Is the left uncinate fasciculus essential for language?

Despite a better understanding of the anatomy of the uncinate fasciculus (UF), its function remains poorly known. Our aim was to study the exact role of UF in language, and the possible existence of parallel distributed language networks within the “ventral stream”, underlaid by distinct subcortical tracts – namely the inferior occipito-temporal fasciculus (IOF) and UF. We report a series of 13 patients operated on awake for a glioma involving the left anterior temporal lobe or the orbitofrontal area. We used intraoperative electrostimulation, to perform accurate and reliable anatomofunctional correlations both at cortical and subcortical levels. Using postoperative MRI, we correlated these functional findings with the anatomical locations of the sites where language disturbances were elicited by stimulation. Intraoperative cortical stimulation found perilesional language sites in all cases. Subcortically, semantic paraphasia were induced in the 13 patients by stimulating the IOF, and phonological paraphasia were generated in 6 patients by stimulating the arcuate fasciculus. Interestingly, subcortical stimulation never elicited any language disturbances when performed at the level of the UF. Moreover, after a transient postoperative language deficit, all patients recovered, despite the removal of at least one part of the UF, as confirmed by control MRI. We suggest that UF is not systematically essential for language. It can be explained by the fact that the “semantic ventral stream” might be constituted by at least two parallel pathways, i. e. a direct pathway underlaid by the IOF, crucial for language semantics, and an indirect pathway subserved by UF, which can be functionally compensated. However, we have to underline the fact not all language functions can be probed during surgery, and that more sensitive tasks have now to be added.     

Diffusion tensor analysis of temporal and extra-temporal lobe tracts in temporal lobe epilepsy

OBJECTIVE: To determine whether the major temporal lobe white matter tracts in patients with temporal lobe epilepsy manifest abnormal water diffusion properties. METHODS: Diffusion tensor MRI measurements were obtained from tractography for uncinate, arcuate, inferior longitudinal fasciculi and corticospinal tract in 13 children with left temporal lobe epilepsy and normal conventional MRI, and the data were compared to measurements in 12 age-matched normal volunteers. The relationship between tensor parameters and duration of epilepsy was also determined. RESULTS: All four tracts in the affected left hemisphere showed lower mean anisotropy, planar and linear indices, but higher spherical index in patients versus controls. Diffusion changes in the left uncinate and arcuate fasciculus correlated significantly with duration of epilepsy. Arcuate fasciculus showed a reversal of the normal left-right asymmetry. Various diffusion abnormalities were also seen in the four tracts studied in the right hemisphere. CONCLUSION: Our findings indicate abnormal water diffusion in temporal lobe and extra-temporal lobe tracts with robust changes in the direction perpendicular to the axons. Diffusion abnormalities associated with duration of epilepsy suggest progressive changes in ipsilateral uncinate and arcuate fasciculus due to chronic seizure activity. Finally, our results in arcuate fasciculus are consistent with language reorganization to the contralateral right hemisphere.     

Naming and the Role of the Uncinate Fasciculus in Language Function

In this paper, an overview of the studies relating naming to the uncinate fasciculus is reported. With the introduction of contemporary neuroimaging techniques, namely of diffusion tensor imaging, white matter tracts have been investigated more thoroughly and possible changes in the uncinate fasciculus integrity have been correlated to different neuropsychological deficits. Although previous research has proposed a role of the left uncinate fasciculus on action and object naming or in semantic processing, a more recent study has suggested that naming famous people could be the most relevant task in which this bundle is involved, the semantic component being intact. The uncinate fasciculus connects the orbitofrontal cortex, involved in face encoding and in processing famous names, to the temporal pole, which is crucial in naming people. This conclusion is supported by the fact that tip-of-the-tongue states in older adults with reduced integrity of the uncinate fasciculus mainly concern proper names.     

