后皮质萎缩临床和影像学特点分析  

Clinical and neuroimaging characterization of posterior cortical atrophy

作　　者：石志鸿[1] 蔡莉[3] 刘帅[1] 王颖[3] 韩彤[2] 刘淑玲[1] 周玉颖[1] 王晓丹[1] 王新平[1] 高硕[3] 纪勇[1] 

机构地区：[1]天津市环湖医院神经内科,300060 [2]天津市环湖医院影像科,300060 [3]天津医科大学总医院核医学科

出　　处：《中华老年医学杂志》2015年第3期264-269,共6页Chinese Journal of Geriatrics

基　　金：天津市科委科技支撑计划重点项目基金（12ZCZDSY02900）;天津市自然科学基金（13JCYBJC21300）

摘　　要：目的 探讨后皮质萎缩（PCA）的临床及影像学特点. 方法 对5例PCA患者的临床、神经心理量表及核磁共振、18F-脱氧葡萄糖（FDG）及11C-匹兹堡化合物B（PIB）正电子发射断层（PET）显像进行分析,并与6例早发典型的阿尔茨海默病（AD）进行比较. 结果 PCA患者早期症状主要为视空间障碍、视觉失认、失用、方向感缺失、失写及失算.神经心理量表提示视空间结构、书写、计算力受累突出.PCA组较典型AD组后部皮层萎缩明显（P＜0.05）,轻度痴呆患者典型AD组较PCA组颞叶内侧萎缩（MTA）明显,但中度痴呆患者均表现为明显萎缩,两组比较差异无统计学意义.FDG PET提示右侧为著的颞顶枕联合区低代谢,额叶受累较轻.PCA组较典型AD组患者枕叶代谢减低,尤其在右枕（BA18,19,37）.基于体素水平自动化分析结果显示PCA和典型AD患者PIB平均摄取率（SUVR）在下顶叶、颞叶外侧、额中回、前额内侧皮质、后扣带回和（或）楔前叶、枕叶、辅助运动区和纹状体增高（1.6～2.6,正常对照1.1～1.2,P＜0.05）.PCA和典型AD患者比较PIB SUVR在所有感兴趣区差异无统计学意义（P＞0.05）. 结论 PCA以视觉障碍、失用、顶叶皮层萎缩、右侧为著的颞顶枕联合区低代谢为主要特点,皮层淀粉样蛋白沉积与典型早发阿尔茨海默病相似.Objective To investigate the clinical and image characteristics in patients with posterior cortical atrophy （PCA）.Methods Totally 5 patients with PCA and 6 patients with typical Alzheimer＇s disease （tAD） were selected in this study.Cognitive function was measured by the MiniMental State Examination （MMSE）,Montreal Cognitive Assessment （MCA） and Clinical Dementia Rating （CDR）.Brain magnetic resonance imaging was conducted to evaluate the ventricular enlargement,and posterior atrophy and medial temporal lobe atrophy.18F Fluorodeoxyglucose （FDG） and 18C-Pittsburg Compound B （PiB） PET cerebral imaging were performed.The above indictors were compared between PCA and AD patients.Results The most common symptoms at onset were visual space impairment,visual agnosia,apraxia,disorientation,agrapha,and acalculia in PCA patients.PCA subjects had marked impairment in visuospatial tasks,writing and calculationon neuropsychological testing.Posterior cortical atrophy were greater in PCA patients than in tAD patients （P〈0.05）,but atrophy in medial temporal lobe （MTL） was greater in mild AD patients than in tAD patients,and there was no significant difference in posterior cortical and MTL atrophy between moderate AD and PCA patients.The results of 18F-FDG PET showed that relative regional cerebral uptake （rCMRGlu） was decreased in temporal-parieto-occipital cortex （R〉 L） in PCA,but more diffused cortical decreased in typical AD.Occipical cortex（BA18,19,37） was the most obvious rCMRGlu decreasing place in PCA relative to tAD.The voxel-based automatic quantitative analysis showed that the mean PIB standardized uptake value ratio （SUVR） was higher in the inferior parietal lobe,lateral temporal cortex,middle frontal gyrus,medial prefrontal cortex,posterior cingulate cortex and precuneus,occipital lobe,supplementary motor area,and striatum in PCA and typical AD patients as compared with controls （1.6-2.6 vs.1.1-1.2,P〈0.05）.No significant difference in the PIB SUVR was foun

关 键 词：萎缩 大脑皮质 阿尔茨海默病 正电子发射断层显像术 氟脱氧葡萄糖F18 

分 类 号：R742[医药卫生—神经病学与精神病学]