本文選題：磁共振成像 + 成人原發(fā)性不寧腿綜合征��； 參考：《南昌大學》2014年碩士論文

【摘要】：目的：通過應用ESWAN序列測量腦內鐵含量技術，對成人原發(fā)性不寧腿綜合征患者與年齡、性別相匹配的健康志愿者之間進行對照研究，探討ESWAN序列在定量分析成人原發(fā)性不寧腿綜合征患者腦內灰質核團鐵含量改變中的作用，同時按照國際不寧腿綜合征研究組制定的評分標準對RLS患者的病情程度進行臨床評分，并與腦內灰質核團鐵含量的幅度log值（即log(magnitude signalintensity)）、相對幅度信號強度值（relative magnitude signal intensity RMSI）、相位值（Phase value）以及R2*值進行雙變量相關性分析，最后比較上述方法評估RLS患者病情程度的敏感性與特異性。 材料和方法：選取2012年6月-2014年2月經我院經神經內科醫(yī)師根據(jù)國際不寧腿研究小組（International Restless Legs Study Group IRLSSG）制定的RLS診斷標準診斷為原發(fā)性不寧腿的患者，有腦卒中、腦內微出血等腦血管性病變，，其他中樞神經系統(tǒng)疾病（如帕金森等神經退行性疾�。⒅車到y(tǒng)疾�。ㄈ缣悄虿　⒛蚨景Y等）引起的繼發(fā)性周期性腿動（Periodic leg movement in sleep-PLMS）或不寧腿類似癥狀的患者均被排除。常規(guī)MRI檢查中如發(fā)現(xiàn)T2WI和/或T2flair上出現(xiàn)直徑5mm的高信號病灶或直徑5mm但數(shù)量超過5個者剔除。本研究共收集61例病例，排除急性腔梗患者4例，陳舊性腦梗塞患者5例，腦內多發(fā)缺血灶符合排除標準患者7例，另有不能配合完成檢查者3例，以及圖像偽影較重者7例，最后納入35例（患者組），所有患者均為年齡大于45歲的成人，平均年齡約54歲（53.71±10.12），男女比約3:2；年齡、性別相匹配的健康志愿者35例（對照組），平均年齡約54歲（54.20±9.26），男女比約3:2，對每位患者病情程度嚴格按照國際不寧腿綜合征研究組評分標準進行臨床評分。所有研究對象均行MRI頭顱掃描：采用GE3.0T磁共振掃描儀及8通道頭顱專用線圈進行掃描。掃描序列包括多回波采集T2*加權的三維梯度回波序列（Enhancedgradient echo T2*weighted angiography，ESWAN）、T2WI及T2FLAIR序列。圖像后處理：應用GE Medical Systems Functool4.4工作站軟件將ESWAN序列圖像進行后處理生成校正后的幅度圖、相位圖，同時也可得到ESWAN序列自動生成的R2*圖。在上述功能圖上測量研究對象相同層面的雙側紅核（RN）、黑質致密部（SNc）、黑質網狀部（SNr）、蒼白球（GP）、殼核（PU）、尾狀核頭（CN）、齒狀核（DN）、丘腦（TH）的幅度信號強度值、相位值及R2*值。數(shù)據(jù)處理：采用盲法（在未知是否為患者的情況下），由一位有5年以上神經影像MRI診斷經驗的大夫手動勾勒出上述感興趣區(qū)進行測量并記錄。每間隔1個月左右由同一大夫對上述感興趣區(qū)進行重復測量，共3次。取3次測量的平均值作為最終各感興趣區(qū)域的幅度信號強度值、相位值和R2*值。將各感興趣區(qū)的幅度信號強度值取自然對數(shù)（原始數(shù)據(jù)較分散，為了使數(shù)據(jù)更集中，利于統(tǒng)計學分析），即幅度log值，同時測量所有研究對象雙側額前白質的幅度信號強度值，各感興趣區(qū)的幅度信號強度值與額前白質的幅度信號強度值的比值即為各感興趣區(qū)的RMSI值（可以消除個體差異）。 結果：一、與對照組比較：1.幅度log值：RLS組的紅核（RN）（P=0.004）、黑質致密部（SNc）（P=0.002）、黑質網狀部（SNr）（P=0.024）、蒼白球（GP）（P=0.024）、齒狀核（DN）（P=0.032）均顯著性升高，差異具有統(tǒng)計學意義。殼核（PU）、尾狀核（CN）、丘腦（TH）的幅度log值升高，但無統(tǒng)計學差異。2. RMSI值：RLS組的RN（P=0.000）、SNc（P=0.025）、SNr（P=0.044）、GP（P=0.018）的均顯著性升高，差異具有統(tǒng)計學意義。PU、CN、DN、TH的RMSI值升高，但無統(tǒng)計學差異。3.相位值： RLS組的RN（P=0.014）、SNc（P=0.000）、TH（P=0.027）均顯著性的升高，有統(tǒng)計學意義， PU、CN、SNr、GPDN的相位值升高，但無統(tǒng)計學差異。4. R2*值：RLS患者的RN（P=0.000）、SNc（P=0.000）、SNr（P=0.000）、GP（P=0.001）、DN（P=0.007）均顯著性的降低，有統(tǒng)計學差異。PU、CN、TH的R2*值降低但無統(tǒng)計學差異。 二、與臨床評分的相關性分析：1.紅核（R=0.836，P=0.000）、黑質致密部（R=0.763，P=0.000）、蒼白球（R=0.507，P=0.000）、丘腦（R=0.797，P=0.000）的幅度log值與臨床評分具有相關性，即與RLS的病情呈正相關。2.丘腦的相位值與臨床評分具有正性相關（R=0.399，P=0.018）。3.各感興趣區(qū)的相對幅度信號強度值、R2*值與臨床評分均不具有顯著相關性。 三、以紅核、黑質致密部、黑質網狀部、蒼白球、齒狀核和丘腦的幅度log值、RMSI值、相位值以及R2*值繪制受試者工作特征曲線（ROC曲線）：1.以丘腦的幅度log值繪制的ROC曲線下面積最大為0.949，其余感興趣區(qū)ROC曲線下面積均小于0.9。2.上述各感興趣區(qū)RSMI值、相位值、R2*值ROC曲線下面積均在0.7-0.9范圍內。 結論：通過應用ESWAN序列對RLS患者紅核、黑質（SNr、SNc）、蒼白球、殼核、尾狀核頭、齒狀核、丘腦的鐵含量定量，結果支持紅核、黑質致密部、蒼白球、齒狀核的鐵含量降低。幅度log值、R2*值對評價RLS腦內灰質核團鐵含量較RMSI值和相位值相對更敏感，同時幅度log值與RLS患者的臨床評分具有顯著相關性， ROC曲線下面積以丘腦幅度log值最大，且取值3.36時其敏感性為100%，特異性為76.2%。綜上可知，磁共振ESWAN技術在準確定量RLS患者腦內灰質核團鐵含量、監(jiān)測病程等方面具有一定的應用價值。
[Abstract]:Objective: To investigate the role of ESWAN sequence in quantitative analysis of iron content in the cerebral gray nucleus of adult patients with primary restless leg syndrome by using the ESWAN sequence to measure the iron content in the brain, and to study the effect of ESWAN sequence on the changes of iron content in the cerebral gray nucleus of the patients with adult primary restless leg syndrome by the control study of the adult patients with primary restless leg syndrome and the age and sex matched healthy volunteers. The score standard of the International Restless leg syndrome group was evaluated for the degree of RLS patients, with the log value of the iron content in the gray nucleus of the brain (log (magnitude signalintensity)), the relative amplitude signal intensity value (relative magnitude signal intensity RMSI), the phase value (Phase value) and the value of the two. Variable correlation analysis was used to compare the sensitivity and specificity of the above methods in evaluating the severity of RLS patients.