Fascículos asociativos ínsulo-operculares: revisión de su anatomía y de las implicaciones para el abordaje transopercular a la ínsula

IntroductionThe insula is a highly connected area, as an intricate network of afferent and efferent projections connect it with adjacent and distant cortical regions.ObjectiveTo perform an extensive review of recent literature to analyse the anatomy of the associative tracts related to the insula.ResultsThe frontal aslant tract, arcuate fasciculus, horizontal portion of the superior longitudinal fasciculus and the middle longitudinal fasciculus are associative tracts connected to the opercula. The inferior fronto-occipital fasciculus (IFOF) and uncinate fasciculus run under the anterior and inferior portion of the insula.Conclusionsthe pars triangularis and orbicularis of the inferior frontal gyrus, as well as the middle and anterior part of the superior temporal gyrus, have few connections with the perisylvian associative network. Consequently, in the trans-opercular approach to the insula, these 2 regions represent anatomical corridors that give access to the insula. The IFOF and the uncinate fasciculus represent the deep functional margin of resection.     

Association fiber pathways to the frontal cortex from the superior temporal region in the rhesus monkey

The projections to the frontal cortex that originate from the various areas of the superior temporal region of the rhesus monkey were investigated with the autoradiographic technique. The results demonstrated that the rostral part of the superior temporal gyrus (areas Pro, Ts1, and Ts2) projects to the proisocortical areas of the orbital and medial frontal cortex, as well as to the nearby orbital areas 13, 12, and 11, and to medial areas 9, 10, and 14. These fibers travel to the frontal lobe as part of the uncinate fascicle. The middle part of the superior temporal gyrus (areas Ts3 and paAlt) projects predominantly to the lateral frontal cortex (areas 12, upper 46, and 9) and to the dorsal aspect of the medial frontal lobe (areas 9 and 10). Only a small number of these fibers terminated within the orbitofrontal cortex. The temporofrontal fibers originating from the middle part of the superior temporal gyrus occupy the lower portion of the extreme capsule and lie just dorsal to the fibers of the uncinate fascicle. The posterior part of the superior temporal gyrus projects to the lateral frontal cortex (area 46, dorsal area 8, and the rostralmost part of dorsal area 6). Some of the fibers from the posterior superior temporal gyrus run initially through the extreme capsule and then cross the claustrum as they ascend to enter the external capsule before continuing their course to the frontal lobe. A larger group of fibers curves round the caudalmost Sylvian fissure and travels to the frontal cortex occupying a position just above and medial to the upper branch of the circular sulcus. This latter pathway constitutes a part of the classically described arcuate fasciculus.     

Evidence of frontotemporal structural hypoconnectivity in social anxiety disorder: A quantitative fiber tractography study

Investigation of the brain's white matter fiber tracts in social anxiety disorder (SAD) may provide insight into the underlying pathophysiology. Because models of pathological anxiety posit altered frontolimbic interactions, the uncinate fasciculus (UF) connecting (orbito‐) frontal and temporal areas including the amygdala is of particular interest. Microstructural alterations in parts of the UF have been reported previously, whereas examination of the UF as discrete fiber tract with regard to more large‐scale properties is still lacking. Diffusion tensor imaging was applied in 25 patients with generalized SAD and 25 healthy control subjects matched by age and gender. By means of fiber tractography, the UF was reconstructed for each participant. The inferior fronto‐occipital fasciculus (IFOF), originating from the frontal cortex similarly to the UF, was additionally included as control tract. Volume and fractional anisotropy (FA) were compared between the groups for both tracts. Volume of left and right UF was reduced in patients with SAD, reaching statistical significance for the left UF. Bilateral IFOF volume was not different between groups. A similar pattern was observed for FA. Reduced volume of the left UF in SAD fits well into pathophysiological models of anxiety, as it suggests deficient structural connectivity between higher‐level control areas in the orbitofrontal cortex and more basal limbic areas like the amygdala. The results point to a specific role of the left UF with regard to altered white matter volume in SAD. However, results should be replicated and functional correlates of altered UF volume be determined in future studies. Hum Brain Mapp, 2013. © 2011 Wiley Periodicals, Inc.     

