动脉瘤性蛛网膜下腔出血术后皮层下核团体积、DKI参数与认知功能障碍的相关性研究  

Correlations of cognitive dysfunction with subcortical nuclei volumes and diffusion kurtosis imaging parameters in patients with aneurysmal subarachnoid hemorrhage after surgery

作　　者：陈德美 赖玉洁 庞美艳 向守洪 周代全 王毅 王军大 严敏 Chen Demei;Lai Yujie;Pang Meiyan;Xiang Shouhong;Zhou Daiquan;Wang Yi;Wang Junda;Yan Min(Department of Radiology,Third Affiliated Hospital of Chongqing Medical University,Chongqing 401120,China;Center for Neurological Diseases,Third Affiliated Hospital of Chongqing Medical University,Chongqing 401120,China;Department of Radiology,Chongqing Hospital of Traditional Chinese Medicine,Chongqing 400021,China)

机构地区：[1]重庆医科大学附属第三医院放射科,重庆401120 [2]重庆医科大学附属第三医院神经疾病中心,重庆401120 [3]重庆市中医院放射科,400021

出　　处：《中华神经医学杂志》2021年第7期682-688,共7页Chinese Journal of Neuromedicine

基　　金：重庆市2018年科卫联合中医药科技项目(ZY201802025)。

摘　　要：目的探讨动脉瘤性蛛网膜下腔出血(aSAH)患者术后认知功能、皮层下核团体积和扩散峰度成像(DKI)参数的改变,分析各核团体积、DKI参数与认知功能障碍的相关性。方法前瞻性选择重庆医科大学附属第三医院神经疾病中心自2019年9月至2020年6月行手术治疗的17例aSAH患者作为研究组,选择同期年龄、性别和受教育年限与aSAH患者相匹配的16例健康者作为对照组。研究组患者术后3个月、对照组受试者入组后即刻进行认知功能评估和MRI检查,对所有受试者的结构影像数据进行后处理,分析双侧皮层下核团体积和扩散峰度成像(DKI)参数,比较2组受试者一般资料、各核团体积和DKI参数的差异,相关性分析研究组患者皮层下核团体积、DKI参数和简易智能精神状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)评分的相关性。结果与对照组比较,研究组患者的MMSE及MoCA评分较低,术侧海马、术侧丘脑、术侧豆状核的体积降低,差异均有统计学意义(P<0.05)。与对照组比较,研究组患者对侧尾状核各向异性分数(FA)值、双侧豆状核FA值、双侧丘脑FA值均降低,术侧尾状核平均扩散系数(MD)值增高,术侧海马平均扩散峰度(MK)值降低,差异均有统计学意义(P<0.05)。相关性分析显示研究组患者术侧海马体积与MoCA评分呈正相关关系(r=0.604,P=0.038),对侧尾状核FA值与MMSE评分呈负相关关系(r=-0.579,P=0.049)。结论aSAH患者术后存在认知功能障碍,术侧海马、丘脑和豆状核萎缩和DKI参数改变。术侧海马体积和对侧尾状核FA值的改变与患者术后认知功能障碍有关。Objective To observe the changes of cognitive function,subcortical nuclei volumes,and diffusion kurtosis imaging(DKI)parameters(values of fractional anisotropy[FA],mean diffusivity[MD]and mean kurtosis[MK])after surgery in patients with aneurysmal subarachnoid hemorrhage(aSAH),and analyze the correlations of cognitive dysfunction with subcortical nuclei volumes and DKI parameters.Methods A prospective sutdy was conducted;17 patients with aSAH confirmed by surgery in our hospital from September 2019 to June 2020 were selected as patient group,and 16 healthy volunteers whose age,gender,and education level were matched with the patient group were recruited as control group.Neuropsychological tests and MR imaging were performed in the patients 3 months after surgery and the controls right after enrollment.The structural image data of all subjects were post-processed.Bilateral subcortical nuclei volumes and DKI parameters were analyzed.The differences of general clinical data,subcortical nuclei volumes and DKI parameters were compared between the two groups.The correlations of mini-mental state examination(MMSE)and Montreal cognitive assessment(MoCA)scores with subcortical nuclei volumes and DKI parameters were analyzed.Results As compared with the control group,the patient group had significantly lower MMSE and MoCA scores,and statistically decreased volumes of ipsilateral hippocampus,ipsilateral thalamus and ipsilateral lentiform nucleus(P<0.05).The FA values of the contralateral caudate nucleus,bilateral thalamus and bilateral lentiform nucleus and MK values of the ipsilateral hippocampus in the patient group were significantly decreased as compared with those in the control group(P<0.05);while the MD values of the ipsilateral caudate nucleus in the patient group were significantly increased as compared with those in the control group(P<0.05).The volume of ipsilateral hippocampus was positively with MoCA scores(r=0.604,P=0.038);the FA values of contralateral caudate nucleus were negatively correlated with MMSE scor

关 键 词：动脉瘤性蛛网膜下腔出血 皮层下核团 认知功能障碍 MRI 扩散峰度成像 

分 类 号：R651.12[医药卫生—外科学]