Objective:To analyze the changes in white matter volume of the temporal lobe subre-gions in patients with medial temporal lobe epilepsy with hippocampal sclerosis(MTLE-HS)by auto-matic brain segmentation technique(FreeSurfer)and to investigate its clinical application value in MTLE-HS.Methods:A total of 53 patients diagnosed with MTLE-HS through postoperative pathology or magnetic resonance imaging(MRI)from January 2021 to September 2023 were collected,including 30 patients with left MTLE-HS(LMTLE-HS)and 23 patients with right MTLE-HS(RMTLE-HS).Meanwhile,43 gender-and age-matched healthy controls were recruited.All participants underwent T1-weighted three-dimensional magnetization-prepared rapid acquisition gradient echo sequence(3D-T1 WI-MPRAGE)scanning on a 3.0T MR.The FreeSurfer software was used to perform whole-brain segmentation on the T1-MPRAGE images,and white matter volume data of the temporal lobe subre-gions(posterior superior temporal gyrus,temporal pole,superior temporal gyrus,middle temporal gy-rus,inferior temporal gyrus,fusiform gyrus and parahippocampal gyrus)were collected.Paired t-tests were used to compare the differences in white matter volumes of each subregion between the left and right temporal lobes in the control group.Independent samples t-tests were used to compare the differ-ences in white matter volumes of each temporal lobe subregion between the control group and the LM-TLE-HS and RMTLE-HS groups,as well as between the affected and unaffected sides within the LM-TLE-HS and RMTLE-HS groups.Results:There were statistically significant differences in white mat-ter volumes of the transverse temporal gyrus,superior temporal gyrus,middle temporal gyrus,inferior temporal gyrus,fusiform gyrus and parahippocampal gyrus between the left and right sides in the con-trol group(P＜0.05).Significant differences in white matter volumes were found in the affected side of the LMTLE-HS group compared to the left side of the control group(temporal pole,transverse temporal gyrus,superior temporal gyrus,middle temporal gyrus,inferior temporal gyrus,fusiform gy-rus and parahippocampal gyrus)(P＜0.05).Significant differences in white matter volumes were found in the unaffected side of the LMTLE-HS group(posterior superior temporal gyrus,superior temporal gyrus,middle temporal gyrus,inferior temporal gyrus,fusiform gyrus and parahippocampal gyrus)and in the affected side of the RMTLE-HS group(posterior superior temporal gyrus,middle temporal gyrus,inferior temporal gyrus,fusiform gyrus and parahippocampal gyrus)compared to the right side of the control groups(P＜0.05).There were no statistically significant differences in volume among the other subregions(P＞0.05).Conclusion:The quantitative analysis of temporal lobe white matter volume using the automatic brain segmentation technique is of certain significance for preoper-ative evaluation and surgical approach selection in patients with hippocampal sclerotic medial temporal lobe epilepsy.

目的 探讨集成磁共振成像(SyMRI)技术在颞叶内侧癫痫伴海马硬化(HS)中各亚区的定量研究价值.资料与方法 前瞻性纳入2021年1月—2023年1月宁夏医科大学总医院经MRI诊断或病理证实为单侧HS的患者(病例组)28例,并纳入同期健康志愿者(对照组)38 例.两组对象均于 3.0T MRI行T1 加权等体素三维磁化强度预备梯度回波序列及集成MRI序列扫描.扫描图像分别经freesurfer V7、SyMRI StandAlone 8.0.4后处理得到海马及其亚区的感兴趣区及T1、T2、质子密度(PD)定量图,二者融合得到T1、T2、PD值.比较HS患侧组、健侧组及对照组各项参数值并进行多重比较.对组间差异有统计学意义的参数采用逐步回归分析筛选出显著性变量,并采用受试者工作特征曲线下面积评价其诊断效能.结果 3组间下托(SUB)的T1 和PD值差异无统计学意义(F=1.819、0.570,P均>0.05),其余亚区各参数差异均有统计学意义(F/H=5.539～71.570,P均<0.05).组间两两比较显示,患侧组CA1、CA3、CA4、齿状回的T2、T1值均高于健侧组及对照组,PD值高于对照组,患侧组SUB的T2值高于对照组,患侧组CA3的PD值高于健侧组(P均<0.05).逐步回归法显示CA1、CA3、SUB的T2值为显著性变量(模型调整后R2=0.828,F=105.089,P<0.001,方差扩大因子=2.693、2.113、1.721).CA1、CA3区T2值的曲线下面积最大,均为0.972,截断值、敏感度、特异度分别为101.42 ms、92.86%、100%,95.56 ms、92.86%、92.11%.结论 SyMRI对颞叶内侧癫痫伴HS海马亚区组织弛豫时间的定量测量可为临床提供更加精准的影像学参考依据,尤其是CA1、CA3区T2值可有效提高HS的诊断效能.