颞叶癫癎弥散张量成像的影像学特征

颞叶癫癎（TLE）作为常见的一类局限性癫癎,了解其颅内病灶至关重要。MR弥散张量成像是一种水弥散成像技术,能够反映白质纤维的解剖和病理过程。本文介绍了TLE在弥散张量成像中的影像学表现：TLE患者病灶侧海马,与致癎灶相关连接结构如穹窿、扣带回、胼胝体和额颞叶联系纤维在弥散张量成像中均有异常信号,另外在双侧丘脑、额枕叶、双侧小脑亦有异常信号发现。TLE患者颅内各类白质纤维的信号异常与患者的某些认知功能有关。     

White matter integrity alterations in post‐traumatic stress disorder

Post‐traumatic stress disorder (PTSD) is a debilitating condition which can develop after exposure to traumatic stressors. Seventy‐five adults were recruited from the community, 25 diagnosed with PTSD along with 25 healthy and 25 trauma‐exposed age‐ and gender‐matched controls. Participants underwent clinical assessment and magnetic resonance imaging. A previous voxel based morphometry (VBM) study using the same subject cohort identified decreased grey matter (GM) volumes within frontal/subcortical brain regions including the hippocampus, amygdala, and anterior cingulate cortex (ACC). This study examines the microstructural integrity of white matter (WM) tracts connecting the aforementioned regions/structures. Using diffusion tensor imaging, we investigated the integrity of frontal/subcortical WM tracts between all three subject groups. Trauma exposed subjects with and without PTSD diagnosis were identified to have significant disruption in WM integrity as indexed by decreased fractional anisotropy (FA) in the uncinate fasciculus (UF), cingulum cingulate gyrus (CCG), and corpus callosum (CC), when compared with healthy non‐trauma‐exposed controls. Significant negative correlations were found between total Clinician Administered PTSD scale (CAPS) lifetime clinical subscores and FA values of PTSD subjects in the right UF, CCG, CC body, and right superior longitudinal fasciculus (SLF). An analysis between UF and SLF FA values and VBM determined rostral ACC GM values found a negative correlation in PTSD subjects. Findings suggest that compromised WM integrity in important tracts connecting limbic structures such as the amygdala to frontal regions including the ACC (i.e., the UF and CCG) may contribute to impairments in threat/fear processing associated with PTSD.     

Efferent projections of the insular and temporal neocortex of the cat

Anterograde degeneration resulting from small lesions placed in either the insular or temporal cortex were traced with the Fink-Heiner reduced silver procedure. In neocortical regions ipsilateral to the lesion axonal degeneration was present in auditory subdivisions AI, AII, Ep, I, T, in the second somatosensory are(SII), in the anterior and middle suprasylvian gyrus, in the posteromedial suprasylvian and posterior lateral gyri, in the posterior splenial gyrus, in the anterior two-thirds of the cingulate gyrus and in the orbitofrontal regions. With respect interhemispheric connections, evidence was obtained for a dual pattern of projection. In addition to significant amounts of axonal and terminal degeneration in the corresponding insular or temporal fields, axonal degeneration was also present in posterior AII.In the thalamus degeneration was found in the medial dorsal, suprageniculate, and lateral posterior-pulvinar nuclei. In the posterior nuclear group (Po) and the principal division of the medial geniculate (GMp) evidence was obtained for a topographic pattern of projection; significantly more degeneration occurred in caudal Po following insular lesions whereas with temporal lesions more degeneration occurred in caudal GMp. Degeneration was also found in the dorsal cortex of the ipsilateral inferior colliculus, bilaterally in the deep layers of the superior colliculus and the periventricular central gray region, ipsilaterally in the ventromedial aspects of the head and body of the caudate nucleus, and in the lateral and central nuclei of the amygdala. These findings are discussed in terms of their significance for a possible role for the insular and temporal neocortex (I-T) in both multimodal sensory discrimination and sensory-visceral integrative functions.     

Cytoarchitecture and neural afferents of orbitofrontal cortex in the brain of the monkey.

