单纯脊髓受累型多发性硬化患者脑结构和脑功能的MRI研究  

MRI of Brain Structure and Function in Multiple Sclerosis with Only Spinal Cord Involved

作　　者：刘义[1] 李咏梅[1] 曾春[1] 王静杰[1] 熊华[1] 

机构地区：[1]重庆医科大学附属第一医院放射科,重庆400016

出　　处：《中国医学影像学杂志》2015年第10期725-729,共5页Chinese Journal of Medical Imaging

基　　金：国家自然科学基金项目(81371523);重庆市卫生局资助项目(2011-1-031;2012-1-017);国家临床重点专科建设项目([2013]544)

摘　　要：目的脊髓是多发性硬化(MS)的好发部位之一,严重影响患者生活质量。本文探讨基于体素的形态学(VBM)方法及静息态功能磁共振成像(RS-f MRI)在单纯脊髓受累的多发性硬化(MS-SSCI)患者中的应用价值。资料与方法 20例MS-SSCI患者及对照组20例健康志愿者行3D T1WI及RS-f MRI扫描,通过VBM方法分析脑灰质及白质体积、全脑体积、局部核团体积变化情况,以后扣带回(PCC)作为种子点行全脑静息态功能连接分析并行组间比较,进一步分析MS-SSCI结构、功能变化参数与临床扩展残疾状态量表(EDSS)评分的相关性。结果 1 MS-SSCI组较对照组全脑灰、白质体积、全脑体积未见明显变化(P>0.05),双侧颞中回、左侧颞下回灰质体积萎缩(P<0.01);左侧内侧前额叶、左侧颞下回、左侧尾状核、右侧补充运动区与PCC之间的功能连接(FC)明显升高(双样本t检验,经Alpha Sim校正,P<0.05,体素大小>40);2 MS-SSCI结构变化参数与EDSS评分均无明显相关性(P>0.05);左侧颞下回FC值与EDSS评分呈正相关(r=0.63,P<0.05)。结论MS-SSCI脑内结构及PCC的FC均发生改变,但仅功能变化参数与临床残疾状况相关,提示功能活动异常较微结构损伤更加敏感。Purpose Spinal cord is one of the most frequently involved sites of multiple sclerosis（MS）, which seriously affects the life quality of patients. In this paper, we investigate the application value of voxel-based morphology（VBM） and resting-state magnetic resonance imaging（RS-f MRI） in multiple sclerosis patients with single spinal cord involvement（MS-SSCI）. Materials and Methods Three-dimensional T1 WI data and RS-f MRI data were acquired from 20 patients with MS-SSCI and 20 normal controls, grey matter volume（GMV）, changes of white matter volume（WMV）, total intracranial volume（TIV） and local nuclei volume were compared between the two groups using VBM, posterior cingulate cortex（PCC） was regarded as the seed point and the functional connectivity about whole brain was compared between the two groups by using restingstate functional connectivity analysis, the relationships between MS-SSCI structure, function change parameters and expanded disability states scale（EDSS） scores were further explored. Results 1 Compared with the control group, GMV, WMV, TIV of MSSSCI group were not significantly reduced, only the volume of some regions（bilateral middle temporal gyrus, left inferior temporal gyrus） showed significant atrophy（P〈0.01）; MS-SSCI exhibited increased functional connectivity（FC） in the left medial prefrontal cortex, left inferior temporal gyrus, left caudate nucleus and right supplementary motor area（two-sample t test, after Alpha Sim correction, P〈0.01, voxel size 40）. 2 There was no significant correlation（P〈0.05） between MS-SSCI structure change parameters and EDSS; while a significant correlation between EDSS scores and FC was noted in the left inferior temporal gyrus（r=0.633, P〈0.05）. Conclusion Both structural abnormalities and altered FC with PCC can be detected in MS-SSCI, but only functional parameters are associated with clinical abnormalities, which are more sensitive than microstructural changes.

关 键 词：多发性硬化 脊髓疾病 磁共振成像 静息态 图像处理 计算机辅助 功能网络 

分 类 号：R744.51[医药卫生—神经病学与精神病学] R445.2[医药卫生—临床医学]