neuromyelitis optica brain magnetic resonance imaging study of changes in

　　Title: neuromyelitis optica brain magnetic resonance imaging study of changes in
　　Authors: Xiao Hui
　　Degree-granting units: PLA Postgraduate Medical School
　　Keywords: neuromyelitis optica;; magnetic resonance imaging;; NMO-IgG; diffusion-weighted imaging;; optic myelitis;; multiple sclerosis; optic myelitis;; VBM;; brain atrophy; optic myelitis;; iron deposition; ; ESWAN
　　Abstract:
　　Objective: To analyze optic myelitis (neuromyelitis optica, NMO) in patients with brain MRI changes, and general performance characteristics, the occurrence Neodymium Magnet of brain lesions associated risk factors, trying to find NMO rules and characteristics of the brain involved.
　　Materials and Methods: 54 patients with clinical diagnosis, diagnostic criteria in line with the 2006 Wingerchuk NMO patients, 5 males, 49 females, age range 17 to 71 years, an average of 40.59 ± 11.82 years old. All patients had head and spinal cord MRI scans, and check the same day in the EDSS score. Nerve by the two radiologists longevity analysis of MRI images. First determine whether the brain lesions. Records of patients with abnormal brain MRI brain lesions and signal distribution characteristics, and lesions are classified. Using logistic regression analysis assessing brain lesions occur with sex, age, disease duration, relapse frequency, the first symptom, the length of the spinal cord lesion, combined infection autoimmune disease and precursor history, EDSS score and the NMO-IgG antibody level of correlation.
　　Results: 54 cases of NMO patients, normal brain MRI in 24 patients (44.44%), abnormal in 30 cases (55.56%). MRI abnormalities in the brain to multiple, small non-specific subcortical lesions most common (13/30, 43.33%); the corpus callosum, basal ganglia, brain stem are more easily affected. Typical NMO brain lesions in the hypothalamus, periaqueductal paraneoplastic ventricle, and AQP-4-rich region consistent with the distribution. 16 cases of brain-enhanced MRI, the lesions were no abnormal enhancement. All patients showed spinal cord lesions were more than three vertebral segments of the continuity of long lesions, mainly involved the central gray matter (51.85%). Logistic regression analysis showed that disease and autoimmune disease or precursor combined bacterial, viral infection history and brain MRI abnormalities associated with larger, OR values ​​were 1.203 and 3.519.
　　Conclusion: NMO brain abnormalities have a higher incidence of NMO have brain abnormalities can not rule out the diagnosis. Periventricular, corpus callosum, hypothalamus and brainstem of NMO brain lesions specific predilection sites. With systemic autoimmune diseases and bacteria, virus precursor prone to infection history of NMO brain MRI abnormalities.
　　Objective: Magnetic resonance diffusion imaging (diffusion weighted imaging, DWI) of neuromyelitis optica (neuomyelitis optica, NMO) in patients with normal MRI showed the presence of occult brain tissue damage, and analyzed with multiple sclerosis (multiple sclerosis, MS ) the similarities and differences.
　　Materials and Methods: 36 patients with clinical diagnosis of NMO patients (4 males, 32 females, aged 17 to 67 years, mean age 40.69 years), 20 patients with clinically diagnosed relapsing-remitting MS patients (5 males, female 15 females, aged 16 to 53 years, mean 36.85 years) and age and sex matched with the NMO group of healthy volunteers, 25 patients http://www.everbeenmagnet.com/ underwent MRI scan at the head brain DWI scans. Application of regions of interest (ROI) methods to measure the performance of each group normal white matter on the screen, on screen and normal-appearing gray matter ADC values ​​of the structure under the screen. ROI compare differences between groups, and analysis of regional brain tissue in patients with NMO ADC values ​​and duration of disease, relapses and EDSS score correlation.
　　NMO patients with supratentorial results show normal white matter, bilateral caudate nucleus, putamen and infratentorial structures ADC values ​​were significantly higher than the healthy control group (P <0.05). NMO patients with ADC values ​​of normal-appearing white matter below the MS group, and the difference was statistically significant (P <0.05); between the two groups with bilateral caudate nucleus, putamen and infratentorial structures ADC value was no significant difference. NMO, MS and healthy controls in the bilateral thalamus and brain ADC value was no significant difference (P> 0.05). Correlation analysis showed that, NMO patients with occipital lobe white matter ADC values ​​correlated with the EDSS score (r = 0.413, P = 0.015). NMO patients brain ADC values ​​of each ROI and age, duration, frequency of recurrence showed no significant correlation.
