磁共振体素内不相干运动成像对复发缓解型多发性硬化患者小脑异常的研究
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摘要
目的探讨磁共振体素内不相干运动成像(IVIM)在复发缓解型多发性硬化(RRMS)患者小脑中的应用价值。方法 20例有运动障碍的RRMS患者及20例性别年龄相匹配的健康对照组行常规MRI和IVIM扫描,取多个b值(10,20,30,40,50,100,150,200,350,500,650,800,1000 s/mm~2),获取反映RRMS患者小脑上脚、小脑中脚组织扩散特点的表观扩散系数(ADC)、ADC_(slow)、ADC_(fast)及组织微血管灌注f值。采用SPSS 21.0对数据进行统计学分析,对RRMS患者及健康对照组ADC、ADC_(slow)、ADC_(fast)及f值分别进行非参数检验Mann-Whitney U对比,P<0.05为差异有统计学意义。结果RRMS患者双侧小脑上脚ADC值、双侧小脑上脚ADC_(slow)值、双侧小脑中脚ADC_(fast)值、右侧小脑上脚ADC_(fast)值较健康对照组升高(Z_(ADC左侧小脑上脚)=-3.349,Z_(ADC右侧小脑上脚)=-2.116,Z_(ADCslow左侧小脑上脚)=-2.497,Z_(ADCslow右侧小脑上脚)=-2.242,Z_(ADCfast右侧小脑中脚)=-4.594,Z_(ADCfast左侧小脑中脚)=-4.887,Z_(ADCfast右侧小脑上脚)=-4.450,P<0.05)。双侧小脑中脚f值、右侧小脑上脚f值较对照组明显减低(Z_(f左侧小脑中脚)=-3.220,Z_(f右侧小脑中脚)=-3.147,Z_(f右侧小脑上脚)=-4.460,P<0.05)。但左侧小脑上脚的ADC_(fast)、f值及双侧小脑中脚ADC、ADC_(slow)值较对照组差异无统计学意义(P>0.05)。结论磁共振IVIM成像能定量分析RRMS患者小脑上脚、中脚的扩散及灌注特点,有助于推测小脑局部的病理微循环改变。
Objective To evaluate the application value of using intravoxel incoherent motion( IVIM) MRI for cerebellar abnormalities in patients with relapsing-remitting multiple sclerosis( RRMS). Methods 20 patients with clinically definite RRMS suffering from movement disorders and 20 ag-and gender-matched normal controls underwent the conventional MRI and IVIM MRI based on multi-b-factor( b values of 10,20,30,40,50,100,150,200,350,500,650,800,1000 s/mm~2) with 3. 0T MR scanner. The apparent diffusion coefficient( ADC),ADCslow,ADCfastand f values were evaluated to reflect the diffusion and perfusion status of the superior cerebellar peduncle and brachium pontis regions in RRMS. Statistical analysis of the data was carried out by using statistical package for the social science( SPSS) version 21. 0 software( SPSS,Inc,Chicago,IL). The Mann-Whitney U test was used to compare the differences of ADC,ADCslow,ADCfastand f values between the two groups,P value determinations of < 0. 05 was considered statistically significant. Results Compared with the controls,RRMS exhibited significantly increased ADC and ADCslowin bilateral superior cerebellar peduncle,ADCfast in bilateral brachium pontis and right superior cerebellar peduncle( ZADC left superior cerebellar peduncle=-3. 349,ZADC right superior cerebellar peduncle=-2. 116,ZADCslow left superior cerebellar peduncle=-2. 497,ZADCslow right superior cerebellar peduncle=-2. 242,ZADCfast right brachium pontis=-4. 594,ZADCfast left brachium pontis=-4. 887,ZADCfast right superior cerebellar peduncle=-4. 450,P < 0. 05). And the f value of bilateral brachium pontis and right superior cerebellar peduncle in RRMS decreased significantly( Zf left brachium pontis=-3. 220,Zf right brachium pontis=-3. 147,Zf right superior cerebellar peduncle=-4. 460,P < 0. 05). However,the ADCfastand f values in left superior cerebellar peduncle,the ADC、ADCslowvalues in bilateral brachium pontis had no significant differences. Conclusion Our results demonstrated the IVIM MRI can measure the diffusion and perfusion status of the superior cerebellar peduncle and brachium pontis in RRMS patients. Furthermore,it may be helpful for speculating the microcirculation abnormalities in the cerebellum..
