脑小血管病患者DTI-ALPS及血管周围间隙改变及其与认知功能的关联性研究  

The association between DTI-ALPS,perivascular space and cognitive impairment in cerebral small vessel disease

作　　者：赵婧含 常佩佩 杜伟 曹家骏 王嫚 胡帅[1] 宋清伟[1] 苗延巍[1] ZHAO Jinghan;CHANG Peipei;DU Wei;CAO Jiajun;WANG Man;HU Shuai;SONG Qingwei;MIAO Yanwei(Department of Radiology,the First Affiliated Hospital of Dalian Medical University,Dalian 116011,China)

机构地区：[1]大连医科大学附属第一医院放射科,大连116011

出　　处：《磁共振成像》2025年第3期31-37,共7页Chinese Journal of Magnetic Resonance Imaging

摘　　要：目的采用沿血管周围间隙的扩散张量成像分析(diffusion tensor imaging analysis along the perivascular space,DTI-ALPS)指标及血管周围间隙扩大(enlarged perivascular space,EPVS)状态评价脑小血管疾病(cerebral small vessel disease,CSVD)患者的类淋巴功能,并探究其与认知功能的关系。材料与方法前瞻性纳入CSVD组(81例)和健康对照组(20例)的临床资料,根据神经心理学量表评估结果将CSVD患者分为认知正常组(CSVD-NC组,27例)、轻度认知障碍(mild cognitive impairment,MCI)组(CSVD-MCI组,31例)和血管性痴呆(vascular dementia,VaD)组(CSVD-VaD组,23例)。所有被试行常规MRI序列、扩散张量成像(diffusion tensor imaging,DTI)检查。对所有被试的基底神经节(basal ganglio,BG)以及半卵圆中心(centrum semi-ovale,CSO)的EPVS等级进行量化评分;并测量ALPS指标(ALPS-index)。比较EPVS等级及ALPS指标的组间差异,分析影像指标与认知评分的关系,并进一步进行多元线性回归分析。结果与HC组相比,CSVD-NC组、CSVD-MCI组、CSVD-VaD组的ALPS指标均降低,CSVD-MCI组、CSVD-VaD组的BG-EPVS等级评分及CSO-EPVS等级评分均增高(P<0.05)。相关性分析显示,CSVD患者的BG-EPVS等级与ALPS指标、MoCA评分、MMSE评分均呈负相关(r=-0.291,P=0.008;r=-0.342,P=0.002;r=-0.309,P=0.005);同时,ALPS指标与MoCA评分、MMSE评分呈正相关(r=0.226,P=0.043;r=0.225,P=0.044)。回归分析结果显示,BG-EPVS等级评分是MoCA评分及MMSE评分的独立影响因素(β=-0.294,P=0.009;β=-0.274,P=0.017)。结论CSVD患者的DTI-ALPS指标及EPVS等级评分均发生不同程度改变,提示存在类淋巴系统功能损害,且与认知功能障碍密切相关。Objective:To evaluate the glymphatic system with diffusion tensor imaging analysis along the perivascular space(DTI-ALPS) and enlarged perivascular space(EPVS) changes,and to explore its relationship with cognitive function,and then to find influence factors for cognitive changes in cerebral small vessel disease(CSVD) patients.Materials and Methods:The clinical data of CSVD group(n = 81) and control group(n = 20) were prospectively collected.According to the neuropsychological evaluation results,the CSVD patients were divided into normal cognition group(CSVD-NC,n = 27),mild cognitive impairment group(CSVD-MCI,n =31),and vascular dementia group(CSVD-VaD,n = 23).The routine MRI sequence,diffusion tensor imaging(DTI) were performed in all.The grade of EPVS of basal ganglia(BG) and centrum semi-ovale(CSO) was quantitatively scored,and ALPS-index was measured.The differences of EPVS and ALPS-index were compared among the four groups.Correlation analysis and multiple linear regression was further analyzed between ALPS-index,EPVS and cognitive function.Results:Compared with the HC group,the ALPS-index were decreased in the CSVD-NC group,CSVD-MCI group and CSVD-VaD group,the BG-EPVS and CSO-EPVS score were increased in the CSVD-MCI group and the CSVD-VaD group(P < 0.05).The BG-EPVS was negatively correlated with ALPS index,MoCA score and MMSE score in CSVD patients(r =-0.291,P = 0.008;r =-0.342,P = 0.002;r =-0.309,P = 0.005),and ALPS-index was positively correlated with MoCA score and MMSE score(r = 0.226,P = 0.043;r = 0.225,P = 0.044).Multiple linear regression analysis showed that BG-EPVS was independent factor of MoCA score and MMSE score(β =-0.294,P = 0.009;β =-0.274,P = 0.017).Conclusions:The ALPS index and EPVS changes could be used to evaluate glymphatic system in CSVD patients,which were closely related to cognition impairment.

关 键 词：脑小血管疾病 沿血管周围间隙的扩散张量成像分析 磁共振成像 类淋巴系统 认知功能 血管周围间隙 

分 类 号：R445.2[医药卫生—影像医学与核医学] R743[医药卫生—诊断学]