The orbitofrontal cortex of the monkey can be subdivided into a caudal agranular sector, a transitional dysgranular sector, and an anterior granular sector. The neural input into these sectors was investigated with the help of large horseradish peroxidase injections that covered the different sectors of orbitofrontal cortex. The distribution of retrograde labeling showed that the majority of the cortical projections to orbitofrontal cortex arises from a restricted set of telencephalic sources, which include prefrontal cortex, lateral, and inferomedial temporal cortex, the temporal pole, cingulate gyrus, insula, entorhinal cortex, hippocampus, amygdala, and claustrum. The posterior portion of the orbitofrontal cortex receives additional input from the piriform cortex and the anterolateral portion from gustatory, somatosensory, and premotor areas. Thalamic projections to the orbitofrontal cortex arise from midline and intralaminar nuclei, from the anteromedial nucleus, the medial dorsal nucleus, and the pulvinar nucleus. Orbitofrontal cortex also receives projections from the hypothalamus, nucleus basalis, ventral tegmental area, the raphe nuclei, the nucleus locus coeruleus, and scattered neurons of the pontomesencephalic tegmentum. The non-isocortical (agranular-dysgranular) sectors of orbitofrontal cortex receive more intense projections from the non-isocortical sectors of paralimbic areas, the hippocampus, amygdala, and midline thalamic nuclei, whereas the isocortical (granular) sector receives more intense projections from the dorsolateral prefrontal area, the granular insula, granular temporopolar cortex, posterolateral temporal cortex, and from the medial dorsal and pulvinar thalamic nuclei. Retrograde labeling within cingulate, entorhinal, and hippocampal cortices was most pronounced when the injection site extended medially into the dysgranular paraolfactory cortex of the gyrus rectus, an area that can be conceptualized as an orbitofrontal extension of the cingulate complex. These observations demonstrate that the orbitofrontal cortex has cytoarchitectonically organized projections and that it provides a convergence zone for afferents from heteromodal association and limbic areas. The diverse connections of orbitofrontal cortex are in keeping with the participation of this region in visceral, gustatory, and olfactory functions and with its importance in memory, motivation, and epileptogenesis.     

Uncinate fasciculus findings in schizophrenia: a magnetic resonance diffusion tensor imaging study

OBJECTIVE: Disruptions in connectivity between the frontal and temporal lobes may explain some of the symptoms observed in schizophrenia. Conventional magnetic resonance imaging (MRI) studies, however, have not shown compelling evidence for white matter abnormalities, because white matter fiber tracts cannot be visualized by conventional MRI. Diffusion tensor imaging is a relatively new technique that can detect subtle white matter abnormalities in vivo by assessing the degree to which directionally organized fibers have lost their normal integrity. The first three diffusion tensor imaging studies in schizophrenia showed lower anisotropic diffusion, relative to comparison subjects, in whole-brain white matter, prefrontal and temporal white matter, and the corpus callosum, respectively. Here the authors focus on fiber tracts forming temporal-frontal connections. METHOD: Anisotropic diffusion was assessed in the uncinate fasciculus, the most prominent white matter tract connecting temporal and frontal brain regions, in 15 patients with chronic schizophrenia and 18 normal comparison subjects. A 1.5-T GE Echospeed system was used to acquire 4-mm-thick coronal line-scan diffusion tensor images. Maps of the fractional anisotropy were generated to quantify the water diffusion within the uncinate fasciculus. RESULTS: Findings revealed a group-by-side interaction for fractional anisotropy and for uncinate fasciculus area, derived from automatic segmentation. The patients with schizophrenia showed a lack of normal left-greater-than-right asymmetry seen in the comparison subjects. CONCLUSIONS: These findings demonstrate the importance of investigating white matter tracts in vivo in schizophrenia and support the hypothesis of a disruption in the normal pattern of connectivity between temporal and frontal brain regions in schizophrenia.     

