足月缺氧缺血性脑病患儿磁共振扩散张量成像各向异性分数的动态变化及其诊断价值分析

目的:了解足月缺氧缺血性脑病(HIE)患儿在磁共振扩散张量成像(DTI)下各向异性分数(FA)的动态变化,分析其诊断价值。方法:选取我院从2016年2月~2019年5月收治的足月HIE患儿90例,将其按照病情严重程度的差异分成轻度HIE组45例、中度HIE组27例、重度HIE组18例,另取同期30例正常足月新生儿作为对照组。所有新生儿均进行颅脑常规磁共振成像(MRI)以及DTI扫描,测量并对比内囊前肢、内囊后肢、胼胝体膝部、胼胝体压部以及豆状核的FA值。通过ROC曲线分析各FA值的诊断效能,以Spearman相关性分析各FA值和HIE病情严重程度的相关性。结果:中度HIE组、重度HIE组内囊前肢、内囊后肢、胼胝体膝部、胼胝体压部的FA值均低于对照组,且轻度HIE组、中度HIE组患儿上述FA值高于重度HIE组(均P<0.05)。ROC曲线分析结果显示,内囊后肢FA值对HIE的诊断效能最高,FA值的截断点为0.545,曲线下面积为0.804,其诊断敏感度、特异度以及Youden指数分别为61.4%、85.9%、0.473。Spearman相关性分析显示内囊前肢、内囊后肢、胼胝体膝部、胼胝体压部的FA值与HIE严重程度均呈负相关关系(均P<0.05)。结论:足月HIE患儿中,中、重度HIE患儿的内囊前肢、内囊后肢、胼胝体膝部、胼胝体压部的FA值较正常足月新生儿存在明显的降低,且上述FA值与HIE病情严重程度呈负相关关系,其中内囊后肢FA值对HIE的诊断效能最高,或可作为临床诊断足月新生儿HIE的参考指标。     

磁共振扩散张量成像技术在诊断脊髓型颈椎病中的价值分析

目的探讨磁共振扩散张量成像技术(DTI)在诊断脊髓型颈椎病(CSM)中的应用价值。方法选取2015年3月~2017年9月在我院确诊为CSM的患者32例为实验组,同时选择31例健康志愿者为对照组,两组患者均行MRI及DTI扫描。观察比较两组患者颈髓表面扩散系数(ADC)及分数各向异性值(FA)情况。结果实验组的C_(3/4)、C_(4/5)、C_(5/6)节段的颈髓ADC值均显著高于对照组,组间差异有统计学意义(均P0.01)。而且实验组的C_(3/4)、C_(4/5)、C_(5/6)节段的颈髓FA值均显著低于对照组,组间差异有统计学意义(均P0.01)。结论在诊断CSM中采用磁共振扩散张量成像技术(DTI),能够更准确检测脊髓损伤结构的变化,为医生早期诊疗脊髓型颈椎病提供依据。     

扩散张量成像对颈椎病脊髓早期损伤的研究

目的:探讨磁共振(MR)扩散张量成像(DTI)作为定量分析方法,对脊髓型颈椎病(CSM)脊髓早期损伤诊断的应用价值.方法:选择45例经临床及影像诊断为脊髓型颈椎病患者,颈椎常规MRI检查显示脊髓内无异常信号,使用单次激发自旋回波平面(SE-EPI)序列,进行DTI扫描.测量压迫部位脊髓的ADC值及FA值作为病例组,选择病变上或下方两个节段以上未受压正常脊髓作为正常对照组,测量其ADC值及FA值.分析病例组与对照组间ADC及FA值差别,计算ADC值及FA值诊断脊髓损伤的敏感性.结果:所有脊髓型颈椎病患者经DTI检查均可得到ADC图及FA图,经图像后处理,脊髓显示清晰,图像无变形及伪影.3例脊髓型颈椎病患者ADC值降低,42例脊髓型颈椎病患者ADC值增高,平均ADC值为(1.388± 0.149)x 10-3 mm2/s.44名脊髓型颈椎病患者FA值降低,1名脊髓型颈椎病患者FA值增高,平均FA值为0.476±0.085,受压处脊髓平均ADC值升高,平均FA值下降,与正常值比较差别有统计学意义.ADC值诊断的敏感性为93.33％,FA值诊断的敏感性为97.78％.结论:DTI与常规MR比较,能早期而准确地诊断脊髓型颈椎病脊髓早期损伤.     