Objective To evaluate the application value of using intravoxel incoherent motion( IVIM) MRI for cerebellar abnormalities in patients with relapsing-remitting multiple sclerosis( RRMS). Methods 20 patients with clinically definite RRMS suffering from movement disorders and 20 ag-and gender-matched normal controls underwent the conventional MRI and IVIM MRI based on multi-b-factor( b values of 10,20,30,40,50,100,150,200,350,500,650,800,1000 s/mm~2) with 3. 0T MR scanner. The apparent diffusion coefficient( ADC),ADCslow,ADCfastand f values were evaluated to reflect the diffusion and perfusion status of the superior cerebellar peduncle and brachium pontis regions in RRMS. Statistical analysis of the data was carried out by using statistical package for the social science( SPSS) version 21. 0 software( SPSS,Inc,Chicago,IL). The Mann-Whitney U test was used to compare the differences of ADC,ADCslow,ADCfastand f values between the two groups,P value determinations of < 0. 05 was considered statistically significant. Results Compared with the controls,RRMS exhibited significantly increased ADC and ADCslowin bilateral superior cerebellar peduncle,ADCfast in bilateral brachium pontis and right superior cerebellar peduncle( ZADC left superior cerebellar peduncle=-3. 349,ZADC right superior cerebellar peduncle=-2. 116,ZADCslow left superior cerebellar peduncle=-2. 497,ZADCslow right superior cerebellar peduncle=-2. 242,ZADCfast right brachium pontis=-4. 594,ZADCfast left brachium pontis=-4. 887,ZADCfast right superior cerebellar peduncle=-4. 450,P < 0. 05). And the f value of bilateral brachium pontis and right superior cerebellar peduncle in RRMS decreased significantly( Zf left brachium pontis=-3. 220,Zf right brachium pontis=-3. 147,Zf right superior cerebellar peduncle=-4. 460,P < 0. 05). However,the ADCfastand f values in left superior cerebellar peduncle,the ADC、ADCslowvalues in bilateral brachium pontis had no significant differences. Conclusion Our results demonstrated the IVIM MRI can measure the diffusion and perfusion status of the superior cerebellar peduncle and brachium pontis in RRMS patients. Furthermore,it may be helpful for speculating the microcirculation abnormalities in the cerebellum..
引文
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11尹平,曾春,王静杰,等.复发缓解型多发性硬化患者脑内病灶动态对比增强MRI灌注及渗透特点[J].中华放射学杂志,2015,49:731-735.
12 King MD,van Bruggen N,Busza AL,et al.Perfusion and diffusion MR imaging[J].Magn Reson Med,1992,24:288-301.
13 Bisdas S,Koh TS,Roder C,et al.Intravoxel incoherent motion diffusion-weighted MR imaging of gliomas:feasibility of the method and initial results[J].Neuroradiology,2013,55:1189-1196.
2 Preziosa P,Rocca MA,Mesaros S,et al.Relationship between damage to the cerebellar peduncles and clinical disability in multiple sclerosis[J].Radiology,2014,271:822-830.
3 Calabrese M,Mattisi I,Rinaldi F,et al.Magnetic resonance evidence of cerebellar cortical pathology in multiple sclerosis[J].J Neurol Neurosurg Psychiatry,2010,81:401-404.
4周津如,李咏梅,刘义,等.纤维示踪技术对多发性硬化患者小脑结构的研究[J].中国医学计算机成像杂志,2016,22:101-105.
5余晖,刘艳,蒲伟,等.联合应用VBA和TBSS方法检测复发缓解型多发性硬化患者脑损害[J].临床放射学杂志,2015,34:1384-1388.
6 Le Bihan D,Breton E,Lallemand D,et al.Separation of diffusion and perfusion in intravoxel incoherent motion MR imaging[J].Radiology,1988,168:497-505.
7 Dyvorne HA,Galea N,Nevers T,et al.Diffusion-weighted imaging of the liver with multiple b values:effect of diffusion gradient polarity and breathing acquisition on image quality and intravoxel incoherent motion parameters-a pilot study[J].Radiology,2013,266:920-929.
8 Filippi M,Rocca MA,Ciccarelli O,et al.MRI criteria for the diagnosis of multiple sclerosis:MAGNIMS consensus guidelines[J].Lancet Neurol,2016,15:292-303.
9 Federau C,Maeder P,O'Brien K,et al.Quantitative measurement of brain perfusion with intravoxel incoherent motion MR imaging[J].Radiology,2012,265:874-881.
10马婉玲.体素内不相干运动扩散加权成像的临床应用进展[J].功能与分子医学影像学杂志(电子版),2014,3:50-55.
11尹平,曾春,王静杰,等.复发缓解型多发性硬化患者脑内病灶动态对比增强MRI灌注及渗透特点[J].中华放射学杂志,2015,49:731-735.
12 King MD,van Bruggen N,Busza AL,et al.Perfusion and diffusion MR imaging[J].Magn Reson Med,1992,24:288-301.
13 Bisdas S,Koh TS,Roder C,et al.Intravoxel incoherent motion diffusion-weighted MR imaging of gliomas:feasibility of the method and initial results[J].Neuroradiology,2013,55:1189-1196.