磁共振在多发梗死性痴呆与阿尔茨海默病中的鉴别诊断价值  

Value of MRI in differential diagnosis of multi-infarct dementia and Alzheimer's disease

作　　者：王晓[1] 曹季祥 蒋惟伟[1] 束飞[2] 王先红 WANG Xiao;CAO Ji-xiang;JIANG Wei-wei;SHU Fei;WANG Xian-hong(Radiology department,The Affiliated Brain Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学附属脑科医院放射科,210029 [2]南京医科大学附属脑科医院精神科,210029 [3]南京医科大学附属脑科医院神经内科,210029

出　　处：《临床精神医学杂志》2025年第2期120-124,共5页Journal of Clinical Psychiatry

基　　金：南京医科大学科技发展基金(NMUB2020233)。

摘　　要：目的:比较多发梗死性痴呆(multi-infarct dementia,MID)、阿尔茨海默病(Alzheimer's disease,AD)、正常老年人的脑结构及脑白质高信号(white matter hyperintensities,WMH)差异,探究磁共振(magnetic resonance imaging,MRI)对MID与AD的鉴别诊断价值。方法:回顾性分析南京脑科医院2018年至2022年116例MID组、152例AD组以及162名正常对照(normal control,NC)组的临床及MRI影像资料,对各组脑萎缩、腔隙性脑梗死、WMH进行分级,并进一步测量各组WMH区域表观扩散系数(the diffusion coefficient,ADC)值,采用单因素方差分析及多元无序Logistic回归分析各指标的差异。结果:3组患者腔隙性脑梗死、脑萎缩、Fazekas分级差异均有统计学意义(P均<0.05),AD组腔隙性脑梗死发生率高于NC组,且发生重度脑萎缩的可能性最高,而MID组Fazekas分级3级发生率最高。MID组、AD组和NC组脑室前后角WMH区域的ADC值差异均有统计学意义(P均<0.05)。结论:MID与AD患者脑结构及WMH严重程度及信号强度具有显著差异,MRI可以在多角度为鉴别MID与AD提供依据。Objective:To compare differences in brain structure and white matter hyperintensities(WMH)among patients with multi-infarct dementia(MID),Alzheimer's disease(AD),and normal elderly individuals,and to evaluate the diagnostic value of magnetic resonance imaging(MRI)in distinguishing MID from AD.Method:Retrospective analysis was conducted on clinical and MRI data of 116 MID patients,152 AD patients and 162 normal controls(NC)at Nanjing Brain Hospital from 2018 to 2022.Brain atrophy,lacunar infarcts,and WMH were graded,and the apparent diffusion coefficient(ADC)values of WMH regions were measured.One-way ANOVA and multivariate unordered Logistic regression were used to analyze differences among groups.Results:Significant differences were observed in lacunar infarcts,brain atrophy,and Fazekas grading among the three groups(all P<0.05).The AD group had a higher incidence of lacunar infarcts than the NC group and the highest likelihood of severe brain atrophy.The MID group showed the highest incidence of Fazekas grade 3.Significant differences in ADC values of WMH regions in the anterior and posterior horns of the ventricles were also found among the MID,AD,and NC groups(all P<0.05).Conclusion:Significant differences exist in brain structure,WMH severity,and signal intensity between MID and AD patients.MRI can provide multi-dimensional evidence for distinguishing MID from AD.

关 键 词：磁共振成像 多发梗死性痴呆 阿尔茨海默病 脑白质高信号 

分 类 号：R749.05[医药卫生—神经病学与精神病学]