本文選題：腦卒中失語癥 + 功能磁共振成像　； 參考：《電子科技大學》2016年博士論文

【摘要】：失語癥是指獲得性語言障礙,因大腦皮層(優(yōu)勢半球)的語言中樞損傷所引起的語言理解和表達能力受損。其中由優(yōu)勢半球腦卒中所引起的失語癥,也稱腦卒中后失語癥,最為常見。眾多結構、功能神經(jīng)影像技術已經(jīng)廣泛用以探究其失語患者的語言損害、恢復及其神經(jīng)生理機制。但腦卒中后失語癥患者腦部功能和結構變化仍不明確,需要融合多模態(tài)腦影像方法進行深入的探究。本文融合多模態(tài)的靜息態(tài)功能磁共振成像、三維T1結構成像和彌散張量成像,探測失語患者腦功能和結構異常變化的影像特征,為臨床診斷和評估提供客觀的神經(jīng)影像學依據(jù)。主要內(nèi)容如下:(1)針對腦卒中失語癥患者靜息態(tài)腦功能活動局部一致性改變的問題,通過計算17名腦卒中后失語癥患者和20名年齡、性別和受教育程度相匹配的健康對照的局部一致性來研究大腦局部區(qū)域同步性變化,檢測了異常局部一致性值和腦卒中失語癥患者的失語癥嚴重程度的相關性。結果發(fā)現(xiàn):與正常對照組相比,腦卒中失語癥患者的右側(cè)舌回、左側(cè)距狀溝、楔葉、額上回以及額上回內(nèi)側(cè)的局部區(qū)域同步性降低。且左側(cè)額上回內(nèi)側(cè)的局部同步性與漢語失語成套測驗(ABC)中的失語癥嚴重程度(r=0.55,P=0.027)及命名分數(shù)(r=0.66,P=0.005)呈正相關。這一結果表明腦卒中失語癥的發(fā)病機理可能歸因于多個局部腦區(qū)同步化的異常。(2)針對腦卒中后失語癥腦功能局部活動強度的異常和該區(qū)域引起的腦功能連接改變的問題,采用靜息態(tài)功能磁共振成像結合低頻振幅和區(qū)域間功能連接分析方法,探測失語癥患者的局部腦活動和遠程腦網(wǎng)絡功能連接的改變。采用17名左半球腦卒中的失語患者與20名年齡、性別和受教育程度相匹配的正常對照作為研究對象。失語癥患者主要在右側(cè)顳葉內(nèi)側(cè)(海馬/海馬旁回)和左側(cè)顳皮層部位表現(xiàn)出局部區(qū)域內(nèi)腦活動顯著增強。而右側(cè)海馬/海馬旁回的局部區(qū)域內(nèi)腦活動強度和造句能力呈負相關。失語癥患者的遠程腦網(wǎng)絡功能連接在右側(cè)海馬/海馬旁回和梭狀回間增強,但在左側(cè)枕葉和頂葉皮質(zhì)降低。這些結果顯示出失語癥患者局部區(qū)域內(nèi)大腦功能障礙和區(qū)域間的功能連接相關。局部區(qū)域內(nèi)腦功能活動強度和遠程腦網(wǎng)絡連接可為失語癥的病理生理學機制的深入理解提供客觀的影像學特征。(3)針對腦卒中后失語癥患者腦局部結構異常以及該區(qū)域腦功能連接的變化,采用結合基于體素形態(tài)學灰質(zhì)體積度量和靜息態(tài)功能連接的方法探測腦卒中失語癥患者的腦結構和功能網(wǎng)絡的改變。本研究采用基于體素形態(tài)學測量法檢測17名腦卒中失語癥患者與年齡、性別、受教育程度相匹配的20名正常對照灰質(zhì)體積相異的特定腦區(qū),進而檢測灰質(zhì)的異常與功能連接改變之間是否存在關聯(lián)。最后,計算異常功能連接與失語癥患者的臨床量表分數(shù)之間的相關性。結果顯示失語癥患者的右側(cè)顳上回、頂下小葉/緣上回以及左側(cè)枕中回的灰質(zhì)體積顯著升高,而右側(cè)尾狀回和雙側(cè)丘腦的灰質(zhì)體積顯著降低�；颊叩挠覀�(cè)頂下小葉/緣上回與右側(cè)楔前葉、角回、枕上回之間的遠程功能連接增強,而右側(cè)尾狀回與輔助運動區(qū)、背外側(cè)額上回之間的功能連接減弱。同時發(fā)現(xiàn)左側(cè)枕中回與左側(cè)眶部額中回的功能連接強度與操作指數(shù)呈正相關。我們推測失語癥患者的灰質(zhì)體積異�？赡軙䦟е履X區(qū)間的功能連接改變。這些結果將為理解腦卒中失語癥的發(fā)病機制提供結構和功能影像方面的證據(jù)。(4)針對腦卒中后失語癥全腦功能連接模式中關鍵網(wǎng)絡特征的個體識別問題,采用基于全腦功能連接為特征的多變量模式分析方法來識別失語癥患者和正常對照。本實驗對17名失語癥患者與20名年齡、性別和受教育程度相匹配的健康對照的功能影像數(shù)據(jù)進行模式識別分析,首先通過功能連接方法得到兩組人的功能網(wǎng)絡,選擇其主要特征,采用支持向量機進行模式分類。結果顯示:失語癥患者分類正確率最高可達86.5%,靈敏度可達76.5%,特異性可達95.0%。此外,核心連接主要是位于額頂葉網(wǎng)絡、聽覺網(wǎng)絡、感覺運動網(wǎng)絡和視覺網(wǎng)絡,而右側(cè)羅蘭迪克島蓋對分類貢獻最大。實驗結果表明全腦功能連接可以作為一個潛在的神經(jīng)學標識,用以區(qū)分失語癥患者和健康人。(5)針對失語癥患者腦腹側(cè)與背側(cè)語言通路纖維連接受損的問題,采用全腦無偏空間統(tǒng)計方法分析腦卒中失語癥患者和正常對照白質(zhì)纖維連接的改變。本實驗選用了18名腦卒中失語癥患者和20名年齡、性別、受教育程度相匹配的正常對照,進行語言評估和彌散張量成像掃描。采用全腦無偏空間統(tǒng)計方法來估計每組被試的白質(zhì)完整性(即部分各向異性),用線性相關分析法評估白質(zhì)的完整性和臨床量表值的關系。結果顯示失語癥患者左下額枕纖維素\下縱束、左側(cè)鉤狀纖維束和左側(cè)上縱束的白質(zhì)纖維完整性減少。此外,左下額枕纖維束和左上縱束的白質(zhì)纖維完整性分別與失語指數(shù)(AQ)、操作指數(shù)(PQ)和皮層指數(shù)(CQ)成正相關。左下額枕纖維素\下縱束與左上縱束分別是腹側(cè)和背側(cè)語言通路的重要組成部分,因此,本研究表明白質(zhì)纖維完整性的損傷,即多個背側(cè)和腹側(cè)結構連接的缺失,而導致語言表達缺失和認知功能損害。因此,上述多重結構連接的缺失可作為腦卒中失語癥的重要生物學標記。
[Abstract]:Aphasia refers to the impairment of language comprehension and expression caused by the impairment of the language center of the cerebral cortex (the dominant hemisphere). The aphasia caused by the stroke in the dominant hemisphere, also known as post stroke aphasia, is the most common. Many structures are widely used to explore their aphasia. The changes in the brain function and structure of the patients with aphasia after stroke are still not clear, and the multimodal brain imaging methods need to be integrated in depth. This paper combines multimodal resting state functional magnetic resonance imaging, three-dimensional T1 structure imaging and diffusion tensor imaging, to detect the brain work of aphasia patients. The image features of abnormal changes of energy and structure provide an objective neuroimaging basis for clinical diagnosis and evaluation. The main contents are as