3D-DIR在RNMO与RRMS皮层病变研究中的应用  

Clinical application of magnetic resonance three-dimensional double inversion recovery sequence in cortical lesions of relapsing neuromyelitis optica and relapsing-remitting multiple sclerosis

作　　者：李鑫[1] 刘雅婷[2] 刘光耀[3] 王蕾[1] 武国德[1] 吴闯[3] 原铂尧 王满侠[1] LI Xin;LIU Yating;LIU Guangyao;WANG Lei;WU Guode;WU Chuang;YUAN Boyao;WANG Manxia(Department of Neurology,Lanzhou University Second Hospital,Lanzhou Gansu 730000,China)

机构地区：[1]兰州大学第二医院神经内科,730000 [2]兰州大学第二医院肿瘤内科,730000 [3]兰州大学第二医院放射科,730000

出　　处：《中国神经免疫学和神经病学杂志》2018年第4期236-241,共6页Chinese Journal of Neuroimmunology and Neurology

摘　　要：目的利用磁共振三维双翻转恢复序列(three-dimensional double inversion recovery,3D-DIR)观察在复发型视神经脊髓炎(relapsing neuromyelitis optica,RNMO)与复发缓解型多发性硬化(relapsing-remitting multiple sclerosis,RRMS)中皮层病变的差异。方法选取2015-02-28-2017-02-28期间兰州大学第二医院神经内科中枢神经系统炎性脱髓鞘患者数据库中的RNMO患者、RRMS患者各22例,以年龄性别匹配的健康体检者22名作为对照。用3D-DIR序列对3组观察对象皮层病变进行区域检测,同时测量三组各个区域皮层厚度,比较各组间差异。结果常规MRI T2、Flair序列下,RRMS患者皮层病变出现率为27.27%(n=6),而对照组和RNMO组均未见皮层病变。DIR序列下RNMO病例与健康对照组均未见皮层病变,而22例RRMS的皮层病变出现率为81.82%(n=18)。通过双反转恢复序列三维重建显示RRMS患者存在严重的皮层病变(90.91%,n=20),通过freesurfer软件三维重建的皮层区病灶分布更为明显,几乎所有RRMS患者均存在皮层病变(100%,n=22),而RNMO未见皮层病变。RNMO患者与NC的额颞交界区(P<0.001)、枕叶下区(P<0.001)、顶叶下区(P<0.001)以及距状回[(1.92±0.42)mmvs.(2.16±0.32),F=11.712,P=0.016]的皮层厚度比较有统计学差异,其余区域的皮层厚度的比较无统计学差异。RRMS与NC在大脑皮层厚度比较除枕极无明显区别[(2.13±0.35)mmvs.(2.12±0.33)mm,F=0.266,P=0.609)]之外,大脑其他部位的皮层厚度均变薄(P<0.05)。RRMS与RNMO两组间皮层厚度比较,额极区[(2.18±0.29)mmvs.(2.70±0.22)mm,F=113.648,P=0.003]、额颞交界区[(2.23±0.33)mmvs.(2.72±0.29)mm,F=67.876,P=0.009]、颞叶上区[(2.12±0.31)mmvs.(2.83±0.27)mm,F=144.361,P=0.003)]、中区[(2.34±0.41)mmvs.(2.91±0.43)mm,F=58.123,P=0.004]、下区[(2.54±0.31)mmvs.(2.97±0.32)mm,F=51.779,P=0.005]、颞枕交界区[(2.12±0.26)mmvs.(2.61±0.17)mm,F=171.844,P=0.009]、枕叶下区[(1.98±0.27)mmvs.(2.12±0.17)mm,F=9.771,P=0.003)]、旁中央回[(1Objective To investigate the difference of cortical lesions between relapsing neuromyelitis optica（RNMO）and relapsing remitting multiple sclerosis（RRMS）by using magnetic resonance threedimensional double recovery sequence.Methods Selected randomly RNMO,RRMS of the 22 patients on Lanzhou University Second Hospital from 28,February 2015 to 28,February 2017 and the healthy check-up of qualified for 22 people were selected as normal controls.The cortical thickness and lesions in three groups was measured by using magnetic resonance three-dimensional double reverse recovery sequence.Between-group differences were assessed using an analysis of variance.All statistical analyses were performed using SPSS 21.Results In Routine T2、Flair sequence,the rate of emergence of cortical lesions was 27.27%（n=6）,the control group and RNMO group had no cortical lesions.In the DIR sequence,there were no cortical lesions in RNMO between the control group and RNMO group,and the rate of emergence of cortical lesions was 81.82%（n=18）in RRMS.Three-dimensional reconstruction of double-inversion recovery sequence showed that the cortical lesions in RRMS patients was more obvious（90.91%,n=20）.Almost all RRMS patients had cortical lesions by freesurfer software（100%,n=22）that showed the distribution of lesions was more obvious,RNMO has no lesions.Comparing in cortical thickness of Frontotemporal（P〈0.001）,Temporal superior（P〈0.001）,parietal superior（P〈0.001）and spur gyrus [（1.92±0.42）mm vs.（2.16±0.32）mm,F=11.712,P=0.016）]between RNMO and NC were statically significant（P〈0.05）.There were no significant differences in other areas of cortical thickness.There were no significant differences in cortical thickness between RRMS and NC [（2.13±0.35）mmvs.（2.12±0.33）mm,F=0.266,P=0.609）]except occipital lobe.The cortical thickness of other parts of brain had statistical difference.Comparing in cortical thickness between RRMS and RNMO,Frontal pole [（2.18±0.29） mm vs.（2.70±0.22

关 键 词：磁共振三维双反转恢复序列 复发型视神经脊髓炎 复发缓解型多发性硬化 

分 类 号：R744.51[医药卫生—神经病学与精神病学]