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目的探讨磁共振弥散加权成像(DWI)技术对2型糖尿病(T2DM)视网膜病变脑部功能区域损伤的评估价值。方法 T2DM患者54例分为增殖期糖尿病视网膜病变(A)组、非增殖期糖尿病视网膜病变(B)组和糖尿病无视网膜病变(C)组,每组均为18例;另选择18例健康志愿者作为对照(D)组。运用3.0T磁共振成像系统行脑部DWI,分别测量7个脑相关功能区域的表观扩散系数(ADC)值。结果 A、B组眶额叶皮层、扣带回及视皮层区域ADC值均高于C、D组(P<0.01),A组上述区域ADC值亦高于B组(P<0.01)。A组病程长于C组,A组HbA1c高于C组(P<0.01)。T2DM患者中,HbA1c、病程与眶额叶皮层(r_s=0.408、0.592,P<0.01)、扣带回(r_s=0.384、0.514,P<0.01)及视皮层(r_s=0.292、0.506,P<0.05)的ADC值呈正相关。糖尿病视网膜病变分期与视皮层的ADC值呈正相关(r_s=0.632,P<0.01)。结论脑部视觉中枢ADC值升高提示糖尿病视网膜病变与脑部功能损伤具有一定关联性。DWI技术对评估亚临床阶段糖尿病视网膜病变的脑部相关功能损伤具有一定价值。
Objective To investigate the value of magnetic resonance diffusion-weighted imaging (DWI) in assessing brain functional area damage in type 2 diabetic (T2DM) retinopathy. Methods Fifty-four patients with T2DM were divided into two groups: proliferative diabetic retinopathy (A), non-proliferative diabetic retinopathy (B) and diabetic retinopathy (C), with 18 cases in each group. Another 18 healthy volunteers As a control (D) group. Brain DWI was performed using a 3.0T magnetic resonance imaging system, and apparent diffusion coefficient (ADC) values of seven brain-related functional areas were measured. Results The ADC value of orbitofrontal cortex, cingulate gyrus and visual cortex in group A and group B were significantly higher than those in group C and D (P <0.01). The ADC value of group A and group B was also higher than that of group B (P <0.01). The course of disease in group A was longer than that in group C, and the level of HbA1c in group A was higher than that in group C (P <0.01). T2DM patients, HbA1c, duration and orbitofrontal cortex (r_s = 0.408,0.592, P <0.01), cingulate gyri (r_s = 0.384,0.514, P <0.01) and visual cortex (r_s = 0.292,0.506, P < 0.05) ADC value was positively correlated. Diabetic retinopathy stage and visual cortex ADC value was positively correlated (r_s = 0.632, P <0.01). Conclusions The elevated ADC value in the visual center of the brain suggests that diabetic retinopathy has a certain relationship with functional impairment of the brain. DWI is of value in assessing brain-related impairment in subclinical diabetic retinopathy.