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目的在多发性硬化(MS)病人的基底节区应用定量磁化率图(QSM),并将其与对疾病严重程度的临床及形态学测量非常敏感的R2*图进行比较。材料与方法本项研究经地方伦理委员会批准,所有受试者均签署知情同意书。68例病人(26例为临床孤立综合征,42例为复发-缓解型MS)和23例对照受试者行3TMR成像。应用三维多回波扰相梯度回波序列分别重建出磁化率图与R2*图。测量基底节区的平均磁化率和平均R2*率,采用方差分析比较MS不同类型(临床孤立综合征,MS)与对照组的测量值,采用回归分析确定独立预测因素。结果与对照组相比,MS病人及孤立综合征病人的基底节区磁化率增高(更高的顺磁性)。R2*图对组间差异的敏感性较QSM更低。磁化率的最强预测因子是年龄。磁化率随神经功能缺损程度加重而增高(r=0.34,P<0.01),并随灰质(r=-0.35,P<0.01)和皮质(r=-0.35,P<0.005)的正常体积减少而降低。结论 QSM检测基底节区MS相关组织变化的敏感性优于R2*图。应用QSM已经可以观察到临床孤立综合征病人的组织变化,而R2*图却不能,这说明QSM可作为疾病最早期的敏感预测指标。
Objective To quantify the susceptibility map (QSM) in the basal ganglia of patients with multiple sclerosis (MS) and compare them with the R2 * plot, which is very sensitive to clinical and morphological measurements of disease severity. Materials and Methods The study was approved by the local ethics committee and all subjects signed an informed consent form. Sixty-three patients (26 clinically isolated syndromes, 42 with relapsing-remitting MS) and 23 control subjects underwent 3TMR imaging. The three-dimensional multi-echo spoiler gradient echo sequence was used to reconstruct the susceptibility maps and R2 * plots respectively. The mean magnetic susceptibility and R2 * ratio of the basal ganglia were measured. ANOVA was used to compare the measurements of different types of MS (clinical isolated syndrome, MS) with those of the control group, and regression analysis was used to determine independent predictors. Results Compared with the control group, MS patients and patients with isolated syndrome increased basal ganglia magnetic susceptibility (higher paramagnetic). The R2 * plot is less sensitive to differences between groups than QSM. The strongest predictor of magnetic susceptibility is age. The magnetic susceptibility increased with the severity of neurological impairment (r = 0.34, P <0.01), and decreased with the normal volume of gray matter (r = -0.35, P <0.01) and cortical (r = -0.35, P <0.005) reduce. Conclusion The sensitivity of QSM for detecting MS-related changes in basal ganglia is better than that of R2 *. QSM can be used to observe the tissue changes in patients with clinically isolated syndrome, but R2 * can not, which shows QSM can be used as the earliest sensitive predictor of disease.