3.0T磁共振扩张量成像对腰椎间盘突出致神经根受压的诊断价值及其与Oswestry功能障碍指数及视觉模拟评分的相关性

目的:研究3.0T磁共振扩张量成像(DTI)对腰椎间盘突出致神经根受压的诊断价值及其与Oswestry功能障碍指数(ODI)及视觉模拟评分(VAS)的相关性。方法:纳入我院从2017年1月~2019年1月收治的腰椎间盘突出致神经根受压患者50例进行研究,记作研究组。另取同期我院收治的单纯腰椎间盘突出患者50例作为对照组。两组受试者均接受DTI扫描以及ODI、VAS评分。比较两组神经根不同层面的各向异性分数(FA)值、弥散系数(ADC)值、ODI、VAS评分,并作相关性分析。同时,以手术病理诊断为金标准,分析DTI诊断腰椎间盘突出致神经根受压的敏感性、特异性、准确度。结果:研究组患者神经根近层、中层、远层的FA值均显著低于对照组,而ADC值均显著高于对照组(均P<0.05)。以手术病理诊断为金标准,DTI诊断腰椎间盘突出致神经根受压的敏感性为94.00%、特异性为96.00%、准确度为95.00%。研究组ODI、VAS评分分别为(43.22±7.25)分、(6.68±1.92)分,相较于对照组的(28.56±6.22)分、(4.02±1.34)分显著更高(均P<0.05)。经Pearson相关性分析可得:腰椎间盘突出致神经根受压患者的FA值与ODI、VAS评分均呈负相关关系(均P<0.05),而ADC值与ODI、VAS评分无相关性(均P>0.05)。结论:DTI对腰椎间盘突出致神经根受压的诊断价值较高,且FA值与ODI、VAS均存在明显相关性。临床工作中可能将DTI的FA值作为量化神经根结构改变的重要参数,值得临床重点关注。     

DTI定量参数对脑胶质瘤的诊断价值及其与血管内皮生长因子、细胞核增殖相关抗原的关系

目的:探讨扩散张量成像(DTI)定量参数对脑胶质瘤的诊断价值及其与血管内皮生长因子(VEGF)、细胞核增殖相关抗原(Ki-67)的关系。方法:选取2014年6月到2017年6月期间在我院接受治疗的90例脑胶质瘤患者,根据病理分级的不同分为中低级别组(n=46)和高级别组(n=44),比较两组患者表观扩散系数(ADC)值、各向异性分数(FA)值、相对表观扩散系数(rADC)值、相对各向异性分数(rFA)值、VEGF和Ki-67的阳性率,分析ADC值、FA值、rADC值、rFA值与VEGF、Ki-67表达的相关性。结果:高级别组的ADC值、FA值、rADC值和rFA值低于中低级别组(P0.05)。高级别组病理组织中VEGF、Ki-67的阳性表达率高于中低级别组(P0.05)。经Spearman相关分析显示,ADC值、FA值、rADC值和rFA值与VEGF、Ki-67的表达水平均呈负相关(P0.05)。结论:DTI定量参数与脑胶质瘤病理分级和VEGF、Ki-67的表达水平密切相关。     

磁共振成像弥散张量成像参数联合血清NSE、Lp-PLA2在脑梗死患者的诊断和预后不良风险评估中的应用价值

摘要 目的：探讨磁共振成像（MRI）弥散张量成像（DTI）参数联合血清神经元特异性烯醇化酶（NSE）、脂蛋白相关磷脂酶A2（Lp-PLA2）在脑梗死患者的诊断和预后不良风险评估中的应用价值。方法：选择2021年3月至2022年9月吉林大学中日联谊医院收治的106例脑梗死患者作为脑梗死组，另选同期62例体检健康志愿者作为对照组，比较两组DTI参数，血清NSE和Lp-PLA2水平。脑梗死组出院90d后，采用改良Rankin量表（mRS）进行预后评估，分为预后良好组与预后不良组，并比较两组上述指标水平。受试者工作特征（ROC）曲线分析DTI参数联合血清NSE、Lp-PLA2诊断脑梗死和预测脑梗死患者预后的价值。结果：脑梗死组表观弥散系数（ADC）值、部分各向异性指数（FA）值低于对照组（P＜0.05），血清NSE、Lp-PLA2水平高于对照组（P＜0.05）。预后不良组FA值、ADC值低于预后良好组（P＜0.05），血清NSE、Lp-PLA2水平高于预后良好组（P＜0.05）。联合FA值、ADC值、NSE和Lp-PLA2诊断脑梗死以及预测脑梗死患者预后不良的曲线下面积（AUC）分别为0.852、0.874，均高于各因素单独诊断和预测。结论：脑梗死DTI参数FA值、ADC值降低，血清NSE、Lp-PLA2水平增高，联合DTI参数和血清NSE、Lp-PLA2检测在脑梗死诊断和预后预测中具有较高价值。     

