以强迫思维为主的强迫症患者脑灰质体积与静息态功能连接的改变北大核心CSCD

目的探讨以强迫思维为主的强迫症患者脑灰质体积与全脑静息态功能连接的改变。方法选取以强迫思维为主的强迫症患者20例（强迫思维组）,混合型强迫症患者20例（混合型组）,以及年龄、性别、受教育程度与患者相匹配的健康对照者20名（对照组）,分别进行头部磁共振扫描。采用基于体素的形态学分析方法检测受试者大脑灰质体积;将以强迫思维为主的强迫症患者异常灰质体积脑区作为种子点,进行全脑静息态功能连接分析;采用Spearman相关分析方法探讨以强迫思维为主的强迫症患者全脑功能连接与临床资料的相关关系。结果与对照组相比,强迫思维组右侧苍白球灰质体积减小（0.17±0.02与0.10±0.01）;右侧舌回（0.39±0.04与0.47±0.07）、右侧顶下小叶（0.22±0.02与0.30±0.05）灰质体积增加（t=-25.37、5.03、7.79,GRF校正,均P〈0.05）;混合型组左侧苍白球灰质体积减小,右侧舌回、左侧颞下回灰质体积增加（t=-24.87、6.17、11.37,GRF校正,均P〈0.05）。强迫思维组右侧苍白球内部,右侧苍白球与右侧小脑、左侧苍白球之间功能连接显著降低,与左侧辅助运动区的功能连接显著增强（t=-7.44, -4.03, -4.30, 3.93, GRF校正,P〈0.05）。强迫思维组右侧苍白球与右侧小脑之间的功能连接与病程存在正相关（r=0.488,P=0.029）。结论以强迫思维为主的强迫症患者脑灰质结构及静息态脑功能出现异常,其异常改变不仅局限于皮质-纹状体-丘脑-皮质环路,小脑可能也参与了强迫思维的发生。     

语义性痴呆结构性磁共振成像研究

目的分析语义性痴呆患者灰质和白质结构变化,提高对其病理改变和发生机制的认识。方法采用3.0T MRI扫描仪对16例语义性痴呆患者和17例正常对照者进行全脑扫描,扫描序列包括三维高分辨力结构像和扩散张量成像(DTI)。通过专业统计软件分别对全脑灰质密度和白质纤维束部分各向异性(FA)值进行分析,比较两组受试者全脑灰质密度(P0.001,Voxel338)和白质纤维束FA值(P0.005,Voxel103)。结果与对照组相比,语义性痴呆组患者双侧颞叶,特别是颞极表现为灰质密度显著降低,以左侧大脑半球额颞顶叶灰质密度减低区域更为广泛,包括左侧颞下回、缘上回、顶下回和额中回;同时双侧颞叶白质纤维束FA值显著降低,包括双侧钩束、左侧扣带(海马)纤维和双侧下额枕束。白质纤维束FA值分析结果与VBM法所显示的灰质密度在解剖学上呈现极高的一致性。结论本研究在体揭示了语义性痴呆的病理学和解剖学基础,为理解语义性痴呆的病理学机制提供了客观佐证。     

精神分裂症首次发病患者的脑扩散张量成像研究

目的 利用磁共振扩散张量成像(DTI)技术研究未经药物治疗的精神分裂症首次发病(以下简称首发)患者主要脑区白质纤维束的异常.方法 选取26例首发精神分裂症患者(患者组)和20名健康志愿者(对照组)行脑DTI扫描(两组均为右利手),测量胼胝体膝部、压部、双侧额叶白质、扣带束前部及海马头的部分各向异性(FA)值.结果 (1)对照组左侧扣带束FA值(0.428±0.067)大于右侧(0.375±0.079;P＜0.05).(2)患者组两侧相对应感兴趣区FA值差异均无统计学意义(P＞0.05).(3)患者组左右侧胼胝体压部FA值(均为0.734±0.085)、左右侧扣带束前部FA值(0.300±0.068和0.306 4±0.062)均低于对照组(0.785±0.045,0.428±0.067,0.375±0.079;均P＜0.05).结论 首发精神分裂症患者存在双侧扣带束、胼胝体压部白质纤维束的受损,支持脑内连接异常假说.     

