阻塞性睡眠呼吸暫停綜合征病人腦組織結構及代謝改變MRI評價
發(fā)布時間：2019-06-29 18:55
【摘要】：目的： 探討VBM、擴散加權成像ADC圖及MRS在評價OSAS腦結構及代謝改變中的價值。 材料和方法： OSAS重度組(AHI40次/小時)21例、OSAS輕中度組(5次/小時AHI40次/小時)14例及健康對照組15例。所有受試者均在hilips公司生產(chǎn)的Marconi Medical System (Eclipse) 1.5Tesla超導型磁共振機上進行掃描。 掃描方法為：1.T1WI-RF-FAST序列容積掃描(掃描參數(shù)：TR/TE=12 ms/4.5 ms,視野FOV 25 cm2,層厚1.2 mm,間隔0 mm,矩陣256×256,采集次數(shù)1次,FLIP 20°)。2.擴散加權像SE-EPI-DWI的橫斷面掃描(掃描參數(shù)：TR/TE=6000 ms/94.9 ms,層厚5.0mm,間隔1 mm,矩陣100×100,翻轉角90°,1次激勵,b=0 s/mm2和b=1000 s/mm2)。3.所有受試者在雙側額葉及左側顳-頂-枕葉交界區(qū)(興趣區(qū)20mmx20mmx20mm)、左側海馬(興趣區(qū)15mmx15mmx20mm)行單體素氫質子波譜—點分辨自旋回波波譜序列(point-resolved echo spin spectroscopy, PRESS)掃描(掃描參數(shù)：TR/TE=1500ms/35ms,翻轉角900,采集次數(shù)為192次)。 統(tǒng)計學分析：1.采用VBM1.5 toolkit進行單因素方差分析。采用p0.01(FDR校正),或p0.0001(未校正),體素大于50為差別具有統(tǒng)計學意義。2.獲得ADC圖后,在SPM5軟件上進行圖像的分析。采用單因素方差分析尋找兩組間差異,采用t檢驗觀察差異的方向性,閾值為p0.001(未校正),體素大于50個認為有統(tǒng)計學意義。3.MRS所測數(shù)據(jù)采用SPSS13軟件進行統(tǒng)計分析與處理,主要的統(tǒng)計學方法包括,方差齊性檢驗,方差齊性數(shù)據(jù)采用方差分析及benoffen校正多重比較,方差不齊數(shù)據(jù)采用多組獨立樣本的秩和檢驗,P0.05為有統(tǒng)計學意義。 結果： 1.VBM測量顯示：(1)在總體積測量中,灰質總體積OSAS輕中度組(p=0.24)及OSAS重度組(P=0.32)小于健康對照組,提示：OSAS病人組腦灰質總體積縮小較其他成份改變明顯。(2).在各腦區(qū)的測量中,在以雙側額葉、邊緣葉、顳中回、楔前葉及小腦為主的腦區(qū),①灰質密度及體積OSAS病人組小于健康對照組,OSAS輕中度組小于OSAS重度組,考慮OSAS病人有神經(jīng)元的丟失及膠質細胞的增生；②白質密度及體積除腦干區(qū)OSAS重度組小于健康對照組外,其它腦區(qū)OSAS病人組均大于健康對照組,OSAS輕中度組大于重度組,考慮OSAS病人有白質軸索損傷及膠質細胞的增生、肥大并在此基礎上進一步出現(xiàn)白質稀疏。 2.ADC圖分析顯示：(1)OSAS輕中度組ADC值較健康對照組升高主要發(fā)生于以灰質為主的腦區(qū),此結果與VBM測量所推測的OSAS輕中度時灰質發(fā)生輕度神經(jīng)原丟失,造成灰質細胞間隙增大,而白質此期多處于膠質細胞的增生、肥大階段的假設相符合；(2) OSAS重度組ADC值較健康對照組升高發(fā)生于以以右側額葉、左側楔前葉及雙側小腦前葉腦區(qū)為主的灰質和白質,且胼胝體右側枕鉗ADC值也明顯升高,此結果與VBM測量所推測的OSAS重度時,灰質神經(jīng)元進一步丟失、膠質細胞增生及白質內在膠質細胞增生、肥大基礎上發(fā)生白質稀疏的假設相對應；(3)OSAS重度組腦干區(qū)ADC值較輕中度組增高,且VBM顯示OSAS病人腦干白質密度小于健康對照組、腦干白質體積OSAS重度組小于輕中度組,提示OSAS病人組腦干區(qū)有微觀結構上的改變。 3.(1)左側額葉NAA/CrOSAS重度組明顯小于健康對照組(F=6.003,p=0.004)；右側額葉NAA/Cr, OSAS輕中度組及重度組均小于健康對照組(χ2=11.677,p=0.003)；另外,OSAS病人組左側海馬NAA/Cr較健康對照組差異雖無統(tǒng)計學意義,但顯示有減低的趨勢,提示OSAS病人組神經(jīng)元的減少以雙側額葉為主,且首先發(fā)生于右側額葉,額葉的改變先于海馬區(qū)的改變；(2)右側額葉MI/Cr, OSAS輕中度組及重度組均大于健康對照組(χ2=16.518,p=0.000),提示OSAS病人有神經(jīng)膠質細胞的增生；(3)左側額葉Glx/CrOSAS重度組明顯小于健康對照組(F=4.381,p=0.019),右側額葉Glx/CrOSAS重度組較健康對照組差異雖無統(tǒng)計學意義,但顯示有減低的趨勢,這與重度OSAS病人興奮性低、反應能力差等的臨床癥狀相吻合。 結論：VBM測量、應用SPM分析軟件的ADC圖及MRS對顯示OSAS引起的腦組織結構的改變是敏感的,在評價OSAS腦部病變中起重要作用。
[Abstract]:Purpose: To investigate the effects of VBM, diffusion-weighted imaging ADC and MRS in evaluating the structure and metabolic changes of OSAS Value. Materials and Methods: OSAS severe group (AHI40 times/ hr)21 cases, OSAS mild moderate group (5 times/ hr AHI40 times/ hr)14 cases; 15 healthy controls. All subjects were Marconi Medical System (Eclipse) 1.5 Tesla superconducting magnetic produced by hilips. Scan on the resonance machine. The scanning method is 1. T1WI-RF-FAST sequence volume scanning (scanning parameters: TR/ TE = 12 ms/ 4.5 ms, visual field FOV 25 cm2, layer thickness 1.2 mm, interval 0 mm, matrix 256-256, acquisition times 1 time (FLIP 20 擄).2. Cross-sectional scan of diffusion-weighted image SE-EPI-DWI (scan parameters: TR/ TE = 6000 ms/ 94.9 ms, layer thickness 5.0 mm, interval 1 mm, matrix 100-100, flip angle 90 擄,1 excitation, b = 0 s/ mm2, and b = 1 000 s/ mm2).3. All subjects were scanned by a point-resolved echo spectrum (PRESS) scan (scan parameter: TR/ TE = 1500 ms/ 35 ms, flip angle 900 , the number of