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体素内不相干运动成像评估脑白质高信号微观结构改变的价值

Value of intravoxel incoherent motion diffusion weighted imaging in evaluating the microstructure changes in white matter hyperintensities
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摘要 目的利用体素内不相干运动成像(IVIM)技术,探讨脑白质高信号(WMH)区微观结构改变并分析其定量参数与WMH严重程度及认知功能的相关性。方法2014年12月至2018年3月前瞻性收集浙江医院62例WMH患者行磁共振成像(MRI)常规扫描及IVIM检查,年龄60~92(74±10)岁,其中男37例、女25例。以深部脑白质高信号(DWMH)、侧脑室周围白质高信号(PWMH)及灶周正常脑白质区(NWM)为感兴趣区获得IVIM双指数模型参数:扩散系数(D),伪扩散系数(D^*)及灌注分数(f)。根据T2液体衰减反转恢复(FLAIR)序列表现及Fazekas评分判断WMH严重程度。不同感兴趣区D、D^*、f值进行Kruskal-Wallis法多组秩和检验,组间两两比较采用Dwass-Steel-Critchlow-Fligner(DSCF)法。轻、重两组组间D、D^*、f值比较采用Wilcoxon秩和检验。采用简易智能状态检查量表(MMSE)评估WMH患者认知功能并与D、D^*、f值进行相关分析。结果D值DWMH[0.83(0.72,0.99)×10^-3mm^2/s]、D值PWMH[(1.13±0.25)×10^-3mm^2/s]显著高于D值NWM[(0.71±0.05)×10^-3mm^2/s](均P<0.01)。f值DWMH[8.94%(7.46%,11.67%)]、f值PWMH[8.34%(6.73%,9.96%)]显著高于f值NWM(6.71%±1.72%)(均P<0.01)。DWMH区D值显著低于PWMH区(P<0.01)。重度WMH患者DWMH及PWMH区的D值均高于轻度WMH患者(P=0.0001,P=0.04),D^*、f值差异均无统计学意义(均P>0.05)。MMSE评分与PWMH区的f值存在显著正相关(r=0.3265,P<0.05)。结论运用IVIM双指数模型能够无创地、同步地获得WMH区的扩散及灌注信息,准确评估WMH严重程度,从而更好的评价及管理WMH。 Objective To investigate the value of intravoxel incoherent motion diffusion weighted imaging (IVIM DWI) in evaluating microstructure changes in elderly white matter hyperintensities (WMH) patients and to analyze the correlation between IVIM parameters and severity grading and cognitive scores. Methods Sixty-two WMH patients in Zhejiang Hospital were collected from December 2014 to March 2018 and underwent conventional magnetic resonance (MR) plain scan and diffusion weighted imaging with different b values. The age was 60-92(74±10) years with 37 males, 25 females. The severity of WMH was assessed by T2 fluid attenuated inversion recovery (FLAIR) sequence and Fazekas score,which were divided into two subgroups. Slow diffusion coefficient (D), fast diffusion coefficient (D^*) and perfusion fraction (f) from IVIM parameters of double exponential model were compared between regions of WMH (deep WMH (DWMH) and periventricular WMH (PWMH)) and surrounding normal white matter (NWM).The Shapiro-Wilk test was used for normality tests, Kruskal-Wallis tests and Dwass-Steel-Critchlow-Fligner (DSCF) procedure were used for the comparison among these parameters. Furthermore, Wilcoxon two-sample test was used for the comparisons between different severity. Pearson correlation analysis was performed to determine whether these D, D^*, f values were correlated with the mini mental state examination (MMSE) scores. Results DDWMH (0.83(0.72,0.99)×10^-3 mm^2/s), DPWMH((1.13±0.25)×10^-3 mm^2/s) were significantly higher than DNWM ((0.71±0.05)×10^-3 mm^2/s)(P<0.01). f DWMH ((8.94%(7.46%,11.67%)), f PWMH(8.34%(6.73%,9.96%)) were significantly higher than f NWM(6.71%±1.72%)(P<0.01).D in DWMH were significantly lower than that in PWMH(P<0.01), there′s no statistically difference between other groups. D in severe WMH (both DWMH and PWMH) were significantly higher than that in mild WMH (P=0.000 1, P=0.04). Only f in PWMH were positively associated with the MMSE scores (r=0.326 5,P<0.05). Conclusions IVIM DWI can noninvasively assess
作者 杨笛 陈尧 董云飞 刘小利 付凤丽 翟利浩 徐晓斌 胡世云 张建军 Yang Di;Chen Yao;Dong Yunfei;Liu Xiaoli;Fu Fengli;Zhai Lihao;Xu Xiaobin;Hu Shiyun;Zhang Jianjun(Department of Radiology,Zhejiang Hospital,Hangzhou 310013,China;Department of Neurology,Zhejiang Hospital,Hangzhou 310013,China;Center for Cardio-cerebrovascular Disease Prevention and Control Research,Zhejiang Province,Zhejiang Hospital,Hangzhou 310013,China)
出处 《中华医学杂志》 CAS CSCD 北大核心 2019年第19期1484-1489,共6页 National Medical Journal of China
基金 浙江省科技厅公益性项目(2013C33207).
关键词 磁共振成像 扩散 脑白质病 体素内不相干运动 Diffusion magnetic resonance imaging Leukoencephalopathies Intravoxel incoherent motion
作者简介 通信作者:张建军,Email:zhangyp31113@163.com.
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