The purpose of this study is to explore the value of different quantitative parameters derived from Synthetic MRI and combined with DWI in the diagnosis of hippocampal sclerosis. It was concluded that the values of T1, T2 and ADC in the hippocampal sclerosis were significantly higher than those in the normal control group .In addition, the AUC of the combined model of T2 and ADC was 0.96, which was higher than that of ADC (AUC 0.884) or T2 alone (AUC 0.952). Its sensitivity, specificity, positive predictive value and negative predictive value were 0.95,0.91,0.81,0.98 respectively.

目的 研究三维伪连续式动脉自旋标记成像(three-dimensional pseudo-continuous arterial spin labeling,3D-pCASL)联合海马自动分割技术在海马硬化型颞叶内侧癫痫(hippocampal sclerotic medial temporal lobe epilepsy,MTLE-HS)中的应用价值.材料与方法 回顾性分析2021年1月至2022年12月经术后病理或MRI诊断为海马硬化(hippocampal sclerosis,HS)的40例单侧MTLE-HS患者病例,招募性别、年龄相匹配的30例健康志愿者作为对照组,均在3.0 T磁共振仪上行轴位T1加权三维磁化强度预备梯度回波(T1WI three dimensional magnetization prepared rapid acquisition gradient echo sequence,3D-T1WI-MPRAGE)序列及3D-pCASL序列扫描.使用FreeSurfer软件对3D-T1WI-MPRAGE图像行海马亚区分割,通过将分割的海马亚区与灌注定量图融合的方法,进行配准后测量亚区脑血流量(cerebral blood flow,CBF).采用配对t检验比较对照组左、右两侧、MTLE-HS组患侧与对侧之间海马亚区CBF值的差异性;采用独立样本t检验分别比较对照组与MTLE-HS组患侧、对照组与MTLE-HS组对侧之间海马亚区CBF值的差异性.采用受试者工作特征(receiver operating characteristic,ROC)曲线及曲线下面积(area under the curve,AUC)评价各亚区CBF值检测MTLE-HS的诊断效能.结果 对照组左、右两侧海马各亚区CA1、CA2-3、CA4、齿状回颗粒细胞层(granular cell layer of dentate gyrus,GC-DG)的CBF值差异无统计学意义(P>0.05);MTLE-HS组患侧CA1区与对侧相应亚区CBF值差异无统计学意义(t=1.075,P=0.289),其余亚区有显著性差异(P均<0.001);MTLE-HS组患侧、对侧分别与对照组比较,海马各亚区CBF值差异均有统计学意义(P<0.001).ROC曲线分析结果显示海马CA1、CA2-3、CA4、GC-DG亚区CBF值诊断MTLE-HS的AUC分别为0.746、0.831、0.837、0.830.结论 针对局灶性颞叶内侧癫痫患者测量海马亚区的血流灌注对术前准确定位致痫灶及其影响区域有一定的意义,为术前了解MTLE-HS亚区的血流灌注变化提供了影像学依据.