Materials and methods: the patients with primary restless legs were diagnosed by the RLS diagnostic criteria of the International Restless Leg research group (International Restless Legs Study Group IRLSSG) by the neurosurgeon in June 2012 -2014 2 period, with cerebral apoplexy, intracerebral hemorrhage and other cerebrovascular diseases, and other central nervous system diseases. (for example, Parkinson and other neurodegenerative diseases), patients with secondary periodic leg movement (Periodic leg movement in sleep-PLMS) or restless leg similar symptoms caused by peripheral systemic diseases (such as diabetes, uremia, etc.) are excluded. In routine MRI examination, a high signal lesion or diameter 5mm but a diameter of 5mm in T2WI and / or T2flair is found. In this study, more than 5 cases were eliminated. A total of 61 cases were collected, including 4 cases of acute infarction, 5 cases of old cerebral infarction, 7 cases of focal cerebral ischemia, 3 cases of complete examination, 7 cases of image artifact, and 35 cases (patient group), all patients were older than 45 years old. In adults, the average age was about 54 years (53.71 + 10.12), the ratio of men and women was about 3:2, and the age and sex matched healthy volunteers were 35 (control group), the average age was about 54 years (54.20 + 9.26), and the ratio of men and women was about 3:2. The clinical score of each patient was strictly according to the standard of the International Restless Leg Syndrome Study Group. All the subjects were MRI Head scan: scanning with GE3.0T magnetic resonance scanner and 8 channel skull special coil. The scanning sequence includes multiple echo acquisition T2* weighted three-dimensional gradient echo sequence (Enhancedgradient echo T2*weighted angiography, ESWAN), T2WI and T2FLAIR sequence. Image post-processing: application of GE Medical Systems workstation software The ESWAN sequence image is processed to generate the corrected amplitude map, phase map, and the R2* map generated automatically by ESWAN sequence. On the above functional map, the bilateral red nucleus (RN), the substantia nigra dense part (SNc), the substantia nigra reticularis (SNr), the globus pallidus (GP), the putamen (PU), the caudate nucleus (CN), the dentate nucleus (DN), the thalamus, and the thalamus are measured. The amplitude signal intensity, phase and R2* value of (TH). Data processing: a blind method (in the case of an unknown patient), by a doctor with more than 5 years of neuroimaging MRI diagnosis, is manually outlined and recorded by the above region of interest. The same doctor repeats the area of interest to the above 1 months or so. Measurement, 3 times. The average value of 3 measurements is taken as the amplitude signal intensity value, phase value and R2* value of the final regions of interest. The amplitude signal intensity value of each region of interest is taken as the natural logarithm (the original data is scattered, in order to make the data more concentrated, for statistical analysis), that is, the amplitude log value, and measure both the bilateral forehead of all the subjects at the same time. The amplitude signal intensity of the anterior white matter, the ratio of the amplitude signal intensity value of each region of interest to the amplitude signal intensity of the prefrontal white matter is the RMSI value of each region of interest (the individual difference can be eliminated).