特发性快速眼动睡眠期行为障碍纹状体微结构磁共振成像研究

目的探讨帕金森病(PD)和特发性快速眼动睡眠期行为障碍(iRBD)患者纹状体结构和白质纤维束完整性。方法联合应用基于体素的形态学分析和扩散张量成像对12例特发性快速眼动睡眠期行为障碍患者、12例帕金森病患者及10例性别、年龄和受教育程度相匹配的正常对照者进行头部MRI检查,观察纹状体结构(灰质体积)和白质纤维束完整性[部分各向异性(FA)值]变化。结果与对照组相比,iRBD组左侧尾状核灰质体积缩小(P0.005),以及左侧(P0.005)和右侧(P0.001)尾状核、右侧壳核(P0.05)FA值降低;PD组仅右侧壳核FA值降低(P0.05)。与PD组相比,iRBD组左侧尾状核灰质体积缩小(P0.001),以及左侧(P0.01)和右侧(P0.005)尾状核FA值降低。结论特发性快速眼动睡眠期行为障碍患者存在纹状体灰质体积缩小和白质纤维束完整性损害,其白质纤维束完整性损害与帕金森病具有一致性,为特发性快速眼动睡眠期行为障碍是帕金森病的临床前期提供解剖学依据。     

首发精神分裂症阳性症状为主型患者脑弥散张量成像研究

目的 探讨首发精神分裂症阳性症状为主型患者主要脑区白质纤维束有无异常.方法 对未系统使用过精神药物治疗的20例首发精神分裂症阳性症状为主型患者和20名正常对照进行磁共振弥散张量成像(DTI)扫描,测量胼胝体膝部、压部、双侧额叶白质、双侧扣带束前部和双侧海马头部分各向异性(FA)值.结果 ①患者组及对照组组内比较,左右侧FA值差异均无统计学意义(P>0.05).②患者组左侧海马头和胼胝体压部FA值[(0.17±0.03),(0.73±0.09)]显著低于对照组[(0.20±0.02),(0.79±0.05)],差异均有统计学意义(P<0.05);③患者组左右侧扣带束前部FA值[(0.28±0.06),(0.29±0.05)]低于对照组[(0.43±0.07),(0.38±0.08)],差异均有统计学意义(P<0.01).结论 首发精神分裂症阳性症状为主型患者双侧扣带束前部、胼胝体压部及左侧海马头的白质纤维束完整性受损,提示其可能存在脑神经发育连接异常.     

首次发病未用药老年抑郁症患者脑白质完整性的弥散张量成像研究

目的 使用弥散张量成像探讨首次发病未用药老年抑郁症患者的脑白质完整性.方法 15例首次发病未用药的老年抑郁症患者和15例正常对照组接受脑弥散张量成像扫描,用基于体素的分析方法对脑内所有体素的各向异性分数(FA)逐一进行组间比较.结果 与正常对照组相比,首次发病未用药老年抑郁症患者左侧前扣带(丛集体积=106体素,t=3.21)、右侧前扣带(丛集体积=60体素,t=2.71)、右侧膝下扣带(丛集体积=63体素,t=3.37)、左侧脑干(丛集体积=62体素,t=3.25)白质FA值显著降低(检验水准为未校正的单侧P＜0.01,体素集阈值＞50体素).结论 老年抑郁症发病早期存在双侧前扣带及右侧膝下扣带白质完整性下降,经由该脑区的神经通路损害可能与老年抑郁症的病理机制有关.     

抑郁症首次发病中年女性患者的弥散张量成像研究

目的 运用基于纤维束示踪的空间统计学方法(tract-based spatial statistics,TBSS)探索首次发病抑郁症中年女性患者脑白质微观结构的损害.方法 对20例首次发病抑郁症中年女性患者(患者组)和15名与患者组性别、年龄、受教育程度相匹配的健康志愿者(对照组)进行全脑弥散张量成像扫描.应用TBSS方法对患者组和对照组的部分各向异性(fractional anisotropy,FA)值进行组间比较.结果 与对照组相比,患者组左侧前额叶、左侧内囊、右侧楔前叶白质的FA值显著降低(P ＜0.005,簇＞40).结论 脑白质病变在抑郁症发病的早期即已存在,异常脑区涉及与认知和情感调节关系较密切的前额叶-子皮质神经环路和默认网络的纤维束.     

未经治疗的强迫症患者脑白质体积变化的初步研究

目的 探讨未经治疗的强迫症患者大脑白质的体积变化.方法 收集强迫症患者23例和年龄、性别与之相匹配的正常对照23名.采用GE Signa TwinSpeed 1.5T 超导型磁共振成像系统获取3D脑结构图像,然后使用基于体素的形态学分析法(VBM)分析影像数据.采用t检验比较两组间脑白质体积的差异,P＜0.005和体素>200的差异区域行小体积校正(small volume correction,SVC)后仍P＜0.05则差异有统计学意义.结果 患者组下列脑区的白质体积较正常对照组增加:右侧中央前回(t=3.58)、右侧中央后回(t=3.60)、左侧楔前叶(t=3.99)、左侧楔前叶(t=3.24)、右侧楔前叶(t=3.55)和左侧枕中回(t=3.55),差异均有统计学意义(小体积校正后P值均小于0.05);而下列脑区的白质体积减少:右侧额上回(t=3.66)、左侧额上回(t=3.31)、左侧中央后回(t=3.44)、左侧海马旁回/胼胝体(t=3.37)和右侧顶下小叶(t=3.18),差异均有统计学意义(小体积校正后P值均小于0.05).结论 未经治疗的强迫症患者存在多个脑区局部白质体积的增加或降低.     

