3D-ASL联合1H-MRS评价重度OSAS患者早期脑组织改变的应用价值  

Value of fMRI parameters in evaluating early cerebral damage of patients with severe obstructive sleep apnea syndrome

作　　者：赵育英[1] 毛新峰[1] 刘东[1] 姚丽娣[1] 张惠美[1] 陆华东[2] ZHAO Yuying;MAO Xinfeng;LIU Dong;YAO Lidi;ZHANG Huimei;LU Huadong(Department of Radiology,Huzhou Central Hospital,Huzhou 313000,China)

机构地区：[1]湖州市中心医院放射科,313000 [2]湖州市中心医院呼吸科,313000

出　　处：《浙江医学》2020年第23期2516-2520,I0003,共6页Zhejiang Medical Journal

基　　金：浙江省医药卫生科技计划项目(2014RCA029);湖州市科技局公益项目(2015GY12)。

摘　　要：目的通过分析重度阻塞性睡眠呼吸暂停综合征(OSAS)患者脑部功能磁共振成像(fMRI)参数变化,探讨三维动脉自旋标记(3D-ASL)联合磁共振波谱(1H-MRS)评价患者早期脑组织改变的应用价值。方法对2015年12月至2019年12月湖州市中心医院83例临床确诊的重度OSAS患者[呼吸暂停低通气指数(AHI)>30次/h]和83例无OSAS表现的健康体检者(AHI<5次/h),头部分别进行3D-ASL、弥散张量成像(DTI)及1H-MRS检查,测量右侧额叶白质、右侧扣带回脑血流量(CBF)、各向异性(FA)值、表观弥散系数(ADC)、N-乙酰天门冬氨酸/胆碱(NAA/Cho)、胆碱/肌酸(Cho/Cr)值,对两组fMRI成像参数进行统计分析,对预测指标进行ROC曲线分析并计算AUC、灵敏度、特异度、最佳临界值。结果重度OSAS患者右侧额叶白质CBF、FA、ADC、NAA/Cho与健康对照组比较差异均有统计学意义(均P<0.05),AUC分别为0.865、0.863、0.826、0.993,提示NAA/Cho是诊断脑白质改变的最优参数,其最佳临界值为1.390,灵敏度为0.967,特异度为0.967;重度OSAS患者右侧额叶扣带回CBF、ADC、NAA/Cho、Cho/Cr与健康对照组比较差异均有统计学意义(均P<0.05),AUC分别为0.950、0.815、0.921、0.897,提示CBF是诊断脑灰质改变的最优参数,其最佳临界值为39.63 ml/(min·100 g),灵敏度为0.917,特异度为0.817。结论3D-ASL联合1H-MRS有助于全面判断重度OSAS患者早期脑组织改变,对临床早期干预和判断预后具有重要参考价值。Objective To assess the value of functional MRI(fMRI)parameters in evaluation of early cerebral damage in patients with severe obstructive sleep apnea syndrome(OSAS).Methods The fMRI scans,including 3D-ASL,DTI and 1H-MRS examinations were performed in 83 patients with severe OSAS and in 83 age-matched control subjects.Cerebral blood flow(CBF),fractional anisotropy(FA),apparent diffusion coefficient(ADC),NAA/Cho,Cho/Cr were measured in right white matter of frontal lobe and right cingulae gyrus.Independent samples t test was used for statistical analysis;receiver operator characteristic curve(ROC)analysis of the prediction indexes were performed,and the optimum parameter and its diagnostic threshold were identified.Results There were significant differences in values of CBF,FA,ADC and NAA/Cho in white matter of the right frontal lobe between OSAS patients and healthy controls(all P<0.05).The areas under the ROC curves(AUCs)of above parameters in predicting white matter injury of OSAS patients were 0.865,0.863,0.826 and 0.993,respectively.The NAA/Cho had best diagnostic value for white matter injury;taken 1.390 as cut-off value,the sensitivity and specificity was 0.967 and 0.967,respectively.There were significant differences in values of CBF,ADC,NAA/Cho and Cho/Cr in cingulate gyrus of the right frontal lobe between OSAS patients and healthy subjects(all P<0.05).The AUCs of above parameters for diagnosis were 0.950,0.815,0.921 and 0.897,respectively.The CBF had best diagnostic value for the injury to cerebral cortex;and taken 39.63 ml/(min·100g)as diagnosis threshold,the sensitivity and specificity was 0.917 and 0.817,respectively.Conclusion The combination of 3D-ASL and 1H-MRS may be used for comprehensive diagnosis of early cerebral injury in patients with severe OSAS.

关 键 词：阻塞性睡眠呼吸暂停综合征 功能磁共振 脑改变 ROC曲线 

分 类 号：R766[医药卫生—耳鼻咽喉科]