PURPOSE:To investigate the diagnostic value of synthetic MRI combined MUSE DWI and 3D-pCASL in hippocampal sclerosis (HS).METHOD:A total of 30 HS patients participated in the study. At the same time, 51 healthy volunteers were collected as the control group. All patients and healthy volunteers underwent epilepsy MR scanning protocol (including oblique coronal MAGiC, MUSE DWI, and axial 3D-pCASL) at 3.0 T MR scanner.The independent samples T test and Mann-Whitney U test were used to compare the differences of the apparent dispersion coefficient(ADC), cerebral blood flow(CBF) and quantitative parameters, including T1 relaxation time (T1), T2 relaxation time (T2), and proton density (PD) values, in the hippocampus of the affected side of HS and the contralateral and control groups, respectively. The diagnostic performance was evaluated using binary logistic regression analysis and area under the receiver operating characteristic (ROC) curves (AUC).RESULTS:Significant statistical differences in T1, T2, CBF, and ADC values were observed between the affected hippocampus of HS patients and contralateral and control hippocampus (all P < 0.005). The T2 has higher discrimination abilities compared with other univariable parameters, with the AUC of 0.899. The combined T2, ADC and CBF model had the best diagnostic performance of HS in MTLE patients with AUC, sensitivity and specificity of 0.946, 86.67 %, 93.33 %, respectively.CONCLUSIONS:Relaxometry parameters derived from synthetic MRI contributed to diagnosis of HS. The proposed approach combining T2, ADC and CBF showed a strong diagnostic capability.

目的探讨集成磁共振成像联合基于复合灵敏度编码的高分辨率扩散加权成像(MUSE-DWI)在海马硬化型颞叶内侧癫痫(MTLE-HS)中的应用价值.资料与方法收集2020年10月—2021年12月宁夏医科大学总医院收治的MTLE-HS 28例,同期收集43例健康受试者作为对照组.所有受试对象均行集成磁共振序列及MUSE-DWI扫描,比较两组定量磁共振参数T1、T2、质子密度及表观扩散系数(ADC)值的特点.采用二元Logistic回归分析诊断MTLE-HS的重要指标,用受试者工作特征曲线下面积(AUC)评价诊断效能.结果MTLE-HS患侧T1、T2、ADC值高于对照组和健侧(F=14.145,H=42.419、32.556,P均<0.05),质子密度差异无统计学意义(H=4.648,P=0.098).T2、ADC值可以作为诊断MTLE-HS的重要参考指标,AUC分别为0.896、0.855,差异无统计学意义(Z=0.89,P=0.38).T2联合ADC值的AUC为0.915,敏感度、特异度、阳性预测值、阴性预测值分别为0.821、0.977、0.958、0.894.结论集成磁共振成像定量参数T2值和MUSE-DWI的ADC值可以作为诊断MTLE-HS的定量参考指标,其中T2联合ADC值可以提高MTLE-HS的诊断效能,为临床诊断MTLE-HS提供更加可靠的影像学参考依据.

