)詈?右側(cè)中央溝蓋,雙側(cè)楔前葉及右側(cè)島葉。3.BECT組和正常對照組比較:相比正常對照組,BECT組海馬頭部與全腦功能連接整體顯示為連接強度的增加。增加的腦區(qū)有雙側(cè)緣上回,左側(cè)中央溝蓋,左側(cè)中央后回,左側(cè)顳極-顳上回、左側(cè)舌回,右側(cè)楔葉,左側(cè)枕上回,左側(cè)中扣帶回及雙側(cè)補充運動區(qū)。4.mTLE組和BECT組比較:mTLE組相較于BECT組海馬頭部與全腦功能連接強度普遍顯示減低。減低的腦區(qū)有雙側(cè)海馬,雙側(cè)海馬旁回,左側(cè)中央后回,左側(cè)顳上回,雙側(cè)中央溝蓋,雙側(cè)顳極-顳上回,雙側(cè)距狀裂周圍皮層,右側(cè)小腦,右側(cè)島葉及右側(cè)中扣帶回。5.海馬頭部與海馬外結(jié)構(gòu)之間的功能連接變化:mTLE組海馬頭部與雙側(cè)額中回功能連接強度較正常對照組減低;BECT組海馬頭部與左側(cè)中央后回及左側(cè)尾狀核功能連接強度較正常對照組增加;mTLE組與BECT組比較海馬頭部與左側(cè)額中回、右側(cè)中央前回、左側(cè)中央后回及左側(cè)尾狀核功能連接強度發(fā)生改變。結(jié)論:1.海馬頭部與皮層呈負相關(guān)激活,癲癇患者的負激活范圍比正常人明顯減小,且mTLE比BECT變化更明顯。2.mTLE和BECT的海馬與全腦功能連接改變模式完全不同,mTLE主要表現(xiàn)在腦網(wǎng)絡(luò)的連接強度減低,而BECT則表現(xiàn)為大腦功能活動的增強。mTLE相比BECT對邊緣系統(tǒng)、中央?yún)^(qū)的損害更為明顯,這可能是mTLE比BECT的病情更加嚴重難治的一個原因,也更易出現(xiàn)認知障礙。3.海馬頭部與海馬外結(jié)構(gòu)之間功能連接的分析顯示m TLE患者額葉損害較為顯著,考慮和mTLE患者易出現(xiàn)認知障礙相關(guān)。
[Abstract]:Objective: To observe the changes in the functional connection between the bilateral hippocampal head and the brain in epileptic patients by using the resting-state functional MRI (rsfMRI) and the function connection seed point analysis method, to analyze and summarize the pathophysiological significance of these changes, and to provide more and more reliable imaging for the diagnosis and treatment of epilepsy. Basis. Objects and methods: 2014~2016 patients diagnosed as epilepsy were collected in our hospital. According to the clinical manifestations of the patients, the characteristics of the discharge of the scalp electroencephalogram and the related multiple imaging examinations, the epileptic patients were divided into two groups, namely, 17 cases of mesial temporal lobe epilepsy, mTLE, and the central temporal area eanthosis. 12 patients with benign epilepsy with centrotemporal spikes (BECT) and 19 healthy volunteers were recruited by the German SIEMENS Trio Tim 3.0T magnetic resonance scanner and 32 channel head coil scanning equipment. M8 software is completed. The seed points are selected in the bilateral hippocampal head to get the ROI of the bilateral hippocampal head in the way of small balls. The coordinates of the ROI center point are + 27, -12, -17, and the radius 5mm. of the ball are processed by REST1.8 software for functional connection analysis of the data. The mTLE group, BECT group and normal control are used by REST1.8 software Group for statistical analysis: (1) a single sample t test was performed in the three groups to observe the difference in the functional connection intensity of all the cases in the whole brain. (2) two independent sample t tests were performed between the three groups and 22 groups, and the changes in the connection between the hippocampus head and the whole brain were observed between the mTLE group and the normal control group; the sea between the BECT group and the normal control group was between the normal control group and the normal control group. The changes in the connection between the head of the horse and the whole brain; finally, the differences between the mTLE group and the BECT group were compared to observe the differences in the connection between the head of the hippocampus and the whole brain of two different types of epilepsy. (3) in the outer hippocampal structure, 12 regions of interest were selected: bilateral frontal gyrus, bilateral anterior central gyrus, bilateral central posterior gyrus, bilateral occipital gyrus, bilateral thalamus and bilateral caudate nucleus, respectively. The correlation coefficients between the three groups of hippocampus heads and these regions were calculated, and the correlation coefficient of the three groups was compared with the two independent sample t test to observe the changes in the functional connection of the hippocampus head between the 22 groups. (1), (2) the statistical results of (2) were on the REST1.8 with the standard T1 with the software. The structure image was shown as the template of the bottom map, and the statistical results were displayed on the