2型糖尿病视网膜病变患者脑部视觉中心损伤的MR弥散加权成像研究  

MR diffusion imaging analysis of visual center injury in the brain of patients with type 2 diabetic retinopathy

作　　者：王中领[1] 葛晓敏[1] 钱农[1] 李晶[1] 陆紫微[2] 陈罕奇 戴伊红[1] 

机构地区：[1]南京医科大学附属常州市第二人民医院MR室,常州213003 [2]苏州大学附属第一医院放射科陆紫微,苏州215006

出　　处：《中华神经医学杂志》2014年第7期736-740,共5页Chinese Journal of Neuromedicine

摘　　要：目的探讨2型糖尿病视网膜病变（增殖期及非增殖期）患者脑部相关功能区域损伤的MR弥散加权成像（DWI）表现。方法选取常州市第二人民医院内分泌科自2012年3月至2013年3月期间住院治疗的2型糖尿病患者45例为研究对象，根据眼底检查结果分3组：增殖期糖尿病视网膜病变组（15例1，非增殖期糖尿病视网膜病变组（15例），糖尿病无视网膜病变组（15例）。另选15名为健康志愿者为对照组。应用3．0TMR成像系统行脑部T2WI及DWI成像，分别测量眶额叶皮层、扣带回及背中线额叶皮层、背外侧额叶皮层、视皮层、丘脑及放射冠区7个相关功能区域的平均ADC值，并将ADC值与糖尿病视网膜病变患者的病程及糖化血红蛋白进行Spearman’s相关性分析。4组间的分析采用配对t检验。结果2型糖尿病增殖期视网膜病变组fPDRl及非增殖期视网膜病变组（NPDR）眶额叶、扣带回及视皮层的平均ADC值明显高于糖尿病无视网膜病变组与正常对照组，4组之间的比较差异具有统计学意义（F=95．268，P=0．000），PDR组的眶额叶皮层、扣带回及视皮层的ADC值高于NPDR组，两两比较差异具有统计学意义（P〈0．05）；而糖尿病无视网膜病变组与正常对照组之间比较无统计学差异（胗0．05）。背中线额叶皮层、背外侧额叶皮层、丘脑及放射冠区的ADC值在各组之间无统计学差异（p＞0．05）。眶额叶皮层（r=0．336，P=0．014）、扣带回（r=0．296，P=0．049）及视皮层（F0．370，P=0．012）的平均ADC值与糖化血红蛋白fHbAlc）值呈正相关；眶额叶皮层（F0．567，P=0．001）、扣带回（r=0．491，P=0．01）及视皮层（r=0．428，P=0．003）的平均ADC值与病程呈正相关。结论视觉中枢（眶额叶皮层、扣带回及视皮层）的ADC值升高证实2型糖尿病视网膜病变与脑部功能损伤具有一定关联性：通过DWI成像能够评估亚�Objective To investigate the possible brain diffusion changes in different sites of the brain, particularly in areas associated with vision fimction, of patients with proliferative and nonproliferative retinopathy by using diffusion-weighted imaging （DWI）. Methods Forty-five type 2 diabetic patients, admitted to our hospital from March 2012 to March 2013, were chosen in our study; according to the fixndus examination, they were divided into group of proliferative retinopathy （n=15） group of non-proliferative retinopathy （n=15） and group of no retinopathy （n=15）; another 15 healthy controls were chosen. T2WI and DWI with 3.0T magnetic resonance imaging （MRI） were performed; the apparent diffusion coefficient （ADC） values in the orbitofrontal cortex, cingnlated gyrus, thalamus, dorsomedial and dorsolateral frontal cortex, and corona radiate were calculated; and then, Spearman＇s correlation analysis was performed between ADC values and both course of disease and glycosylated hemoglobin level. Results The ADC values of orbitofrontal cortex, cingulated gyrus and visual cortex in groups of proliferative and non-proliferative retinopathy were significantly increased as compared with group of no retinopathy and control group （F=95.268, P〈0.05）; the ADC values of orbitofrontal cortex, eingulated gyrus and visual cortex in group of proliferative retinopathy were significantly increased as compared with those in group of non-proliferative retinopathy （P=0.004, 0.001 and 0.009, respectively）; no significant difference of them was noted between group of no retinopathy and control group （P〉0.05）. The mean ADC values of orbitofrontal cortex, cingulated gyrus and visual cortex was positively correlated to the duration of disease （r=0.567 and P=0.001; r=0.491 and P=0.01; r=0.428 and P=0.003） and glycosylated hemoglobin level （r=0.336 and P=0.014; r=0.296 and P=0.049; r=0.370 and P=0.012）. Conclusion Increased ADC values of visual center （orbitoftontal cortex,cingnlated gyrus and

关 键 词：糖尿病视网膜病变 MR弥散加权成像 ADC 视皮层 

分 类 号：R445.2[医药卫生—影像医学与核医学]