目的 探讨定量磁共振成像技术在大鼠小脑深部核团(DCN)钆沉积定量测量中的应用.材料与方法 对21只雄性SD大鼠进行尾静脉注射钆双胺溶液20次(4次/周,共5周),随机选取5只大鼠安乐死后提取小脑DCN组织进行电感耦合等离子体质谱(ICP-MS)实验进行钆浓度测定,将剩余大鼠随机分为2组:钆双胺组7只,继续注射钆双胺,注射次数与剂量与之前相当;无干预对照组7只,除正常饲养无其他干预措施.在首次注射前及每周注射后对所有大鼠进行头部MRI扫描,测量大鼠DCN T1值及DCN/小脑皮质T1WI信号强度比值,最后一次MRI扫描完成后提取组织进行ICP-MS实验测定小脑DCN钆浓度.检测两组各时间点的DCN T1值、DCN/小脑皮质T1WI信号比值与小脑DCN组织钆浓度的差异,评估DCN T1值、DCN/小脑皮质T1WI信号比值与小脑DCN钆浓度的相关性.结果 末次注射后钆双胺组DCN T1值显著低于第5周处死大鼠和对照组[(595.50±20.96)ms比(814.92±17.45)ms比(994.38±7.86)ms;F=0.0027,P<0.01],DCN/小脑皮质T1WI信号强度比值显著高于第5周处死大鼠和对照组(1.15±0.01比0.90±0.02比1.01±0.01;F=0.0084,P<0.01),钆双胺组小脑DCN组织中钆浓度高于第5周处死大鼠和对照组[(2.25±0.14)μg/g比(1.08±0.02)μg/g比(0.90±0.02)μg/g;F=0.0003,P<0.001].DCN组织钆浓度与DCN T1值与呈显著负相关(r=?0.932,P<0.001),与DCN/小脑皮质T1WI信号强度比值呈显著正相关(r=0.907,P<0.001).结论 以ICP-MS实验测定小脑DCN钆浓度为参考标准,定量磁共振成像技术对小脑齿状核区域的T1弛豫时间具有良好的表达性,为临床钆沉积定量磁共振评估研究提供一定依据.

目的:探究在已出现线性钆沉积的大鼠中继续注射大环型钆对比剂后大鼠脑内钆沉积的变化.方法:对28只雄性SD大鼠首先进行钆双胺(线性钆对比剂)注射20次(4次/周,共5周;单次剂量均为0.06 mmol/kg)建立线性钆沉积模型,再随机分为4组分别注射钆双胺(线性),钆特酸葡胺(大环型),钆布醇(大环型)及高渗盐水(1350 mOsm/kg),注射次数与剂量与之前相当.在首次注射前及每周注射后对大鼠进行头部MR I扫描,第5周及第10周分批处死大鼠提取组织进行电感耦合等离子体质谱仪(ICP-MS)实验测定小脑深部核团(DCN)的钆浓度以及进行小脑HE染色切片观察分析.在MRI图像测量大鼠DCN T1值及DCN/小脑皮质T1 WI信号比值,并采用双方差分析(ANOVA)检测各组间各时间点的数值差异;采用Kruskal-Wallis检验DCN中钆浓度的差异.采用Spearman相关系数评估大鼠DCN T1值与DCN/小脑皮质T1 WI信号比值以及DCN中钆浓度的相关性.结果:钆双胺组大鼠DCN的T1值(595.50±20.96 ms)显著低于其它组;钆双胺组大鼠DCN组织中钆浓度(2.25±0.14 ug/g)及DCN/小脑皮质T1 WI信号强度比值(1.15±0.01)显著高于其它组;DCN T1值与DCN/小脑皮质T1 WI信号比值以及DCN中钆浓度呈显著负相关(P值均<0.05).结论:在已出现线性钆沉积的大鼠中,继续使用大环型GBCAs钆特酸葡胺及钆布醇相对一直使用线性GBCAs脑内钆沉积较少,相对较为安全.