磁共振全身扩散加权成像在不同类型淋巴瘤中的应用价值研究

目的:探讨磁共振全身扩散加权成像(WB-DWI)在不同病理类型淋巴瘤的筛查、诊断及治疗中的应用价值。方法:选择2015年1月~2017年6月经我院病理证实的淋巴瘤患者60例作为淋巴瘤组,另选择同期健康志愿者43例作为对照组,所有对象均进行磁共振WB-DWI检查(淋巴瘤组于治疗前和治疗后检查),测量其淋巴结表观扩散系数(ADC)值,比较淋巴瘤组与对照组、淋巴瘤组不同部位、不同病理类型及治疗前后不同疗效淋巴瘤患者的淋巴结ADC值差异。结果:淋巴瘤组平均ADC值为(755.37±48.42)×10-6 mm~2/s,低于对照组的(1185.92±66.53)×10-6 mm~2/s,差异有统计学意义(P0.05);不同部位、不同病理类型(包括不同细胞来源)淋巴瘤患者的ADC值比较,差异无统计学意义(P0.05);不同疗效淋巴瘤患者的ADC值治疗前与治疗后比较,差异有统计学意义(P0.05);治疗前、治疗后不同疗效淋巴瘤患者的ADC值比较,差异有统计学意义(P0.05)。结论:淋巴瘤患者WB-DWI的ADC值较健康者显著降低,而且不同疗效的淋巴瘤患者具有不同的ADC值,因此,WB-DWI检查可作为淋巴瘤的筛查、诊断及疗效评估的方法。     

颈髓损伤的常规MRI表现与DTI技术临床应用

目的:比较不同时期颈髓损伤的MRI表现及DTI的应用价值。方法:收集急性颈髓压迫病例15例、慢性颈髓压迫病例23例、颈髓慢性压迫合并急性压迫病例12例。15例健康志愿者作为对照组。进行常规MRI检查,应用DTI检查测量表观扩散系数(ADC)值和各向异性分数(FA)。比较各组间ADC值和FA值,并进行统计学分析。结果:急性颈髓迫病例,常规MRI显示颈髓增粗,呈等T1长T2信号;慢性颈髓压迫病例,9例呈长T1长T2信号,14例呈等T1长T2信号;慢性颈髓压迫并急性压迫病例颈髓明显增粗,呈等、长T1明显长T2信号。与对照组比较:急性颈髓压迫组的ADC值和FA值均明显降低,两组的差异有显著性;慢性颈髓压迫组的FA值降低,ADC值增高,两组的差异有显著性;慢性脊髓压迫合并急性脊髓压迫组ADC值与对照组比较无差异,FA值低于对照组。颈髓压迫各组间ADC值及FA值比较差异显著。结论:不同时期颈髓损伤常规MRI图像缺乏特异性,根据ADC值及FA值可判断颈髓损伤的时期。     

基于纤维束追踪空间统计的内侧颞叶癫痫患者弥散张量成像研究

本研究通过分析磁共振弥散张量成像(diffusion tensor imaging,DTI)数据,观察内侧颞叶癫痫(mesial temporal lobe epilepsy,mTLE)患者大脑白质的改变。46例伴有单侧海马硬化的内侧颞叶癫痫患者(24例左侧颞叶癫痫和22例右侧颞叶癫痫),以及42例年龄和性别匹配的正常志愿者纳入本研究。采用基于纤维束追踪的空间统计分析方法(track-based spatialstatistics,TBSS),主要观察患者各向异性系数(fractionsal anisotropy,FA)的变化。结果发现,与正常志愿者相比,左侧mTLE患者FA降低的区域呈双侧分布,稍偏向患侧,胼胝体、上纵束、下纵束、内囊前肢等白质双侧都有异常,而扣带束、下额枕束只在左脑显著降低;右侧mTLE患者FA降低主要见于右脑,包括胼胝体、上纵束、下纵束和钩束等。结果表明,基于TBSS方法的DTI研究揭示了伴有海马硬化的mTLE患者的脑白质异常,有助于加深对mTLE病理生理机制的了解。     

