皮质下缺血性血管性认知损害扩散张量成像研究  

Study of diffusion tensor imaging in subcortical ischemic vascular cognitive impairment

作　　者：郭会映[1] 孙芳[1] 张宗军[1] 张志强[1] 戚荣丰[1] 马思懿[1] 卢光明[1] 

机构地区：[1]南京军区南京总医院医学影像科,210002

出　　处：《中国现代神经疾病杂志》2014年第4期309-315,共7页Chinese Journal of Contemporary Neurology and Neurosurgery

摘　　要：目的通过扩散张量成像(DTI)探讨皮质下缺血性血管性认知损害患者白质微结构变化及其与认知功能之间的相关性。方法采集49例皮质下缺血性脑血管病患者[轻度血管性痴呆(VaD)10例、非痴呆型血管性认知损害(VCIND)20例、认知功能正常19例]DTI数据并观察皮质下白质微结构改变,分析VaD组患者DTI参数与认知功能间的相关性。结果与对照组相比,VaD组内侧前额叶、前扣带回、胼胝体干、双侧顶叶、右侧颞叶、双侧眶额叶,以及VCIND组右侧额下回、右侧海马、双侧楔前叶FA值减低(均P=0.000);与VCIND组比较,VaD组内侧前额叶、前扣带回、胼胝体、双侧顶叶、右侧颞叶FA值减低(P=0.000)。与对照组相比,VaD组内侧前额叶、胼胝体、双侧顶叶、双侧颞叶、前扣带回,以及VCIND组双侧楔前叶、右侧海马MD值升高(均P=0.000);与VCIND组相比,VaD组右侧内侧前额叶、前扣带回、胼胝体干、双侧顶叶、双侧颞叶MD值升高(均P=0.000)。VaD组内侧前额叶FA值与数字连线测验A时呈显著负相关(r=-0.782,P=0.007),双侧额下回MD值与数字连线试验A时程呈显著正相关(r=0.877,P=0.001)。结论 DTI对皮质下缺血性认知损害患者白质微结构改变更敏感,能够反映患者认知功能早期异常改变;内侧前额叶白质微结构的改变是影响患者执行能力的重要因素。Objective Using diffusion tensor imaging （DTI） to explore the microstructure changes of white matter in subeortical ischemic vascular cognitive impairment （SIVCI） and its correlation with cognitive function. Methods Forty-nine patients with subcortical ischemic cerebrovascular diseases were collected. By using Clinical Dementia Rating Scale （CDR）, they were classified into 10 cases of vascular dementia （VaD group）, 20 cases of vascular cognitive impairment-no dementia （VCIND group） and 19 cases of normal cognitive function （control group）. Conventional MRI and DTI were performed in all cases. Based on the DTI data, voxel-based analysis was used to assess the whole brain region. Correlation analysis was applied to illustrate the relationship between DTI parameters and cognitive scale in VaD patients. Results Compared with the control group, fractional anisotropy （FA） values of patients in VaD group decreased in medial prefrontal cortex, anterior cingulate cortex, corpus call0sum stem, bilateral parietal lobes, right temporal lobe and bilateral orbitofrontal lobes （P = 0.000, for all）, and FA values of patients in VCIND group decreased in right inferior frontal gyrus, right hippocampus and bilateral precuneus （P = 0.000, for all）. Compared with VCIND group, FA values of patients in VaD group decreased in medial prefrontal cortex, anterior eingulate, corpus eallosum, bilateral parietal lobes and right temporal lobe （P = 0.000, for all）. Compared with the control group, mean diffusivity （MD） values in VaD group increased in medial prefrontal cortex, corpus callosum, bilateral parietal lobes, bilateral temporal lobes and anterior cingulate （P = 0.000, for all）, while in VCIND group increased in bilateral precuneus and right hippocampus （P = 0.000, for all）. Compared with VCIND group, MD values in VaD group increased in right medial prefrontal cortex, anterior cingulate cortex, corpus callosum stem, bilateral parietal lobes and bilateral temporal lobes （P = 0.000, f

关 键 词：认知障碍 痴呆 血管性 脑缺血 大脑皮质 神经心理学测验 磁共振成像 

分 类 号：R749.1[医药卫生—神经病学与精神病学]