目的:探讨集成磁共振成像联合三维伪连续式动脉自旋标记(3D-pCASL)成像对颞叶内侧癫痫(MTLE)患者海马硬化(HS)的诊断价值.方法:将2020年10月-2022年1月在本院经MRI诊断或病理证实有HS的30例MTLE患者纳入本研究,并纳入同期性别与年龄相匹配的45例健康志愿者作为对照组.每例被试在3.0T磁共振仪上采用斜冠状面三维伪连续式动脉自旋标记(3D-pCASL)序列及集成MRI序列(MAGiC)进行扫描.采用单因素方差分析(正态分布数据)或Kruskal-Wallis H检验(非正态分布数据)比较患侧海马与健侧及对照组之间集成MRI定量参数(T1、T2、Pd)及脑血流量(CBF)值的差异,进一步采用Bonferroni法进行组间两两比较,并采用受试者工作特征(ROC)曲线及曲线下面积(AUC)评价各参数对MTLE-HS的诊断效能.结果:T1、T2和CBF值在HS组、健侧和对照组之间的总体差异具有统计学意义(P<0.01),3组之间PD值的差异无统计学意义(P>0.05).组间两两比较结果显示,HS侧的T1、T2值高于健侧及对照组,CBF值低于健侧及对照组,且差异均有统计学意义(P<0.05);T1、T2、PD和CBF值在健侧与对照组之间的差异均无统计学意义(P>0.05).ROC曲线分析结果显示,T1、T2和CBF诊断MTLE-HS的AUC分别为0.759、0.899和0.770.Delong检验结果显示,T2与CBF及T1与CBF之间AUC的差异无统计学意义(P>0.05),而T1与T2之间AUC的差异具有统计学意义(P=0.0293),T2值对MTLE-HS的诊断效能高于T1值.当T2截断值为97.67 ms时,相应诊断敏感度、特异度、阳性预测值和阴性预测值分别为0.8000、0.9556、0.9230和0.8780.结论:集成MRI获得的定量参数中T1和T2值及脑血流量(CBF)能较准确地反映MTLE-HS患者海马的病理变化特征,为临床治疗MTLE-HS患者提供一定的影像学参考依据,其中以T2值对MTLE-HS的诊断效能最高.

Objective:To explore the value of synthetic MRI and dynamic contrast-enhanced MRI (DCE-MRI) in differentiating benign and malignant breast lesions.Methods:Totally 116 patients (female, aged 22-80 years) with suspicious breast lesions found by clinical examination in General Hospital of Ningxia Medical University from September 2020 to March 2021 were retrospectively analyzed. All patients received synthetic MRI and DCE-MRI scans, and the quantitative parameters of synthetic MRI [T 1, T 2, proton density (PD) value before enhancement of breast lesions (T 1pre, T 2pre, PD pre) and T 1, T 2, PD value after enhancement of breast lesions (T 1Gd, T 2Gd, PD Gd)] were measured. The difference before and after enhancement (?T 1, ?T 2, ?PD) and the ratio before and after enhancement(T 1ratio, T 2ratio, PD ratio) were calculated. All lesions were confirmed by biopsy or surgery. Independent sample t test was used to compare the differences of parameters between benign and malignant lesions, and parameters with statistically significant differences were analyzed by multivariate logistic regression to screen out independent predictors for the diagnosis of breast malignant lesions. The efficacy of quantitative parameters alone and in combination with DCE-MRI, was evaluated by the receiver operating characteristic (ROC) curve. Results:Of 116 patients, 27 patients were benign and 89 patients were malignant. T 2pre, PD pre, T 2Gd, PD Gd, ?T 2, T 1ratio and T 2ratio values of malignant patients were lower than those of benign lesions ( P<0.05). Multivariate logistic regression analysis showed that T 2pre (OR=0.961,95%CI 0.926-0.993, P=0.022)and PD pre(OR=0.945, 95%CI 0.908-0.979, P=0.003) were independent predictors of breast malignant lesions. The area under ROC curve (AUC) of T 2pre+PD pre in differentiating benign and malignant breast lesions was 0.77, and the accuracy, sensitivity, specificity, positive predictive value and negative predictive value were 0.84, 0.87, 0.68, 0.92 and 0.56, respectively. The AUC of T 2pre+PD pre combined with DCE-MRI in differentiating benign and malignant breast lesions was 0.95, indicating the best diagnostic efficiency, and higher than that of DCE-MRI alone (0.92)( Z=2.20, P<0.05). Conclusions:T 2pre and PD pre values of synthetic MRI can be used as reference parameters for differentiating benign and malignant breast lesions. Synthetic MRI combined with DCE-MRI can effectively improve the diagnostic efficiency of breast malignant lesions.