创伤后应激障碍患者扣带束及胼胝体纤维束FA值的初步研究

目的探讨创伤后应激障碍患者(PTSD)是否存在连合纤维束胼胝体及联络纤维扣带纤维束的超微结构异常。方法1.5T的MR成像仪下对12例PTSD患者及12名正常对照进行磁共振弥散张量成像(DTI),测量受试者胼胝体膝部、体部、压部、及双侧扣带水平部、后部等感兴趣区内主要白质纤维束的各向异性分数(FA)值,并进行组间比较。结果患者组双侧(左侧、右侧)扣带束水平部、胼胝体压部的FA值较对照组明显降低,差异均有统计学意义(t分别为3.26、-4.13、2.84,P均小于0.05)。结论PTSD患者的边缘系统纤维束可能存在结构异常。     

基于形变的形态学测量对首次发病未服药抑郁症患者大脑灰质异常的研究

目的探讨首次发病未服药抑郁症患者(major depressive disorder)大脑灰质结构改变以及抑郁症早期诊断的影像学指标。方法对38例抑郁症患者(抑郁症组)和65名年龄、性别相匹配的健康对照(对照组)进行3D T1加权结构像磁共振成像扫描,采用基于形变的形态学测量(deformation-based morphometry,DBM)方法及基于感兴趣区方法比较2组灰质形变参数及灰质体积的差异。采用受试者工作曲线(receiver operating characteristic curve,ROC)测试有统计学差异脑区的灰质体积对抑郁症的诊断价值。结果抑郁症组右侧前扣带皮质、右侧中央前回及左侧中央旁小叶萎缩(体素阈值P<0.001,集簇大小>120),且这些脑区的灰质体积明显低于对照组(P<0.01,双侧);右侧前扣带皮质灰质体积对抑郁症诊断有一定准确性,曲线下面积为0.733,最佳为0.414。结论采用DBM方法能够早期发现抑郁症患者前额叶及顶叶灰质萎缩,体积缩小,能够反映灰质微细结构变化;右侧前扣带皮质灰质体积缩小可作为抑郁症早期诊断的影像学指标。     

White matter abnormalities in obsessive-compulsive disorder: a diffusion tensor imaging study

CONTEXT: Several neurobiological models of obsessive-compulsive disorder (OCD) posit a primary role for dysfunction of the anterior cingulate gyrus. Both functional and structural neuroimaging studies have implicated anterior cingulate gray matter abnormalities in the pathophysiology of OCD, but there has been little investigation of the anterior cingulate white matter in this disorder. OBJECTIVE: To test the hypothesis that patients with OCD have abnormal white matter microstructure in the anterior cingulate gyrus compared with healthy volunteers as inferred from diffusion tensor imaging. Additional analyses examined group differences in white matter integrity across the entire brain. DESIGN, SETTING, AND PARTICIPANTS: Fifteen patients with a DSM-IV diagnosis of OCD and 15 healthy volunteers matched for age, sex, and handedness underwent diffusion tensor imaging and structural magnetic resonance imaging examinations. Fractional anisotropy (FA), a robust intravoxel measure of water self-diffusion, was compared between groups on a voxel-by-voxel basis in the anterior cingulate white matter after standardization in Talairach space. MAIN OUTCOME MEASURES: Clinical ratings of symptom severity (ie, Yale-Brown Obsessive-Compulsive Scale) and FA. RESULTS: Compared with healthy volunteers, patients demonstrated significantly lower FA bilaterally in 3 areas of the anterior cingulate gyrus white matter. Additional analyses conducted across the rest of the brain white matter revealed lower FA bilaterally in the parietal region (supramarginal gyri), right posterior cingulate gyrus, and left occipital lobe (lingual gyrus). No areas of significantly higher FA were observed in patients compared with healthy volunteers. Lower FA in the parietal region correlated significantly with higher Yale-Brown Obsessive-Compulsive Scale scores. CONCLUSIONS: These preliminary findings provide evidence of an abnormality that involves the anterior cingulate white matter in the pathogenesis of OCD and are consistent with neurobiological models that posit a defect in connectivity in the anterior cingulate basal ganglia-thalamocortical circuit. White matter abnormalities in other brain regions may also be implicated in the neurobiology of OCD.     