bottom map. The statistical results were corrected by AlphaSim. The results showed that P0.05 had statistical significance. Results: 1. normal control group, mTLE group and BECT group analysis showed that the hippocampus head was positively related to the amygdala and parahippocampal gyrus, and the correlation was strongest. The three groups showed negative correlation in the three groups, such as the frontal lobe, the thalamus, the basal ganglia, the frontal lobe, the parietal lobe, the occipital lobe, and the cortex of the mTLE group and the BECT group were narrower than the normal control group, and the group mTLE was more obviously.2.mTLE and normal. Comparison group: compared with the normal control group, the whole brain functional connection in the hippocampus of the mTLE group was shown to be a reduction in the connection strength. The reduced brain area was the right side of the parahippocampal gyrus, right hippocampus, right temporal gyrus, right temporal gyrus, right temporal - superior temporal gyrus, right lenticular nucleus, right lateral central sulcus cover, bilateral wedge anterior lobe and right Island leaf.3.BECT group. Comparison of the normal control group: compared with the normal control group, the whole brain function connection of the hippocampus in the BECT group showed an increase in the connection strength. The increased brain area had the upper side of the bilateral margin, the left central sulcus cover, the left central posterior gyrus, the left temporal - upper temporal gyrus, the left lingual gyrus, the right cuneate lobe, the left occipital gyrus, the left cingulate gyrus and bilateral supplementary movement. Compared with group BECT, group.4.mTLE and group mTLE showed a general decrease in the strength of the head and the whole brain function in the hippocampus of the BECT group. There were bilateral hippocampus, bilateral parahippocampal gyrus, left posterior central gyrus, left temporal gyrus, bilateral central sulcus cover, bilateral temporal - superior temporal gyrus, double lateral fissure peri cortex, right cerebellum, right Island lobe, and right The functional connection between the hippocampal head and the outer hippocampal structure of the lateral cingulate gyrus.5.: the intensity of the functional connection between the hippocampus head and the bilateral frontal gyrus was lower in the mTLE group than in the normal control group; the functional connection between the hippocampus head and the left caudal caudate nucleus in the BECT group was higher than that in the normal control group; the hippocampus head and the left hippocampus were compared with the BECT group in the group mTLE and the BECT group. The lateral frontal gyrus, the right anterior central gyrus, the left central posterior gyrus and the left caudate nucleus function change. Conclusion: 1. the hippocampal head and the cortex are negatively related to the cortex, and the negative activation range of the epileptic patients is significantly lower than that of the normal people, and the mTLE is more obvious than the BECT change, and the hippocampus and the whole brain function connection change pattern of.2.mTLE and BECT is completely not. In the same way, mTLE is mainly manifested in the decrease in the connection intensity of the brain network, while BECT shows that the enhancement.MTLE of brain function activity is more obvious than that of the BECT on the marginal system and the central region. This may be a cause of the more severe and difficult treatment of mTLE than the BECT, and is also more likely to be a cognitive obstacle between the hippocampal and the outer hippocampal structures of the cognitive impairment.3.. The analysis of connectivity indicated that frontal lobe damage was more significant in M TLE patients, and it was more likely to be associated with cognitive impairment in mTLE patients.

【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R445.2;R742.1

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