Results: (1) compared with the control group, 1. log values: the red nucleus (RN) (P=0.004) of group RLS, SNc (P=0.002), SNr (P=0.024), globus globus (GP) (GP) (P=0.024), and the dentate nucleus (P=0.032) increased significantly, and the difference was statistically significant, but the amplitude of the amplitude of the shell nucleus, caudate nucleus and thalamus increased, but no unification. .2. RMSI value: RN (P=0.000), SNc (P=0.025), SNr (P=0.044), GP (P=0.018) in the RLS group increased significantly, and the difference was statistically significant, but there was no statistical difference. The phase value of N increased, but there was no statistically significant difference in.4. R2* value: RN (P=0.000), SNc (P=0.000), SNr (P=0.000), GP (P=0.001), and GP (P=0.001) in RLS patients.
Two, correlation analysis with clinical score: 1. R=0.836 (P=0.000), R=0.763 (P=0.000), globus pallidus (R=0.507, P=0.000), log value of the thalamus (R=0.797, P=0.000), and the correlation between the amplitude of the thalamus (R=0.797, P=0.000) and the clinical score, that is, the phase of the.2. thalamus is positively correlated with the condition of the RLS. The relative amplitude signal intensity and R2* value of each region of interest had no significant correlation with clinical score.
Three, the amplitude log value, the RMSI value, the phase value and the R2* value of the red nucleus, the dense part of the substantia nigra, the globus pallidus, the dentate nucleus and the thalamus, draw the maximum area of the area under the ROC curve of the log value of the thalamus by the amplitude of the amplitude log of the thalamus, and the area under the ROC curve of the remaining region of interest is less than the above 0.9.2. above the sense of 0.9.2.. The area of interest area RSMI value, phase value, R2* value and ROC curve are all within 0.7-0.9 range.
Conclusion: the iron content of the red nucleus, black matter (SNr, SNc), globus pallidus, caudate nucleus, dentate nucleus and thalamus of RLS patients is quantified. The results support the reduction of iron content in the red nucleus, the dense part of the substantia nigra, the globus pallidus and the dentate nucleus. The value of R2* is relatively more sensitive to the evaluation of the iron content in the gray nucleus of the brain of RLS than the value of RMSI and the phase value in the evaluation of RLS. There is a significant correlation between the log value and the clinical score of the patients with RLS. The area under the ROC curve is the maximum of the log value of the thalamus, and the sensitivity is 100% when the value is 3.36. The specificity is known as 76.2%., and magnetic resonance ESWAN technology has a certain application in the accurate quantitative determination of iron content in the gray nucleus of the brain of RLS patients and the monitoring of the course of disease. Value.
【學位授予單位】：南昌大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R741;R445.2

【引證文獻】

相關碩士學位論文 前1條

1 張曉琦;輸血依賴性疾病多臟器鐵過載MR量化研究[D];天津醫(yī)科大學;2016年

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