Differential regional gray matter volumes in patients with on-line game addiction and professional gamers

Patients with on-line game addiction (POGA) and professional video game players play video games for extended periods of time, but experience very different consequences for their on-line game play. Brain regions consisting of anterior cingulate, thalamus and occpito-temporal areas may increase the likelihood of becoming a pro-gamer or POGA. Twenty POGA, seventeen pro-gamers, and eighteen healthy comparison subjects (HC) were recruited. All magnetic resonance imaging (MRI) was performed on a 1.5 Tesla Espree MRI scanner (SIEMENS, Erlangen, Germany). Voxel-wise comparisons of gray matter volume were performed between the groups using the two-sample t-test with statistical parametric mapping (SPM5). Compared to HC, the POGA group showed increased impulsiveness and perseverative errors, and volume in left thalamus gray matter, but decreased gray matter volume in both inferior temporal gyri, right middle occipital gyrus, and left inferior occipital gyrus, compared with HC. Pro-gamers showed increased gray matter volume in left cingulate gyrus, but decreased gray matter volume in left middle occipital gyrus and right inferior temporal gyrus compared with HC. Additionally, the pro-gamer group showed increased gray matter volume in left cingulate gyrus and decreased left thalamus gray matter volume compared with the POGA group. The current study suggests that increased gray matter volumes of the left cingulate gyrus in pro-gamers and of the left thalamus in POGA may contribute to the different clinical characteristics of pro-gamers and POGA.     

Reduced gray matter volume of dorsal cingulate cortex in patients with obsessive-compulsive disorder: a voxel-based morphometric study

Aims: Previous morphometric studies using magnetic resonance imaging (MRI) have revealed structural brain abnormalities in obsessive–compulsive disorder (OCD). The aim of the present study was to investigate the alterations in brain structure of patients with OCD using a voxel‐based morphometry (VBM) method. Methods: Sixteen patients with OCD free of comorbid major depression, and 32 sex‐ and age‐matched healthy subjects underwent MRI using a 1.5‐T MR scanner. OCD severity was assessed with the Yale–Brown Obsessive–Compulsive Scale (mean ± SD: 22 ± 7.6; range: 7–32). MR images were spatially normalized and segmented using the VBM5 package ( http://dbm.neuro.uni‐jena.de/vbm/ ). Statistical analysis was performed using statistical parametric mapping software. Results: Significant reductions in regional gray matter volume were detected in the left caudal anterior cingulate cortex and right dorsal posterior cingulate cortex in the patients with OCD as compared to healthy controls (uncorrected, P < 0.001). No significant differences in white matter volumes were observed in any brain regions of the patients. No significant correlation between Yale–Brown Obsessive–Compulsive Scale score and regional gray matter or white matter volume was observed. Conclusions: Regional gray matter alteration in the dorsal cingulate cortex, which is suggested to play a role in non‐emotional cognitive processes, may be related to the pathophysiology in OCD.     

Structural changes in the gray matter of unmedicated patients with obsessive-compulsive disorder: a voxel-based morphometric study

The aim of the current study was to use whole brain voxel-based morphometry（VBM）to assess the gray matter（GM）changes in unmedicated patients with obsessive-compulsive disorder（OCD）compared with normal controls.We compared the GM volumes in28 patients with 22 matched healthy controls using a1.5T MRI.Three-dimensional T1-weighted magnetic resonance images were obtained from all participants.VBM was performed to detect GM volume differences between the two groups.We detected increased regional GM volumes in the bilateral middle temporal gyri,bilateral middle occipital gyri,bilateral globus pallidus,right inferior parietal gyrus,left superior parietal gyrus,right parahippocampus,right supramarginal gyrus,right medial superior frontal gyrus,and left inferior frontal opercular cortex in the OCD patients relative to controls（P〈0.001,uncorrected,cluster size〉100 voxels）.No decreased GM volume was found in the OCD group compared with normal controls.Our findings suggest that structural changes in the GM are not limited to fronto-striato-thalamic circuits in the pathogenesis of OCD.Temporo-parietal cortex may also play an important role.     