Insular cortex and neighboring fields in the cat: A redefinition based on cortical microarchitecture and connections with the thalamus

The insular areas of the cerebral cortex in carnivores remain vaguely defined and fragmentarily characterized. We have examined the cortical microarchitecture and thalamic connections of the insular region in cats, as a part of a broader study aimed to clarify their subdivisions, functional affiliations, and eventual similarities with other mammals. We report that cortical areas, which resemble the insular fields of other mammals, are located in the cat's orbital gyrus and anterior rhinal sulcus. Our data suggest four such areas: (a) a “ventral agranular insular area” in the lower bank of the anterior rhinal sulcus, architectonically transitional between iso- and allocortex and sparsely connected to the thalamus, mainly with midline nuclei; (b) a “dorsal agranular insular area” in the upper bank of the anterior rhinal sulcus, linked to the mediodorsal, ventromedial, parafascicular and midline nuclei; (c) a “dysgranular insular area” in the anteroventral half of the orbital gyrus, characterized by its connections with gustatory and viscerosensory portions of the ventroposterior complex and with the ventrolateral nucleus; and (d) a “granular insular area”, dorsocaudal in the orbital gyrus, which is chiefly bound to spinothalamic-recipient thalamic nuclei such as the posterior medial and the ventroposterior inferior. Three further fields are situated caudally to the insular areas. The anterior sylvian gyrus and dorsal lip of the pseudosylvian sulcus, which we designate “anterior sylvian area”, is connected to the ventromedial, suprageniculate, and lateralis medialis nuclei. The fundus and ventral bank of the pseudosylvian sulcus, or “parainsular area”, is associated with caudal portions of the medial geniculate complex. The rostral part of the ventral bank of the anterior ectosylvian sulcus, referred to as “ventral anterior ectosylvian area”, is heavily interconnected with the lateral posterior-pulvinar complex and the ventromedial nucleus. Present results reveal that these areas interact with a wide array of sensory, motor, and limbic thalamic nuclei. In addition, these data provide a consistent basis for comparisons with cortical fields in other mammals. J. Comp. Neurol. 384:456–482, 1997. © 1997 Wiley-Liss, Inc.     

正常成人皮质吞咽中枢功能磁共振的初步研究

目的探讨正常成人皮质吞咽中枢的分布与特点。方法采用血氧水平依赖(BOLD)的功能磁共振方法对6例右利手健康志愿者进行吞咽中枢的定位。在GE公司3.0T磁共振仪上,除常规T1、T2扫描外,患者行吞咽动作,获取BOLD信号变化。扫描时间共60秒,在第1、15、30、45秒时受试者分别完成一次空吞咽动作,吞咽时尽量减少唇、舌、头部的运动。采用SPM软件在Functool4.0工作站上对图像数据进行后处理。结果正常受试者吞咽动作的激活部位位于感觉运动皮质外侧、岛叶、扣带回前部、运动前区,眶额皮质、小脑。仅有岛叶的激活信号以左侧半球为著。结论正常成人的吞咽中枢位于多个脑区。自主吞咽动作的启动及调节需要多个脑区的激活。     

Anterior cingulate, gyrus rectus, and orbitofrontal abnormalities in elderly depressed patients: an MRI-based parcellation of the prefrontal cortex

OBJECTIVE: To examine structural abnormalities in subregions of the prefrontal cortex in elderly patients with depression, the authors explored differences in gray matter, white matter, and CSF volumes by applying a parcellation method based on magnetic resonance imaging (MRI). METHOD: Twenty-four elderly patients with major depression and 19 group-matched comparison subjects were studied with high-resolution MRI. Cortical surface extraction, tissue segmentation, and cortical parcellation methods were applied to obtain volume measures of gray matter, white matter, and CSF in seven prefrontal subregions: the anterior cingulate, gyrus rectus, orbitofrontal cortex, precentral gyrus, superior frontal cortex, middle frontal cortex, and inferior frontal cortex. RESULTS: Highly significant bilateral volume reductions in gray matter were observed in the anterior cingulate, the gyrus rectus, and the orbitofrontal cortex. Depressed patients also exhibited significant bilateral white matter volume reductions and significant CSF volume increases in the anterior cingulate and the gyrus rectus. Finally, the depressed group showed significant CSF volume reductions in the orbitofrontal cortex relative to the comparison subjects. None of the other regions examined revealed significant structural abnormalities. CONCLUSIONS: The prominent bilateral gray matter deficits in the anterior cingulate and the gyrus rectus as well as the orbitofrontal cortex may reflect disease-specific modifications of elderly depression. The differential pattern of abnormalities detected in the white matter and CSF compartments imply that distinct etiopathological mechanisms might underlie the structural cortical changes in these regions.     