acquisition is 19 2). Statistical analysis:1. Use VBM1.5 to Univariate analysis of variance for olkit. p0.01 (FDR correction), or p0.01 (not corrected), voxel greater than 50 is of statistical significance for the difference.2. After obtaining the ADC map, The analysis of the image was carried out on the SPM5 software. The difference between the two groups was found by a single-factor analysis of variance. The directivity of the difference was observed by t-test. The threshold was p0.001 (not corrected), and the voxel was more than 50 considered to be of statistical significance. In comparison with the treatment, the main statistical methods include, the homogeneity test, the analysis of variance and the benoffen correction multiple comparison, the variance of the variance is the rank and the test of multiple sets of independent samples. Inspection, P 0.05 for statistical significance. Results: 1.VBM measurement showed: (1) In total volume measurement, the total volume of gray matter OSAS mild to moderate group (p = 0.24) and OSAS severe group (P = 0.32) were less than that of healthy control group, indicating: OSAS patient group's brain The reduction of the total volume of the gray matter was more obvious than that of the other components. (2) In the measurement of each brain region, the density of the gray matter and the volume of OSAS in the brain of the two-sided frontal lobe, the marginal leaf, the middle and the back of the wedge, the density of the gray matter and the volume of the OSAS in the volume of OSAS were less than that of the healthy control group, and the OSAS mild group was less than the OSAS severe group, taking into account the O In SAS patients, the loss of neurons and the proliferation of glial cells were found in SAS patients. The density and volume of the white matter and the volume of OSAS in the brain stem were lower than those in the healthy control group, and the OSAS patients in the other brain regions were greater than those in the healthy control group, and the OSAS mild to moderate group was greater than the severe group. The white matter axonal injury and the glial cell in the SAS patients 2. ADC graph analysis showed: (1) The higher ADC value of the OSAS mild-to-moderate group occurred mainly in the brain area dominated by gray matter, and this result was slightly moderate with the estimated OSAS in the VBM measurement. (2) The higher ADC value in the OSAS group occurred in the right frontal lobe in the healthy control group. The gray matter and the white matter were the main gray matter and white matter in the left wedge and the anterior lobe of the bilateral cerebellum, and the ADC value of the right occipital forceps in the left wedge was also significantly increased. (3) The ADC value of the brain stem region of the OSAS group was higher than that of the mild and moderate group, and the white matter density of the brain stem of the OSAS patients was lower than that of the healthy control group, and the OSAS severe group of the brain stem white matter volume was less than that of the normal control group. group, The changes of the micro-structure in the brain stem region of the patients with OSAS were indicated. (1) The severe group of the left frontal lobe of the NAA/ CrOSAS was significantly lower than