follows: (1) according to the problem of local conformance changes in resting state brain function of stroke patients with aphasia, 17 patients with aphasia after stroke and 20 age, sex, and educational level are calculated. The local consistency of the matched healthy controls was used to study local regional synchrony changes in the brain, and the correlation between abnormal local consistency and the severity of aphasia in patients with aphasia was detected. Results: the right tongue gyrus, left spur trench, wedge, upper frontal gyrus and forehead of stroke patients with aphasia were compared with the normal control group. The local synchronization in the medial part of the gyrus was reduced, and the local synchrony of the medial upper frontal gyrus was positively correlated with the r=0.55 (P=0.027) and the naming score (r=0.66, P=0.005) in the Chinese aphasia test (ABC). The results suggest that the pathogenesis of stroke aphasia may be attributed to the synchronization of multiple local brain regions. (2) in view of the abnormality of local activity intensity of cerebral apoplexy after stroke and the change of brain function connection caused by this region, resting state function magnetic resonance imaging (fMRI) combined with low frequency amplitude and interregional functional connection analysis to detect the changes of local brain activity and remote brain network function connection in aphasia patients. 17 apoplexy patients with left hemisphere apoplexy were studied with 20 normal controls matched with age, sex and education. Patients with aphasia showed significant regional brain activity in the medial temporal (hippocampus / parahippocampal gyrus) and left temporal cortex, while the right hippocampal / parahippocampal gyrus was in the local area. The intensity of internal brain activity was negatively correlated with the ability to create a sentence. The tele network functional connections of the patients with aphasia were enhanced in the right hippocampus / parahippocampal gyrus and spindle gyrus, but decreased in the left occipital and parietal cortex. These results showed that the brain dysfunction and regional functional connections in the local area of aphasia patients were related. The intensity of brain function and the distance of remote brain network can provide objective imaging features for the in-depth understanding of the pathophysiological mechanism of aphasia. (3) according to the changes in the local structure of the brain and the changes in the brain function connection in the aphasic patients after stroke, a combination of voxel based morphologic gray volume measurement and resting state function connection is used. This study was used to detect the changes in the brain structure and functional network of patients with apoplexy aphasia. In this study, a voxel based morphometry was used to detect the specific brain areas of 17 patients with apoplexy aphasia and 20 normal controls of age, sex and education, and then the abnormal and functional connection of gray matter was detected. Finally, the correlation between the abnormal functional connection and the clinical scale of the aphasic patients was calculated. The results showed that the right temporal upper temporal gyrus, the subapietal lobule / superior gyrus and the left occipital gyrus increased significantly, while the right caudate gyrus and the volume of gray matter in the bilateral thalamus decreased significantly. The functional connection between the right side of the right parietal