岛叶胶质瘤的显微外科治疗

目的探讨岛叶胶质瘤显微外科手术切除的可行性和手术效果。方法回顾性分析2002-2011年收治的43例岛叶胶质瘤病例的临床资料、手术方法和疗效。结果本组43例患者中,手术全切24例,次全切17例,大部分切除2例。术后出现对侧肢体瘫痪9例,短暂性言语障碍4例,均在1月内恢复。35例得到随访,平均随访3．2年,其中术后复发7例,2例经再次放化疗后病变未见增大,5例经综合治疗后随访1年未见有复发。其他病例均可恢复正常工作生活,无死亡病例。结论在熟悉岛叶区域解剖的基础上,采用经侧裂入路切除岛叶胶质瘤是其治疗的有效途径。     

Patterns of extraocular innervation by the oculomotor complex in the chick

The horseradish peroxidase retrograde tracer technique was used to map the projection pattern of the oculomotor nuclear complex to the extraocular muscles in the chick embryo. The following projection pattern was found: The dorsolateral oculomotor subnucleus innervates the ipsilateral inferior rectus muscle, the dorsomedial subnucleus innervates the ipsilateral medial rectus muscle, a lateral division of the ventromedial subnucleus innervates the ipsilateral inferior oblique muscle, and a medial division of the ventromedial subnucleus innervates the contralateral superior rectus muscle. The so-called central nucleus also innervates the contralateral superior rectus muscle. This pattern was extremely discrete, with virtually no overlapping representations. These results provide the first evidence for a functional medial-lateral subdivision of the ventromedial subnucleus. This pattern relates to the unusual development of this subnucleus and suggests that only part of the primordium for this cell group migrates across the midline during its ontogeny, rather than all of it, as was previously believed. The subnuclear organization of the avian oculomotor complex is also considered in comparison to such functional organization in other species.     

Abnormal language pathway in children with Angelman syndrome

Angelman syndrome is a genetic disorder characterized by pervasive developmental disability with failure to develop speech. We examined the basis for severe language delay in patients with Angelman syndrome by diffusion tensor imaging. Magnetic resonance imaging/diffusion tensor imaging was performed in 7 children with genetically confirmed Angelman syndrome (age 70 ± 26 months, 5 boys) and 4 age-matched control children to investigate the microstructural integrity of arcuate fasciculus and other major association tracts. Six of 7 children with Angelman syndrome had unidentifiable left arcuate fasciculus, while all control children had identifiable arcuate fasciculus. The right arcuate fasciculus was absent in 6 of 7 children with Angelman syndrome and 1 of 4 control children. Diffusion tensor imaging color mapping suggested aberrant morphology of the arcuate fasciculus region. Other association tracts, including uncinate fasciculus, inferior fronto-occipital fasciculus, inferior longitudinal fasciculus, and corticospinal tract, were identifiable but manifested decreased fractional anisotropy in children with Angelman syndrome. Increased apparent diffusion coefficient was seen in all tracts except uncinate fasciculus when compared to control children. Patients with Angelman syndrome have global impairment of white matter integrity in association tracts, particularly the arcuate fasciculus, which reveals severe morphologic changes. This finding could be the result of a potential problem with axon guidance during brain development, possibly due to loss of UBE3A gene expression.     

Anatomical and experimental study of certain association fascicles in the cortex of the rabbit (Oryctalagus cuniculus).