　　Conclusion: DWI can be sensitive to detect early brain changes in NMO. NMO patients with normal-appearing brain MRI of memory in the occult injury, and for the whole brain with diffuse lesions. NMO brain through the normal performance of the ADC values ​​of brain tissue quantitative analysis, can be better reflected the pathological changes in the understanding of its pathogenesis and pathophysiology of a certain value.
　　Objective: Voxel-based morphometric (voxel-based morphometry, VBM) Research neuromyelitis (neuromyelitis optica, NMO) in patients with brain volume changes, initially from a structural model of NMO brain damage.
　　Materials and Methods: 23 patients with clinically diagnosed, brain MRI normal NMO patients, 4 males, 19 females, aged 20 to 53 years, mean age 40.13 years; choose sex and age group of patients with NMO-matched healthy volunteers in 15 cases. Application 3.0T MR scanner, all NMO patients and healthy volunteers brain dimensional (3D) fast spoiled gradient echo (fast spoiled gradient echo, FSPGR) sequence scanning. Raw data using statistical parameters (Statistical parametric mapping, SPM) 5 software for processing. Whole-brain gray matter volume were compared (GMV), white matter volume (WMV), the total volume of whole brain (TIV) and the gray matter fraction (GMF), white matter fraction (WMF) and whole brain tissue fraction (BTF) of the difference. SPM was used to compare regional brain volume for statistical analysis. Using Pearson correlation analysis and evaluation of NMO patients brain gray and white matter volume and scores and EDSS score, disease duration, the relevance of the number of disease recurrence.
　　Results: NMO patients of GMV significantly less than the healthy controls (health control, HC) group, there are two significant differences (P <0.01). Between the two groups WMV, TIV, GMF, WMF and BTF was no significant difference (P> 0.05). NMO patients' age and GMF was a significant negative correlation (r =- 0.673, P = 0.000). NMO patients with brain volume and EDSS score was no significant correlation. Partial brain volume analysis showed that compared with the healthy control group NMO gray matter volume reduction is mainly concentrated in the left insula and bilateral posterior cingulate, white matter volume reduction areas are mainly located in the left frontal lobe and left parietal subcortical white matter .
　　Conclusion: VBM technology can detect NMO-sensitive brain volume changes. NMO patients with whole brain gray matter volume reduction compared with the healthy control group. NMO brain gray matter atrophy occurs mainly in the left insula bilateral posterior cingulate; white matter atrophy occurs mainly in the left frontal and parietal white matter. NMO patients with brain volume and EDSS score was no significant correlation.
　　Objective: ESWAN (Enhanced T2 Star Weighted Angiography) Research neuromyelitis (neuromyelitis optica, NMO) in patients with brain iron deposition and analysis with age, duration, frequency and relapse EDSS score correlation.
　　Materials and Methods: The clinical diagnosis, in line with the diagnostic criteria for NMO Wingerchuk2006 in 22 patients, 19 females, 3 males, aged 20 to 56 years old. The control group was 15 NMO patients with sex and age matched normal volunteers. Using 3.0T superconductive MR scanner, the application ESWAN sequence of all NMO patients and normal volunteers head scan. Raw data AW4.3 workstations FuncTool software processing, the resulting phase diagram and the R2 * map. Region of interest (ROI), including bilateral caudate, putamen, globus pallidus, thalamus, red nucleus, substantia nigra and dentate nuclei. Phase of the ROI were measured value and R2 * values. Analysis of phase with the R2 * consistency of approach; more NMO group and the healthy control group and the value of R2 * values ​​of phase difference between the groups; and analysis of NMO patients with brain iron content with age, disease duration, EDSS score and relapse frequency correlation.
　　Results: In the phase value and the value of the linear relationship between R2 * analysis, only the putamen (r =- 0.673, P = 0.000) and red nucleus (r =- 0.635, P = 0.000) the phase value of R2 * values ​​were significant negative correlation between the two other brain regions no significant correlation (r =- 0.275 ~ 0.017). And phase wears comparison, R2 * measurement is more reliable and stable. NMO patients with brain iron levels between the healthy control group no significant difference (P> 0.05). Partial correlation analysis showed that controlling for age, duration, frequency of relapse cases, NMO patients with globus pallidus, red nucleus iron content was positively correlated with the EDSS score (r = 0.598, P = 0.007; r = 0.491, P = 0.033).
　　Conclusion: ESWAN sequence in the quantitative analysis of brain iron levels have a greater application value. R2 * measurements of the phase stability and reliability is higher than the value of measurement. NMO deep gray matter nuclei of the brain iron content compared with the healthy control group, no significant increase. NMO patient group differences in brain iron levels and associated with clinical features.
　　Degree Year: 2010