磁共振波谱检测肌萎缩侧索硬化的上运动神经元损害  

Magnetic resonance spectroscopy in the diagnosis of upper motor neuron involvement in amyotrophic lateral sclerosis

作　　者：翦凡[1] 崔丽英[2] 潘华[1] 邢岩[3] 李晓光[2] 刘明生[2] JIAN Fan CUI Liying PAN Hua XING Yan LI Xiaoguang LIU Mingsheng(Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing 100730, China)

机构地区：[1]首都医科大学附属北京天坛医院神经病学中心,100050 [2]中国医学科学院北京协和医院神经内科,100730 [3]航空总医院神经内科,100012

出　　处：《中国神经免疫学和神经病学杂志》2017年第1期29-33,共5页Chinese Journal of Neuroimmunology and Neurology

摘　　要：目的探讨质子磁共振波谱(proton magnetic resonance spectroscopy,1 H-MRS)检测肌萎缩侧索硬化(amyotrophic lateral sclerosis,ALS)的上运动神经元损害(upper motor neuron,UMN)的特点和诊断准确性。方法收集ALS患者31例和健康对照32名,采用1 H-MRS检测脑中央前回皮质下、内囊后肢和大脑脚感兴趣区代谢产物N-乙酰天冬氨酸(NAA)、胆碱(Cho)、肌酸(Cr)的水平,计算NAA/Cr、NAA/(Cho+Cr)、Cho/Cr比值,采用受试者工作特征(receiver operating characteristic,ROC)曲线分析1 H-MRS对ALS患者UMN损害的诊断价值。结果 ALS患者各锥体束走行部位和部位组合的NAA/Cr和NAA/(Cho+Cr)较对照组显著降低(P<0.05)。NAA比值预测ALS的UMN损害的ROC曲线下面积(area under the curve,AUC)为0.67~0.91,其中内囊后肢、大脑脚两部位的平均NAA/(Cho+Cr)和三部位的平均NAA/(Cho+Cr)的AUC、灵敏度、特异度分别为0.91、0.828、0.906和0.90、0.769、0.875。结论 1 H-MRS可检出ALS患者锥体束走行的生化代谢异常,是评估ALS的UMN损害的客观影像学指标,其诊断准确性中等,多水平检测和综合指标的选择有助于提高其诊断效力。Objective To evaluate the feature and diagnostic accuracy of proton magnetic resonance spectroscopy（1 H-MRS）in detecting upper motor neuron（UMN）involvement in amyotrophic lateral sclerosis（ALS）.Methods The study included 31 ALS patients and 32 healthy controls and measured the concentration of N-acetylaspartate（NAA）,choline（Cho）and creatine（Cr）by 1 H-MRS in subcortical white matter of precentral gyrus,posterior limb of internal capsule（PLIC）and cerebral peduncle（CP）.Ratios of NAA/Cr,NAA/（Cho＋Cr）and Cho/Cr were calculated from these measurements.The diagnostic value of NAA ratios for ALS lesions was analyzed by receiver operating characteristic（ROC）curves.Results Compared with the controls,ALS group had significantly decreased NAA/Cr and NAA/（Cho＋Cr）ratios at the three levels along the corticospinal tract（CST）（P〈0.05）.In ROC analysis,areas under the curves（AUC）ranged from 0.67to0.91.The average NAA/（Cho＋Cr）ratio of PLIC and CP showed the best performance with an AUC of 0.91,a sensitivity of 0.828 and a specificity of 0.906,followed by the average NAA/（Cho＋Cr）ratio of all the three levels,with the corresponding data as 0.90,0.769 and 0.875.Conclusions 1 H-MRS can reveal metabolite abnormalities in the intracranial CTS of ALS patients and serve as a neuroimaging biomarker for UMN involvement.Regarding its moderate diagnostic accuracy, multilevel measurements and synthetically using parameters will help to improve its efficacy.

关 键 词：肌萎缩侧索硬化 锥体束 磁共振波谱 ROC曲线 

分 类 号：R744.8[医药卫生—神经病学与精神病学]