MRS及DWI在糖尿病酮症酸中毒脑损伤中的初步应用  

Preliminary application of MRS and DWI in brain injury of diabetic ketoacidosis

作　　者：李德刚 金国宏[2] 魏璇[2] 张国栋[2] 朱凯[2] 张伟[2] 

机构地区：[1]包头钢铁集团医院影像中心,内蒙古包头014010 [2]宁夏医科大学附属医院放射科,宁夏银川750004

出　　处：《中国医学影像技术》2012年第12期2136-2140,共5页Chinese Journal of Medical Imaging Technology

摘　　要：目的探讨MRS及DWI在糖尿病酮症酸中毒(DKA)脑损伤中的应用价值。方法收集17例临床确诊的DKA患者,于发病早期(初始治疗后0～12h)和恢复以后(治疗开始72h后或更长时间)行脑部MR检查。分别测量发病早期和恢复以后的右侧基底节区和半卵圆中心的ADC值,比较发病早期和恢复以后ADC值;在右侧基底节区、双侧枕叶灰质和中脑导水管周围灰质检测N-乙酰天门冬氨酸(NAA)、胆碱(Cho)、肌酸(Cr),比较以上3个ROI发病早期和恢复以后的NAA/Cr和Cho/Cr及发病早期的NAA/Cr。结果DKA早期与恢复以后右侧基底节区和半卵圆中心ADC值差异无统计学意义(t=-0.94、0.77,P均>0.05);DKA发病早期NAA/Cr降低,经治疗恢复以后NAA/Cr升高;右侧基底节区、双侧枕叶灰质和中脑导水管周围灰质NAA/Cr差异有统计学意义(t=-7.01、-2.88、-2.41,P均<0.05)。发病早期右侧基底节区、枕叶灰质和中脑导水管周围灰质NAA/Cr差异有统计学意义(F=8.40,P<0.01)。发病早期和恢复以后Cho/Cr差异无统计学意义(右侧基底节区:t=1.03,P>0.05;双侧枕叶灰质:t=-0.12,P>0.05;中脑导水管周围灰质:t=0.86,P>0.05)。结论 DKA发病早期脑部神经元活性或功能减低,恢复以后神经元活性或功能有所恢复。DKA发病期间存在代谢性脑损伤。MRS可用于评价DKA患者发病期间脑损伤及其预后。Objective To explore the application value of MRS and DWI in brain injury of diabetic ketoacidosis （DKA）. Methods Totally 17 patients with clinically confirmed DKA underwent cerebral MRI during early onset （0-12 h after ini- tiation of therapy） and recovery periods （72 hours or more after initiation of therapy）. Apparent diffusion coefficient （ADC） was measured in the right basal ganglia and semioval center, respectively. The average ADC value was acquired and compared during DKA and after recovery. Peak heights of N-acetyl asparte （NAA）, choline （Cho）, creatine （Cr） in the right basal ganglia, the occipital gray matter and periaqueductal gray matter were measured, respectively. NAA/Cr and Cho/Cr were compared during early onset and recovery periods in the above regions. NAA/Cr was also compared during the early onset in three regions. Results ADC value had no statistical difference between two regions （right basal ganglia： t=-0.94, P〉0.05; semioval center： t= 0.77, P〉0.05） during early onset and recovery periods. NAA/Cr decreased during early onset and improved in recovery periods. Differences of NAA/Cr had statistical differences in 3 ROIs between early onset and recovery periods （the basal ganglia： t= -7.01, P^0.05; the occipital gray matter： t=- 2.88, P〈0.05; the periaqueductal gray matter： t=-2.41, P〈0.05）. There was statistical difference of NAA/Cr during the acute DKA among three regions （F=8.40, P〈0.01）. In contrast, there was no statistical difference of Cho/Cr in any region （the basal ganglia： t=1. 03, P〉0. 05; the occipital gray matter., t= -0.12, P〉0.05; the periaqueductal gray matter., t= 0.86, P〉0.05） between early onset and recovery periods. Conclusion During early onset, neuronal function or viability or both are compromised and improve after treatment and recovery. Brain injury of metabolism occurs during DKA. MRS can be used to evaluate brain injury and the prognosis of patients with DKA.

关 键 词：磁共振波谱 扩散磁共振成像 糖尿病酮症酸中毒 脑损伤 

分 类 号：R445.2[医药卫生—影像医学与核医学] R587.1[医药卫生—诊断学]