弥散张量成像联合自由水成像对肝豆状核变性脑组织微观结构损害的评估价值

摘要/Abstract

摘要： 目的分析弥散张量成像联合自由水成像对肝豆状核变性脑组织微观结构损害的评估作用。方法选取2022年12月至2024年12月南京市中西医结合医院诊治的30例肝豆状核变性患者为疾病组,选取同期30名健康体检者为对照组。磁共振成像仪采集弥散张量成像、自由水成像,计算游离水值和分数各向异性,采用Pearson相关性检验评估疾病组统一肝豆状核变性评分量表中神经功能评分与游离水值、FAT值的关系。结果疾病组脑桥被盖、双侧尾状核头部、齿状核、苍白球、壳核、红核、黑质、丘脑的游离水值、FAT值分别为(0.2±0.1)、(0.3±0.1)、(0.2±0.1)、(0.2±0.1)、(0.3±0.1)、(0.2±0.1)、(0.2±0.1)、(0.2±0.1)、(0.6±0.2)、(0.3±0.1)、(0.4±0.1)、(0.5±0.1)、(0.3±0.1)、(0.5±0.1)、(0.6±0.2)、(0.3±0.1),均大于对照组的(0.1±0.0)、(0.2±0.1)、(0.1±0.0)、(0.1±0.0)、(0.1±0.0)、(0.1±0.0)、(0.1±0.0)、(0.1±0.0)、(0.5±0.1)、(0.2±0.1)、(0.3±0.1)、(0.4±0.1)、(0.1±0.0)、(0.4±0.1)、(0.5±0.1)、(0.2±0.1),差异均有统计学意义(P<0.05)。疾病组统一肝豆状核变性评分量表中神经功能评分为(17.5±3.8)分。Pearson相关性检验显示,统一肝豆状核变性评分量表中神经功能评分与游离水值、FAT值呈正相关(r=0.856、0.831,P<0.05)。以各感兴趣脑区的游离水值与FAT值为检测指标探讨游离水值及FAT值对肝豆状核变性的诊断价值。结果显示,壳核FAT值AUC最高(0.88),其余如黑质、红核等区域的AUC亦较高,均>0.8,提示游离水值和FAT值具有较好的鉴别能力。结论弥散张量成像联合自由水成像可检测出肝豆状核变性患者脑组织微观结构变化,自由水成像指标与神经损伤严重程度相关。

关键词: 肝豆状核变性, 弥散张量成像, 自由水成像, 脑组织微观结构损害

Abstract: Objective To analyze the evaluation of microstructural damage in brain tissue of hepatolenticular degeneration using diffusion tensor imaging combined with free water imaging. Methods 30 patients with Wilson's disease who underwent diagnosis and treatment in our hospital between December 2022 and December 2024 were selected as the disease group, and 30 healthy volunteers who underwent physical examinations in our hospital during the same period were selected as the control group. Magnetic resonance imaging was used to collect diffusion tensor imaging and free water imaging. Free water values and fractional anisotropy were calculated. Pearson correlation test was used to examine the relationship between nerve function scores, free water values, and FAT values in the unified Hepatolenticular Degeneration Scale for the disease group. Results The free water values of the disease group's pontine tegmentum, bilateral head of the caudate nucleus, dentate nucleus, globus pallidus, putamen, red nucleus, substantia nigra, and thalamus The FAT values [(0.2 ± 0.1), (0.3 ± 0.1), (0.2 ± 0.1), (0.2 ± 0.1), (0.2 ± 0.1), (0.2 ± 0.1), (0.2 ± 0.1), (0.2 ± 0.1), (0.6 ± 0.2), (0.3 ± 0.1), (0.4 ± 0.1), (0.5 ± 0.1), (0.3 ± 0.1), (0.5 ± 0.1), (0.6 ± 0.2), (0.3 ± 0.1)] were all higher than those of the control group [(0.1 ± 0.0), (0.2 ± 0.1), (0.1 ± 0.0), (0.1 ± 0.0), (0.1 ± 0.0), (0.1 ± 0.0), (0.1 ± 0.0) (0.1 ± 0.0), (0.1 ± 0.0), (0.5 ± 0.1), (0.2 ± 0.1), (0.3 ± 0.1), (0.4 ± 0.1), (0.1 ± 0.0), (0.4 ± 0.1), (0.5 ± 0.1), (0.2 ± 0.1), P<0.05]. The neurological function score in the unified hepatolenticular degeneration rating scale for the disease group is (17.5 ± 3.8) points. Pearson correlation test showed that the neurological function score in the Unified Hepatolenticular Degeneration Scale was positively correlated with free water and FAT values (r=0.856, 0.831, P<0.05). To explore the diagnostic value of free water value and FAT value in hepatolenticular degeneration with the free water value and FAT value of each brain region of interest as detection indexes. The results showed that the AUC of FAT in putamen was the highest (0.88), and the AUC of other regions such as substantia nigra and red nucleus was also higher, both of which were higher than 0.8, suggesting that the free water value and FAT value had good discrimination ability. Conclusion The combination of diffusion tensor imaging and free water imaging can detect microstructural changes in the brain tissue of patients with hepatolenticular degeneration, and free water imaging indicators are related to the severity of nerve damage.

Key words: Hepatolenticular degeneration, Diffusion tensor imaging, Free water imaging, Microstructural damage to brain tissue

赵文超, 唐晨虎, 施蒙, 陈新, 胡宇恒. 弥散张量成像联合自由水成像对肝豆状核变性脑组织微观结构损害的评估价值[J]. 肝脏, 2025, 30(12): 1724-1727.

ZHAO Wen-chao, TANG Chen-hu, SHI Meng, CHEN Xin, HU Yu-heng. Clinical observation of diffusion tensor imaging combined with free water imaging on microstructural damage of brain tissue in hepatolenticular degeneration[J]. Chinese Hepatolgy, 2025, 30(12): 1724-1727.

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