fMRI及DTI技术在成人工作记忆研究的初步探索

目的：联合应用脑功能磁共振成像（BOLD—fMRI）和弥散张量成像（DTI）两种磁共振技术,探索工作记忆功能激活部位与叶间白质纤维束的关系。方法：健康志愿者16名,以步进式视觉累加试验作为刺激模式,扫描获得fMRI激活图及各向异性（FA）图。将两者叠加,选取双侧额顶叶白质兴趣区测量其部分FA值。结果：①额顶叶皮质为工作记忆功能最主要的激活区;②脑的激活像素几乎均位于FA程度低的区域（P〈0．01）;③左额顶间白质FA值较对侧高（P〈0．02）。结论：联合应用fMRI和DTI技术提示成人工作记忆功能与额顶叶白质纤维髓鞘化程度密切相关。     

高功能孤独症患儿全脑白质纤维的弥散张量成像研究

目的 分析高功能孤独症患儿的全脑白质纤维的完整性.方法 对18例高功能孤独症患儿(病例组)以及10名年龄、性别、智商与病例组相匹配的健康儿童(对照组)进行全脑弥散张量成像(DTI)测量;应用基于体素的分析方法,比较两组全脑各向异性分数(FA)的差异.使用Spearman相关分析,分析病例组各感兴趣区FA值与儿章期孤独症评定表(CARS)总分及各项目之间的关系.结果 与对照组相比,病例组右侧额下回、左侧额中回及右侧颞下回邻近白质的FA值低(分别为0.67±0.10、0.57±0.09、0.50 ±0.12),左顶上小叶邻近白质的FA值高(0.55±0.15;P<0.001).病例组左额中回邻近白质的FA值与CARS中的与非生命物体的关系的得分呈负相关(r=-0.63,P=0.005).结论 高功能孤独症患儿多个部位的脑白质纤维的完整性受到破坏.     

Perigenual cingulate gyrus volume in patients with schizophrenia: a magnetic resonance imaging study.

BACKGROUND: Anterior cingulate gyrus abnormalities have been suggested to be involved in the pathophysiology of schizophrenia; however, little is known about morphologic changes in the perigenual cingulate gyrus in schizophrenia patients. METHODS: We investigated perigenual cingulate gyrus volume in 40 schizophrenia patients (20 men, 20 women) and 40 age- and gender-matched normal controls using magnetic resonance imaging. Volume of both gray and white matter of the perigenual cingulate gyrus was measured on consecutive axial 1-mm slices. RESULTS: Total (left and right) perigenual cingulate gray matter volume was significantly reduced in female schizophrenia patients compared with female controls. There was no significant difference in the gray matter volume of the perigenual cingulate gyrus between male patients and male controls. Left perigenual cingulate white matter volume was significantly reduced in the patient compared with the control group. Furthermore, significant gender differences were found in the total gray and white matter volume of the perigenual cingulate gyrus in control subjects (women > men), although these gender differences were not significant in the patient group. CONCLUSIONS: Our findings suggests volume reduction of the perigenual cingulate gyrus in schizophrenia patients, especially women and that gender differences in perigenual cingulate morphology among normal subjects are, as has been suggested for other parts of the brain, reduced in schizophrenia patients.     

Neural substrates of rapid eye movement sleep behavior disorder in Parkinson's disease

ObjectivesTo investigate neural substrates of symptomatic rapid eye movement sleep behavior disorder (RBD) in Parkinson's disease (PD) by analyzing brain changes based on both hypothesis-free and hypothesis-driven neuroimaging analyses.MethodsA total of 63 subjects (14 PDRBD−, 24 PDRBD+, and 25 age-matched healthy controls = HC) were enrolled in this study. RBD was defined by RBD screening questionnaire with video-polysomnographic confirmation. All subjects underwent volumetric and diffusion tensor imaging. The whole brain gray- and white-matter changes were analyzed and the central ascending cholinergic pathway involving the pedunculopontine nucleus and thalamus was compared with a region-of-interest analysis and probabilistic tractography.ResultsThe PDRBD+ group showed decreased gray matter volume of the left posterior cingulate and hippocampus compared to the PDRBD− and additional gray matter decrease in the left precuneus, cuneus, medial frontal gyrus, postcentral gyrus and both inferior parietal lobule compared to the HC group (uncorrected p < 0.001, k = 50). There were no significant differences in white matter changes between the PDRBD− and PDRBD+ groups both by fractional anisotropy and mean diffusivities. However, both PD groups showed widespread changes by fractional anisotropy reductions and mean diffusivity increments compared to HC (p < 0.05 corrected). There were no significant differences in tract-based spatial statistics and the normalized tract volumes as well as the diffusion indices of both the thalamus and pedunculopontine nuclei among the study groups.ConclusionsThe appearance of RBD in PD may be related to regional gray matter changes in the left posterior cingulate and hippocampus but not localized to the brainstem.