that in the healthy control group (F = 6.003, p = 0.004); the right frontal lobe, NAA/ Cr, OSAS mild to moderate group, and the severe group were less than that of the healthy control group (Sup2 = 11.677, p = 0.003); in addition, the OSAS patients The difference of NAA/ Cr in the left-hand hippocampus of the group was not statistically significant, but there was a tendency to decrease, suggesting that the decrease of the neurons in the OSAS group was dominated by the bilateral frontal lobe, and first occurred in the right frontal lobe and the change of the frontal lobe before the changes in the hippocampus. (2) The right frontal lobe, MI/ Cr, OSAS mild to moderate, and the severe group. The number of Gx/ CrOSAS in the left frontal lobe was significantly lower than that in the healthy control group (F = 4.381, p = 0.019). Meaning, but there is a tendency to be reduced, which is the same as the weight Conclusion: The measurement of VBM, the application of the ADC map of SPM and MRS on the display of the brain caused by OSAS
【學位授予單位】：天津醫(yī)科大學
【學位級別】：博士
【學位授予年份】：2011
【分類號】：R766
本文編號：2508032
[Abstract]:Purpose: To investigate the effects of VBM, diffusion-weighted imaging ADC and MRS in evaluating the structure and metabolic changes of OSAS Value. Materials and Methods: OSAS severe group (AHI40 times/ hr)21 cases, OSAS mild moderate group (5 times/ hr AHI40 times/ hr)14 cases; 15 healthy controls. All subjects were Marconi Medical System (Eclipse) 1.5 Tesla superconducting magnetic produced by hilips. Scan on the resonance machine. The scanning method is 1. T1WI-RF-FAST sequence volume scanning (scanning parameters: TR/ TE = 12 ms/ 4.5 ms, visual field FOV 25 cm2, layer thickness 1.2 mm, interval 0 mm, matrix 256-256, acquisition times 1 time (FLIP 20 擄).2. Cross-sectional scan of diffusion-weighted image SE-EPI-DWI (scan parameters: TR/ TE = 6000 ms/ 94.9 ms, layer thickness 5.0 mm, interval 1 mm, matrix 100-100, flip angle 90 擄,1 excitation, b = 0 s/ mm2, and b = 1 000 s/ mm2).3. All subjects were scanned by a point-resolved echo spectrum (PRESS) scan (scan parameter: TR/ TE = 1500 ms/ 35 ms, flip angle 900 , the number of acquisition is 19 2). Statistical analysis:1. Use VBM1.5 to Univariate analysis of variance for olkit. p0.01 (FDR correction), or p0.01 (not corrected), voxel greater than 50 is of statistical significance for the difference.2. After obtaining the ADC map, The analysis of the image was carried out on the SPM5 software. The difference between the two groups was found by a single-factor analysis of variance. The directivity of the difference was observed by t-test. The threshold was p0.001 (not corrected), and the voxel was more than 50 considered to be of statistical significance. In comparison with the treatment, the main statistical methods include, the homogeneity test, the analysis of variance and the benoffen correction multiple comparison, the variance of the variance is the rank and the test of multiple sets of independent samples. Inspection, P 0.05 for statistical significance. Results: 1.VBM measurement showed: (1) In total volume measurement, the total volume of gray matter OSAS mild to moderate group (p = 0.24) and OSAS severe group (P = 0.32) were less than that of healthy control group, indicating: OSAS patient