【摘要】 目的探讨磁共振扩散成像(DWI)及磁共振波谱(MRS)在肝豆状核变性(HLD)诊断中的价值。方法对56例临床确诊HLD患者(HLD组)、10名健康志愿者(对照组)行颅脑常规MRI、DWI、1H-MRS检查。采用独立样本t检验比较两组在豆状核区的表观扩散系数(ADC值)及脑代谢产物N-乙酰天门冬氨酸(NAA)/肌酸(Cr)、胆碱复合物(Cho)/肌酸(Cr)比值方面上的差异;采用单因素方差分析HLD豆状核区的DWI信号、ADC值变化与脑代谢产物NAA/Cr、Cho/Cr比值变化的关系。结果按豆状核DWI信号改变,HLD组可分为高(9例)、低(27例)、等(15例)及高低混杂(5例)信号的四个亚组,其ADC值依次为(0.724±0.032)×10-3mm2/s、(1.548±0.053)×10-3mm2/s、(0.951±0.047)×10-3mm2/s、(1.143±0.028)×10-3mm2/s,各亚组间ADC值差异有统计学意义(F=15.75,P=0.000),高信号亚组的ADC值最小,低信号亚组的ADC值最大;高信号亚组的ADC值低于对照组[(0.836±0.024)×10-3mm2/s],低、等、混杂信号亚组的ADC值及HLD组总的ADC值[(1.175±0.035)×10-3mm2/s]均高于对照组,差异均有统计学意义(t=-3.87、5.76、2.94、4.21、4.56,P=0.001、0.000、0.008、0.000、0.000)。HLD组总的豆状核脑代谢产物NAA/Cr比值(1.198±0.534)、Cho/Cr比值(0.753±0.474)均低于对照组[(1.654±0.376)、(0.995±0.274)],差异均有统计学意义(t=-5.43、-3.68,P=0.000、0.001)。HLD各亚组间的豆状核脑代谢产物NAA/Cr、Cho/Cr比值差异均无明显统计学意义(F=1.12、2.35,P=0.306、0.127)。结论 DWI、MRS能较好评价HLD的铜沉积过程中不同病理时期的微观结构变化和代谢异常,在HLD临床诊断中具有较大应用价值。更多还原

【Abstract】 Objective To investigate the value of magnetic resonance diffusion weighted imaging(DWI) and magnetic resonance spectroscopy(MRS) in the diagnosis of hepatolenticular degeneration(HLD).Methods 56 patients with HLD(HLD group) and 10 healthy volunteers(control group) underwent routine brain MRI,DWI,1H-MRS at the same time.The differences of the signal intensity on DWI,apparent diffusion coefficient(ADC value),the ratio of NAA / Cr and Cho / Cr of brain metabolites in the lentiform nucleus were measured and compared between the two groups using independent samples t test;the relationships between DWI signal,apparent diffusion value(ADC) change and the changes of the ratio of NAA / Cr and Cho / Cr of brain metabolites in lenticular nucleus in HLD group were also assessed using one way variance analysis(ANVOA).Results According to the DWI signal changes of lenticular nucleus,HLD group could be divided into four subgroups including hyperintensity signal subgroup(9 cases),hypointensity signal subgroup(27 cases),isointensity signal subgroup(15 cases) and mixed-signal-intensity subgroup(5 cases);ADC values were(0.724 ± 0.032) × 10-3mm2/ s,(1.548 ± 0.053) × 10-3mm2/ s,(0.951 ± 0.047) × 10-3mm2/ s,(1.143 ± 0.028) × 10-3mm2/ s,respectively.ADC values were significant different among the four subgroups(F = 15.75,P = 0.000),and it was the highest in the hypointensity signal subgroup,while was the lowest in the hyperintensity signal subgroup.ADC value of hyperintensity signal subgroup was lower than control group[(0.836 ± 0.024) × 10-3mm2/ s],while ADC values of other subgroups and HLD general group [(1.175 ± 0.035) × 10-3mm2/ s]were higher than control group,the differences were statistically significant(t =-3.87,5.76,2.94,4.21,4.56;P = 0.001,0.000,0.008,0.000,0.000).Both the overall ratio of NAA /Cr and Cho / Cr of brain metabolites in lenticular nucleus in HLD group [(1.198 ± 0.534),(0.753 ± 0.474),respectively] were lower than those of control group [(1.654 ± 0.376),(0.995 ± 0.274),respectively],the differences were statistically significant(t =-5.43,-3.68;P = 0.000,0.001).Both the ratio of NAA / Cr and Cho / Cr in lenticular nucleus among four subgroups in HLD group showed no statistically significant difference(F = 1.12,2.35;P = 0.306,0.127).Conclusion DWI and MRS can be used to evaluate the microstructural changes and metabolic abnormalities in HLD during different periods of pathological process,and have great clinical value in the diagnosis of HLD.更多还原