正常人群磁共振全身弥散加权成像特点的初步研究

目的：探讨健康志愿者不同性别各年龄组人体多脏器全身弥散加权成像的图像特征。方法：对50例健康志愿者行全身弥散加权成像扫描,其中,20．30岁、30．40岁、40—50、50．60、60岁以上各二十例,每组内男女各十例。所得图像均经nDeMR后处理工作站（AW4．3）行MIP重建和黑白反转显示技术,并重建ADC图,观察不同性别各年龄组人体多脏器弥散加权图像的特点,并测定不同部位的ADC值,测量的部位主要包括脑灰质、脑白质、尾状核头、丘脑、桥脑、腮腺、肝脏、脾脏、T8椎体、T8—9椎间盘、L2椎体、L2．3椎间盘、前列腺、乳腺、子宫颈等,每个部位重复测量三次取平均值,单位为×10^-3mm^2／S。结果：1、WB-DWI的正常表现。2、不同性别及年龄组间各组织器官ADC值的统计学分析脑白质、T8椎体ADC值在不同性别及年龄组之间存在统计学差异（P〈0．05）;T8．9椎间盘、L2．3椎间盘及女性乳腺ADC值在不同年龄组之间存在统计学差异（P〈0．05）;L2椎体ADC值在男女之间存在统计学差异（P〈0．05）。3、不同部位ADC值平均值。结论：正常人体不同组织器官弥散加权图像特点及ADC值受到性别、年龄的影响,不同性别各年龄组的正常WB-DWI表现存在差异。了解健康成人正常WB-DWI的表现对于准确判断各组织器官的疾病有着重要的意义。     

White Matter Changes in Patients with Amnestic Mild Cognitive Impairment Detected by Diffusion Tensor Imaging

Compared to normal aging adults, individuals with amnestic mild cognitive impairment (aMCI) have significantly increased risk for progressing into Alzheimer’s disease (AD). Autopsy studies found that most of the brains of aMCI cases showed anatomical features associated with AD pathology. The recent development of non-invasive neuroimaging technique, such as diffusion tensor imaging (DTI), makes it possible to investigate the microstructures of the cerebral white matter in vivo. We hypothesized that disrupted white matter (WM) integrity existed in aMCI. So we used DTI technique, by measuring fractional anisotropy (FA) and mean diffusivity (MD), to test the brain structures involved in patients with aMCI. DTI scans were collected from 40 patients with aMCI, and 28 normal controls (NC). Tract-based spatial statistics (TBSS) analyses of whole-brain FA and MD images in each individual and group comparisons were carried out. Compared to NC, aMCI patients showed significant FA reduction bilaterally, in the association and projection fibers of frontal, parietal, and temporal lobes, corpus callosum, bilateral corona radiation, right posterior thalamic radiation and right sagittal stratum. aMCI patients also showed significantly increased MD widespreadly in the association and projection fibers of frontal, parietal and temporal lobes, and corpus callosum. Assessment of the WM integrity of the frontal, parietal, temporal lobes, and corpus callosum by using DTI measures may aid early diagnosis of aMCI.     

Preliminary Study of MR Diffusion Tensor Imaging of the Liver for the Diagnosis of Hepatocellular Carcinoma

Objectives

To evaluate the feasibility of differentiating between hepatocellular carcinomas (HCC) and healthy liver using diffusion tensor imaging (DTI).

Material and Methods

All subjects underwent an abdominal examination on a 3.0T MRI scanner. Two radiologists independently scored the image quality (IQ). An optimal set of DTI parameters was obtained from a group of fifteen volunteers with multiple b-values (100, 300, 500, and 800 s/mm²) and various diffusion-encoding directions (NED = 6, 9, and 12)using two way ANOVA analysis. Eighteen Patients with HCC underwent DTI scans with the optimized parameters. Fractional anisotropy(FA) and average apparent diffusion coefficient (ADC) values were measured. The differences of FA and ADC values between liver healthy region and HCC lesion were compared through paired t tests.

Results

There were no significant changes in liver IQ and FA/ADC values with increased NED(P >0.05), whereas the liver IQ and FA/ADC values decreased significantly with increased b-values(P <0.05). Good IQ, acceptable scan time and reasonable FA/ADC values were acquired using NED = 9 with b-value of (0,300) s/mm². Using the optimized DTI sequence, ADC value of the tumor lesion was significantly lower than that of the healthy liver region (1.30 ± 0.34×10⁻³ vs 1.52 ± 0.27×10⁻³ mm²/s, P = 0.013), whereas the mean FA value of the tumor lesion (0.42 ± 0.11) was significantly higher than the normal liver region (0.32 ± 0.10) (P = 0.004).

Conclusion

Either FA or ADC value from DTI can be used to differentiate HCC from healthy liver. HCC lead to higher FA value and lower ADC value on DTI than healthy liver.     