group's brain The reduction of the total volume of the gray matter was more obvious than that of the other components. (2) In the measurement of each brain region, the density of the gray matter and the volume of OSAS in the brain of the two-sided frontal lobe, the marginal leaf, the middle and the back of the wedge, the density of the gray matter and the volume of the OSAS in the volume of OSAS were less than that of the healthy control group, and the OSAS mild group was less than the OSAS severe group, taking into account the O In SAS patients, the loss of neurons and the proliferation of glial cells were found in SAS patients. The density and volume of the white matter and the volume of OSAS in the brain stem were lower than those in the healthy control group, and the OSAS patients in the other brain regions were greater than those in the healthy control group, and the OSAS mild to moderate group was greater than the severe group. The white matter axonal injury and the glial cell in the SAS patients 2. ADC graph analysis showed: (1) The higher ADC value of the OSAS mild-to-moderate group occurred mainly in the brain area dominated by gray matter, and this result was slightly moderate with the estimated OSAS in the VBM measurement. (2) The higher ADC value in the OSAS group occurred in the right frontal lobe in the healthy control group. The gray matter and the white matter were the main gray matter and white matter in the left wedge and the anterior lobe of the bilateral cerebellum, and the ADC value of the right occipital forceps in the left wedge was also significantly increased. (3) The ADC value of the brain stem region of the OSAS group was higher than that of the mild and moderate group, and the white matter density of the brain stem of the OSAS patients was lower than that of the healthy control group, and the OSAS severe group of the brain stem white matter volume was less than that of the normal control group. group, The changes of the micro-structure in the brain stem region of the patients with OSAS were indicated. (1) The severe group of the left frontal lobe of the NAA/ CrOSAS was significantly lower than that in the healthy control group (F = 6.003, p = 0.004); the right frontal lobe, NAA/ Cr, OSAS mild to moderate group, and the severe group were less than that of the healthy control group (Sup2 = 11.677, p = 0.003); in addition, the OSAS patients The difference of NAA/ Cr in the left-hand hippocampus of the group was not statistically significant, but there was a tendency to decrease, suggesting that the decrease of the neurons in the OSAS group was dominated by the bilateral frontal lobe, and first occurred in the right frontal lobe and the change of the frontal lobe before the changes in the hippocampus. (2) The right frontal lobe, MI/ Cr, OSAS mild to moderate, and the severe group. The number of Gx/ CrOSAS in the left frontal lobe was significantly lower than that in the healthy control group (F = 4.381, p = 0.019). Meaning, but there is a tendency to be reduced, which is the same as the weight Conclusion: The measurement of VBM, the application of the ADC map of SPM and MRS on the display of the brain caused by OSAS
【學位授予單位】：天津醫(yī)科大學
【學位級別】：博士
【學位授予年份】：2011
【分類號】：R766
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