肝硬化患者基于体素的全脑扩散张量成像研究  

Study of voxel-based whole brain diffusion tensor imaging in cirrhotic patients

作　　者：孔祥[1,2] 戚荣丰[1,2] 梁雪[1,2] 罗松[1,2] 倪玲[1,2] 郭会映[1,2] 卢光明[1,2] 张龙江[1,2] 

机构地区：[1]南京军区南京总医院影像科 [2]南京大学医学院附属金陵医院影像科,南京210002

出　　处：《放射学实践》2014年第1期16-20,共5页Radiologic Practice

基　　金：国家自然科学基金项目资助(81322020;81230032)

摘　　要：目的:探讨基于体素的扩散张量成像(DTI)对无肝性脑病肝硬化(non-HE)到轻微肝性脑病(MHE)进展的潜在应用价值。方法:对45例无明显肝性脑病症状的肝硬化患者和27例年龄、性别相匹配的健康志愿者(对照组)进行常规MRI和DTI检查。采用神经心理学测试中的数字连接实验-A(NCT-A)和数字符号实验(DST)对受试者认知功能进行评估,根据测试结果将肝硬化患者分为MHE组和non-HE组;采用基于体素的SPM8软件对三组受试者的平均扩散率(MD)图及各向异性分数(FA)图进行ANOVA分析,观察MHE和non-HE组MD值和FA值发生改变的脑区。结果:三组间MD值差异脑区主要位于额叶、颞叶、顶叶区;与non-HE组相比,MHE组右侧颞上/中回、右侧角回、右侧顶叶MD值升高。三组间FA值差异脑区主要位于胼胝体、前扣带回、顶叶及额叶区;与non-HE组相比,MHE组在胼胝体及前扣带皮层的FA值减低。结论:基于体素的DTI技术可观察无明显肝性脑病症状的肝硬化患者脑结构的异常;肝硬化患者存在间质性脑水肿,且与疾病进展有关。Objective：To investigate the potential value of voxel-based diffusion tensor imaging （DTI） in the evalua- tion of the development of minimal hepatic encephalopathy （MHE） from non-hepatic encephalopathy （non-HE）. Methods： 45 cirrhotic patients without overt hepatic encephalopathy symptoms and 27 sex-and age- matched healthy controls were in- eluded and conventional MRI and DTI examinations were performed. Neuropsychological tests including number connection test-A （NCT-A） and digit-symbol test （DST） were used to evaluate the cognitive function of all subjects. Patients with cir- rhosis were divided to MHE and non-HE groups according to the results of neuropsychological tests. The mean apparent diffusion coefficient （MD） and fraction anisotropy （FA） maps were compared with ANOVA tests in MHE, non-HE, and healthy control groups using SPM8 software,to study the differences of MD and FA in brain areas of MHE and non-HE. Results：Of the three groups, the differences of MD values mainly located at frontal lobe, temporal lobe and parietal lobe. Compared with non-HE,increase of MD in right superior/middle temporal gyrus, angular gyrus, and parietal lobe could be assessed in MHE patients. The differences of FA values in these 3 groups mainly could be revealed in anterior cingulate, corpus callosum, parietal lobe,and frontal lobe. Compared with non-HE, decrease of FA value in corpus callosum and anteri or cingulate were revealed in MHE patients. Conclusion：The voxel-based DTI could be used to observe brain structure ab- normality in cirrhotic patients. Cirrhotic patients had interstitial brain edema which was associated with the severity of the disease.

关 键 词：肝性脑病 肝硬化 磁共振成像 扩散张量成像 

分 类 号：R575.2[医药卫生—消化系统] R445.2[医药卫生—内科学]