1. All lesions resulted in degeneration of the short intracortical association fibers in cortical layer I and of the short subcortical fibers which extended to the corona radiata before ending in the deeper layers of the overlying neopallium. 2. From all the lesions fibers were traced through the corona radiata to the subcallosal or the so-called superior fronto-occipital association bundle. This bundle had projection fibers to the orbitofrontal cortex. 3. From the lesion in the orbitofrontal neopallium, the orbitofrontal-pyriform connections were established. Such fibers coursed on the dorsal edge of the lateral olfactory tract and distributed to the pyriform cortex and to the nucleus of the lateral olfactory tract. 4. The uncinate fasciculus of man derived its name from its arching course from the base of the frontal lobe to the temporal lobe. Because of the more caudal position of the amygdala in the rabbit, the comparable fasciculus passed directly caudally and exhibited only slight arching. This fasciculus in the rabbit had the typical dorsal and ventral parts. The dorsal part arose from the orbitofrontal cortex to distribute to the pyriform and the temporal lobe cortices. The ventral portion extended into the olfactory tuberculum and the anterior amygdaloid area. 5. The paraventricular component of the transverse frontal fasciculus interconnected the neopallium with the medial part of the olfactory tuberculum. It had origins in the frontal and possibly in other neocortical areas. 6. The cingulum interconnected the medial portion of the olfactory tubercle, the septum, the various cingulate areas and areas of the neopallium with each other. 7. Therefore, the New Zealand white rabbit had short association fibers which were mainly neopallial in origin and termination and long association fibers which had both a neopallial and a limbic component.     

弥漫性轴索损伤后早期磁共振弥散张量成像与工作记忆障碍的相关性研究

目的探讨磁共振弥散张量成像(DTI)对弥漫性轴索损伤(DAI)导致工作记忆障碍早期诊断及预后评估的价值。方法分别对10例DAI患者(DAI组)和10例健康志愿者(正常对照组)行DTI检查,并对两组DTI图像的钩束、皮质脊髓束、胼胝体和扣带回感兴趣区的部分各向异性(FA)值进行比较分析。DAI后6个月对患者与健康志愿者行认知量表评估,并行对比分析;另外将DAI组FA值与其认知量表评分行直线相关分析。结果与对照组相比,DAI患者4个感兴趣区的FA值显著降低(P<0.05),恢复期总体认知能力略降低,但无统计学意义(P>0.05),而工作记忆功能却显著降低(P<0.05)。DAI患者中的钩束和皮质脊髓束的FA值与工作记忆功能呈正相关(r分别为0.898和0.797,P<0.05);胼胝体和扣带回FA值与工作记忆功能无明显相关性(r分别为0.432和0.387,P>0.05)。结论 DTI技术可为DAI导致的工作记忆障碍早期诊断和预后评估提供依据。     

Frontotemporal connections in episodic memory and aging: a diffusion MRI tractography study

Human episodic memory is supported by networks of white matter tracts that connect frontal, temporal, and parietal regions. Degradation of white matter microstructure is increasingly recognized as a general mechanism of cognitive deterioration with aging. However, atrophy of gray matter regions also occurs and, to date, the potential role of specific white matter connections has been largely ignored. Changes to frontotemporal tracts may be important for the decline of episodic memory; while frontotemporal cooperation is known to be critical, the precise pathways of interaction are unknown. Diffusion-weighted MRI tractography was used to reconstruct three candidate fasciculi known to link components of memory networks: the fornix, the parahippocampal cingulum, and the uncinate fasciculus. Age-related changes in the microstructure of these tracts were investigated in 40 healthy older adults between the ages of 53 and 93 years. The relationships between aging, microstructure, and episodic memory were assessed for each individual tract. Age-related reductions of mean fractional anisotropy and/or increased mean diffusivity were found in all three tracts. However, age-related decline in recall was specifically associated with degradation of fornix microstructure, consistent with the view that this tract is important for episodic memory. In contrast, a decline in uncinate fasciculus microstructure was linked to impaired error monitoring in a visual object-location association task, echoing the effects of uncinate transection in monkeys. These results suggest that degradation of microstructure in the fornix and the uncinate fasciculus make critical but differential contributions to the mechanisms underlying age-related cognitive decline and subserve distinct components of memory.