机构地区:[1]南京大学医学院附属鼓楼医院放射科,210008 [2]南京大学医学院附属鼓楼医院神经内科,210008 [3]南京脑科医院神经内科 [4]南京卫生学校
出 处:《中华放射学杂志》2012年第7期586-592,共7页Chinese Journal of Radiology
基 金:江苏省医学重点人才“十二五”兴卫工程(RC2011013);南京市卫生局重点项目(ZKXl0006)
摘 要:目的比较分析额颞叶变性(FTLD)的两个亚型,即行为变异型额颞叶痴呆(bvFTD)和原发性进行性失语(PPA),与阿尔茨海默病(AD)的脑灰质萎缩模式,为早期诊断和鉴别诊断提供客观的支持依据。方法选取FTLD患者23例(bvFTD10例,PPA13例)、AD患者30例及认知正常受试者(CN)30名,使用3.0T超导型MR仪及8通道头线圈行图像采集。以高分辨率的三维梯度回波序列(3D.TFE)横断面T。WI作为脑灰质皮层体积的计算序列,采用统计参数图(SPM)8和其工具箱[基于体素的形态测量学方法(VBM)]对3D-TFET,WI图像进行空间标准化预处理,最后得到灰质分割图像,进行灰质体积的统计分析,多重比较矫正采用假发现率法,用xjview工具显示统计分析结果,体素簇大小设为5。采用4mm的半高全宽高斯核进行空间平滑。统计学分析采用配对t检验。结果与CN组比较,在bvFTD、PPA和AD组中均出现大脑皮层及皮质下结构(如海马、杏仁核、尾状核等)体积弥漫减少。在bvFTD和PPA组中最明显的萎缩脑区位于额颞叶。与AD组比较,bvFTD组灰质明显萎缩的脑区包括:两侧颞叶上中下回、颞极上回及中回、右侧梭状回和两侧额叶上中下回。颞叶和额叶萎缩具有明显的右侧偏侧性,右侧和左侧颞叶萎缩体素的总体数目为14301个和5105个(t=-5.03,P〈0.05),右侧和左侧额叶萎缩体素的数目为1344个和125个(t=3.45,P〈0.05),差异均有统计学意义。在PPA组中左侧颞枕叶萎缩明显大于右侧(t=-2.65,P〈0.05),左侧和右侧颞枕叶萎缩体素的数目为15637个和10723个。结论bvFTD、PPA与AD3组具有不同的脑灰质萎缩模式。其中,bvFTD具有右侧额叶和颞叶萎缩的非对称分布特点,与性格改变的特征性表现相关;而PPA具有左侧颞枕叶非对称性萎缩的特点,可解释PPA患者出现语言障碍的特点。Objective To analyze the patterns of cortical atrophy of the two subtypes of frontotemporal lobar degeneration ( FTLD ), behavioural-variant frontotemporal dementia ( bvFl'D ) and primary progressive aphasia (PPA). And to compare them with that of Alzheimer disease (AD) to provide an objective basis for early diagnosis and differential diagnosis. Methods A total of 83 patients were enrolled in this study and there were 30 patients with cognitively normal controls ( CN), 30 with AD and 23 with FTLD (10 with bvFl'D, 13 with PPA). Philips 3.0 T TX scanner and 8 channel head coil was employed. Three dimensional turbo fast echo (3D-TFE)TtWI sequence with high resolution was used to collect the volume data of gray matter. 3D-TFE T1WI images were normalized and segmented into gray matter map for statistical analysis by SPM 8 and VBM 8. The false discovery rate (FDR) was adopted in P value adjustment, P 〈 0. 001, and the cluster size was set at 5. The full width at half maximum (FWHM) was set at 4 mm for the smoothing. Paired t test was used for statistics. Results In bvFTD, PPA and AD groups, there were diffuse regions with reduced volume in cerebral cortex and subcortieal structures (such as thehippocampus, the amygdala, the caudate nuclei, et al). The most obvious atrophic region in bvFTD and PPA group was found in the frontotemporal. Compared with AD, gray matter atrophy in bvFTD was found in brain regions including bilateral temporal lobes, bilateral superior temporal pole gyri, bilateral middle temporal pole gyri, right fusiform gyrns and bilateral frontal lobes. Among them, temporal and frontal lobes atrophy had obvious right partial lateralizing, with 14 301 voxels in right temporal lobe and 5105 in left (t = -5.03 ,P 〈 0. 05 ). The number of atrophy voxels in right and left frontal lobe were 1344 and 125 (t = 3.45 ,P 〈 0. 05 ). The left temporooccipital lobe atrophy was more obvious th^n the right in PPA, with 15 637 voxels in left and 10 723 in right (
关 键 词:痴呆 失语 原发进行性 阿尔茨海默病 磁共振成像 对比研究
分 类 号:R749.16[医药卫生—神经病学与精神病学]
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