颈髓损伤的常规MRI表现与DTI技术临床应用

目的：比较不同时期颈髓损伤的MRI表现及DTI的应用价值。方法：收集急性颈髓压迫病例15例、慢性颈髓压迫病例23例、颈髓慢性压迫合并急性压迫病例12例。15例健康志愿者作为对照组。进行常规MRI检查,应用DTI检查测量表现扩散系数（ADC）值和各向异性分数（FA）。比较各组间ADC值和FA值,并进行统计学分析。结果：急性颈髓迫病例,常规MRI显示颈髓增粗,呈等T1长T2信号;慢性颈髓压迫病例,9例呈长T1长T2信号,14例呈等T1长T2信号;慢性颈髓压迫并急性压迫病例颈髓明显增粗,呈等、长T1明显长T2信号。与对照组比较：急性颈髓压迫组的ADC值和FA值均明显降低,两组的差异有显著性;慢性颈髓压迫组的FA值降低,ADC值增高,两组的差异有显著性;慢性脊髓压迫合并急性脊髓压迫组ADC值与对照组比较无差异,FA值低于对照组。颈髓压迫各组间ADC值及FA值比较差异显著。结论：不同时期颈髓损伤常规MRI图像缺乏特异性,根据ADC值及FA值可判断颈髓损伤的时期。     

Therapeutic Hypothermia Modifies Perinatal Asphyxia-Induced Changes of the Corpus Callosum and Outcome in Neonates

What Is Known about this Subject?

Diffusion-weighted MRI has demonstrated changes in the corpus callosum of term neonates with perinatal asphyxia. The severity of cerebral changes demonstrated using diffusion-weighted MRI is difficult to assess without measuring values of the Apparent Diffusion Coefficient (ADC).

What Is New?

ADC values of the anterior part of the corpus callosum are slightly higher than of the posterior part in full term infants with perinatal asphyxia. Low ADC values of the corpus callosum were associated with an adverse outcome in infants with perinatal asphyxia. In infants treated with hypothermia lower ADC values than with normothermia were associated with a poor outcome, supporting neuroprotective effects of hypothermia

Background

Using MRI, changes can be detected in the corpus callosum (CC) following perinatal asphyxia which are associated with later neurodevelopmental outcome.

Aim

To study the association between the apparent diffusion coefficient of water (ADC) in the CC on MRI in neonates with perinatal asphyxia and neurodevelopmental outcome at 18 months of age.

Subjects, Methods

Of 121 infants 32 (26%) died and 13 (11%) survived with an adverse neurological outcome. Sixty-five (54%) received therapeutic hypothermia. MRI was performed within 7 days after birth using a 1.5 T or 3.0 T system, and ADC values were measured in the anterior and posterior CC. The association between ADC and composite outcome (death or abnormal neurodevelopment) was analyzed for both normothermia and hypothermia cases using receiver operating characteristics.

Results

ADC values of the posterior CC were lower than of the anterior part (mean difference 0.050 x 10^-3 mm²/s, p<0.001). Field strength did not affect ADC values. ADC values of the posterior part of the CC were significantly lower in infants with basal ganglia/thalamus or near total brain injury (p<0.001). Lower ADC values were associated with an adverse outcome, but cut-off levels were lower after hypothermia (1.024 x 10^-3 mm²/s vs 0.969 x 10^-3 mm²/s)

Conclusion

Low ADC values of the posterior part of the corpus callosum are associated with an adverse outcome in term or near term neonates with perinatal asphyxia. Therapeutic hypothermia slightly modifies this association, showing that lower values were needed for an adverse outcome.     

复方醋酸林格氏液对乳腺癌根治术患者电解质、血糖及乳酸的影响

目的探讨复方醋酸林格氏液对乳腺癌根治术患者电解质、血糖和乳酸的影响。方法选取2015年1月~2016年11月我院收治的乳腺癌患者81例为研究对象,随机分为观察组(41例)和对照组(40例),观察组应用复方醋酸林格氏液,对照组应用乳酸钠林格注射液,比较两组手术前、后动脉血pH、血清K+、Na+、Ca2+离子、血糖和乳酸水平,并进行统计分析。结果观察组术后动脉血pH和血糖水平高于术前,乳酸水平低于术前,差异有显著统计学意义(P0.05)。对照组术后动脉血pH和血糖水平显著高于术前,差异有统计学意义(P0.05)。两组术后动脉血pH比较,观察组明显高于对照组,血糖和乳酸水平低于对照组,差异均有统计学意义(P0.05)。结论复方醋酸林格氏液对乳腺癌根治术患者血糖和乳酸的影响较小,更安全有效。