lobule / upper margin and the right anterior wedge, the angular gyrus and the upper occipital gyrus was enhanced, while the functional connection between the right caudate gyrus and the accessory dorsal frontal gyrus was weakened. We also found that the functional connection between the left occipital gyrus and the left orbital frontal gyrus was positively correlated with the operation index. We speculated that the functional connection was positively related to the operation index. The abnormal volume of gray matter in aphasic patients may lead to functional connectivity changes in the brain region. These results will provide structural and functional evidence for understanding the pathogenesis of apoplexy aphasia. (4) the individual identification of key network characteristics in the whole brain function connection model after stroke, is based on the whole brain. The functional connectivity was characterized by a multivariable model analysis method to identify aphasia patients and normal controls. This experiment was conducted to analyze the functional image data of 17 patients with aphasia and 20 healthy controls matched with age, sex and education. First, functional networks were obtained by functional connection to select the functional networks of two groups of people. The results show that the classification accuracy of the aphasia is up to 86.5%, the sensitivity is up to 76.5%, the specificity can reach 95.0%., and the core connection is mainly located in the frontal parietal network, the auditory network, the sensorimotor network and the visual network, while the right Roland Dick Island cover contributes to the classification. The experimental results show that the whole brain functional connection can be used as a potential neurologic marker to distinguish between aphasia patients and healthy persons. (5) to analyze the problem of impaired fibrous connection between the ventral and dorsal language pathways of aphasic patients, the whole brain unbiased space statistics method is used to analyze the apoplexy aphasia patients and normal control white matter fiber. In this experiment, 18 patients with apoplexy aphasia and 20 normal controls with age, sex, and educational level were used to perform language assessment and diffusion tensor imaging. The whole brain unbiased space statistical method was used to estimate the white matter integrity (i.e., partial anisotropy) in each group, and the linear correlation analysis was used. The results showed that the integrity of the left inferior occipital fiber, the left hook fiber bundle and the left superior longitudinal bundle decreased the integrity of white matter fibers in the left inferior occipital fiber, and the white fiber integrity and the aphasia index (AQ), the operation index (PQ) and the cortex in the left inferior occipital bundle and the left superior longitudinal bundle. The index (CQ) has a positive correlation. The lower longitudinal and upper left longitudinal bundles of the left inferior occipital fiber are an important part of the ventral and dorsal language pathway. Therefore, this study shows that the integrity of the white matter fiber is damaged, that is, the loss of multiple dorsal and ventral structures, which leads to the loss of language and the impairment of cognitive function. Absence of connections can be used as an important biological marker for aphasia in stroke.
【學位授予單位】：電子科技大學
【學位級別】：博士
【學位授予年份】：2016
【分類號】：R445.2;R743.3

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本文編號：1900909