MRS联合DTI评估帕金森病认知障碍的初步研究  

Evaluation the Parkinson's disease patients with congnitive impairment using 1H magnetic resonance spectroscopy and diffusion tensor imaging

作　　者：魏欢[1] 王晋[2] 战丽萍[1] 李青芸[1] 翟娜[2] 李建辉[1] 安明顺[1] 张丽娟[1] WEI Huan WANG Jin ZHAN Liping et al(Department of Neurology ,the Affiliated Yan＇ an Hospital of Kunming Medical University, Kunming 650051, China)

机构地区：[1]昆明医科大学附属延安医院神经内科,云南昆明650051 [2]昆明医科大学附属延安医院影像科,云南昆明650051

出　　处：《中风与神经疾病杂志》2017年第1期21-26,共6页Journal of Apoplexy and Nervous Diseases

基　　金：云南省科技厅-昆医联合专项(No.2011FB236)

摘　　要：目的探讨1~H-磁共振波谱(1~H-MRS)及弥散张量成像(DTI)技术对早期诊断帕金森病(PD)患者认知障碍(PD-CI)患者脑部损害,探讨其在PD-CI的早期诊断及临床病情评估中的价值。方法采用Mo CA量表对14例PD患者及健康对照进行认知功能评定;应用1~H-MRS采集各感兴趣区(ROI)N-乙酰天门冬氨酸(NAA)、胆碱(Cho)及肌酸(Cr)浓度,计算NAA/Cr、Cho/Cr比值。然后对1~H-MRS所选ROI相同区域进行DTI扫描,测定各向异性分数(FA),并进一步分析三者之间及其与Mo CA评分之间的关系。结果 PD组Mo CA量表得分较对照组明显降低(P<0.05),认知障碍明显。PD组额叶、颞叶、纹状体NAA/Cr值与对照组相比明显下降(P<0.05),而两组黑质NAA/Cr值、各部位Cho/Cr值对比无明显差异。PD组额叶、黑质FA值与对照组相比明显降低(P<0.05),而两组颞叶、纹状体FA值对比无明显差异。PD患者额叶、颞叶平均NAA/Cr值与Mo CA量表得分呈正相关(P<0.05);额叶平均FA值与Mo CA量表得分呈正相关(P<0.05)。PD患者额叶平均NAA/Cr值与FA值呈正相关(P<0.05)。结论 1~H-MRS联合DTI扫描能更好地检测出PD认知障碍的患者可能存在的隐匿性损伤;分别从结构和代谢两方面为PD-CI的早期诊断提供客观指标;额叶NAA/Cr、FA值的下降与认知功能下降相关。Objective To investigate the cerebral lesions in Parkinson＇s disease patients with cognitive impairment by using 1H magnetic resonance spectroscopy（ 1H-MRS） and diffusion tensor imaging（ DTI）,and to assess the value of these advanced MRI techniques in early diagnosis and severity assessment of PD-CI. Methods Fourteen patients with PD and fourteen normal controls were recruited. Disease severity of the PD patients was measured with Hoehn and Yahr scale.Cognitive damage of all the subjects was measured with Montreal Cognitive Assessment（ Mo CA） scale. The resonance signals concentration of N-acetylaspartate（ NAA）,Choline（ Cho）,and Creatine（ Cr） in the bilateral frontal lobes,temporal lobes,substantia nigra and corpus striatum were measured. Fractional anisotropy（ FA） values in the same ROI regions were examined by using DTI. The relationships were analyzed among the Mo CA sores,MRS ratios,and the DTI values. Results The Mo CA sore showed an apparent decrease in the PD patients（ 20. 29 ± 2. 867） compared with controls（ 26. 36 ± 1.393）（ P〈0. 05）. The NAA / Cr ratio showed a gradual decrease in the frontal lobe,temporal lobe,and corpus striatum of PD patients compared with controls（ P〈0. 05）. But the NAA / Cr ratio discrepancy in substantia nigra was negative. There was no significant difference in Cho / Cr ratio between PD patients and controls. Compared with controls,PD patients revealed decreased FA value in the frontal lobe and substantia nigra（ P〈0. 05）. There was no significant difference of the FA value in temporal lobe and corpus striatum between PD patients and controls（ P〉0. 05）. Mo CA scale was positively associated with NAA / Cr ratio in frontal lobe（ r = 0. 833,P〈0. 05）,temporal lobe（ r = 0. 785,P〈0. 05） and with FA value in the frontal lobe（ r = 0. 871,P〈0. 05）. Furthermore,in the frontal lobe of PD patients,the NAA / Cr ratio was positively associated with the FA value（ r = 0. 866,P〈0. 05）. Conclusion Combination of

关 键 词：帕金森病 认知障碍 磁共振波谱成像 弥散张量成像 

分 类 号：R742.5[医药卫生—神经病学与精神病学]