双相情感障碍I型患者脑灰质体积变化的偏侧性

目的 探索双相情感障碍I型患者脑灰质体积的变化,进一步研究双相情感障碍I型的病理生理学机制。方法 于2012年1月-2014年7月,随机入组22例符合《精神障碍诊断与统计手册（第4版）》（DSM-IV）诊断标准的双相情感障碍I型患者（患者组）和25名健康对照组,两组年龄、性别及受教育年限匹配良好（P均>0.05）。收集两组头部结构相磁共振影像资料,使用SPM8对结构相影像资料进行分割、标准化、平滑,采用两独立样本t检验,分析两组灰质体积有统计学差异的脑区。结果 与对照组相比,患者组灰质体积降低的脑区包括右侧颞上回（P<0.01）、右侧中央前回（P<0.01）及右侧楔叶（P<0.01）;患者组灰质体积增大的脑区包括左侧小脑上部（P<0.01）、左侧颞中回（P<0.01）及左侧颞下回（P=0.001）。结论 与健康对照组相比,双相情感障碍I型患者灰质体积降低的脑区主要集中于右侧,体积增大的脑区主要集中于左侧。     

基于弥散张量成像技术的双相障碍患者脑白质纤维束异常分析

目的探讨抑郁期双相障碍患者脑白质纤维束的变化。方法选取42例未用药双相障碍抑郁期患者(患者组)和年龄、性别及右利手与之相匹配的59名对照者(对照组)进行DTI检查,根据约翰霍普金斯大学人类白质纤维束图谱,将大脑白质组织分割为20条公认存在的粗大纤维束,应用PANDA软件计算每个被试者每条白质纤维束的4项平均弥散属性,采用非参数置换检验比较2组在20条白质纤维束上弥散指标的差异,将差异有统计学意义的脑白质纤维束弥散指标与临床指标进行Pearson相关分析。结果患者组左侧钩束各向异性分数(fractional anisotropy,FA)值低于对照组(0.40±0.01与0.41±0.01,P=0.001);胼胝体辐射线额部FA值低于对照组(0.36±0.02与0.38±0.02,P<0.001);左侧钩束径向弥散率(radial diffusivity,RD)值高于对照组(6.57×10^-4±2.41×10^-5与6.40×10^-4±2.42×10^-5,P=0.0017)。Pearson相关分析显示,2组弥散指标差异有统计学意义的白质纤维束与临床指标之间均无相关性。结论抑郁期双相障碍患者钩束及胼胝体辐射线额部存在脑白质完整性破坏。     

精神分裂症患者全脑白质纤维弥散张量成像的初步研究

目的运用能够提示白质纤维(white matter,WM)完整性的弥散张量成像(diffusion tensor imaging,DTI)技术,探讨精神分裂症患者全脑白质纤维是否受到损害。方法对21例精神分裂症患者(患者组)和21名健康人(对照组)进行全脑DTI扫描,用SPM2(Statistical Parametric Maps,SPM)软件对图像进行处理,采用以像素为基础的分析方法(voxel-based analysis,VBA)对两组的分数各向异性(fractional anisotropy,FA)值进行组间比较。结果患者组下列脑区的FA值显著低于对照组(P<0·001):左侧额眶区和右侧额中回的白质、双侧颞下回白质、双侧顶叶内侧白质、右侧前扣带、双侧海马、双侧大脑脚、双侧岛叶、右侧放射冠和右侧小脑上脚。结论精神分裂症多个部位脑白质纤维的完整性受到破坏。     

精神分裂症早发患者脑白质的弥散张量成像研究

目的 分析发病年龄<18岁的早发精神分裂症(early-onset schizophrenia,EOS)患者脑结构连接的变化.方法 对26例EOS患者(患者组)和23名健康对照(对照组)全脑进行磁共振弥散张量成像,2组图像经过DTIstudio软件和统计参数图5(SPM5)软件包进行标准化、平滑等预处理后,再以SPM5软件包对2组全脑白质分数各向异性(FA)值图像进行两样本t检验.结果 (1)患者组脑白质FA值较对照组显著降低的脑区有:胼胝体体部及相邻双侧前扣带[蒙特利尔脑科学研究所(MNI)坐标:3、16、23;体素集合=1003体素]、左侧颞叶区域(MNI坐标:-28、28、30;体素集合=170体素)、左侧前额叶区域(MNI坐标:-28、28、30;体素集合=99体素)、右侧前额叶区域(MNI坐标:48、-10、54;体素集合=81体素).(2)未发现患者组有脑区白质FA值高于对照组.结论 早发精神分裂症患者存在胼胝体、扣带、前额叶和颞叶白质结构连接异常,可能与精神分裂症的发病机制有关.

Abstract：

Objective To investigate the changes of the brain structural connectivity in patients with early-onset schizophrenia (EOS, the onset of psychotic symptoms occurs before 18 years of age).Methods The subjects were 26 patients with EOS and 23 healthy controls (age, sex and years of received education were no significantly different from those of patients). Diffusion weighted images of the whole brains were acquired with a single-shot echo planar imaging (EPI) sequence aligned to the straight axial plane. After preprocessed with DTI-studio and Statistical Parametric Mapping-V (SPM5) software, the fractional anisotropy (FA) images of the two groups underwent two-sample t-test with the methods of voxel-based analysis (VBA) using SPM5 software package. Symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS). Results EOS patients had significantly reduced FA of white matter in the truncus corporis callosi (MNI: 3,16,23; cluser = 1003 voxels) , left temporal lobe (MNI:-28,28,30;cluser = 170 voxels) , left prefrontal lobe (MNI:-28,28,30; cluser = 99 voxels) and right prefrontal lobe (MNI:48,-10,54; cluser =81 voxels) , compared with the healthy controls. Conclusions There is structural disconnectivity of white matter in several brain regions. These abnormal changes may be involved in the neuropathology of schizophrenia.     

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.     

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.     

高功能孤独症患儿全脑白质纤维的弥散张量成像研究

Objectlve To analysis the changes of white matter fiber in autistic disorder.Methods Diffusion tensor imaging(DTI)data were obtained from 18 autistic children and 10 age-,sex-and intelligent quotient matched normal controls.Voxel-based analysis Was applied to assess the fractional anisotropy(FA)in cerebral tissues.Results Compared with the controls,the FA values in autistic children were significantly decreased in the white matter of right inferior frontal gyrus,left middle frontal gyrus and right inferior temporal gyms,and increased in the white matter of left superior parietal lobule(P＜0.001).Furthermore.the white matter changes on left middie frontal gyrus were significandy correlated with the scores of Childhond Autism Rming Scale(CARS)in autistic children(r=-0.63,P=0.005).Conclusion The white matter integrity is probably disconnected in many brain regions in children with autistic disorder.     

高功能孤独症患儿全脑白质纤维的弥散张量成像研究

Objectlve To analysis the changes of white matter fiber in autistic disorder.Methods Diffusion tensor imaging(DTI)data were obtained from 18 autistic children and 10 age-,sex-and intelligent quotient matched normal controls.Voxel-based analysis Was applied to assess the fractional anisotropy(FA)in cerebral tissues.Results Compared with the controls,the FA values in autistic children were significantly decreased in the white matter of right inferior frontal gyrus,left middle frontal gyrus and right inferior temporal gyms,and increased in the white matter of left superior parietal lobule(P＜0.001).Furthermore.the white matter changes on left middie frontal gyrus were significandy correlated with the scores of Childhond Autism Rming Scale(CARS)in autistic children(r=-0.63,P=0.005).Conclusion The white matter integrity is probably disconnected in many brain regions in children with autistic disorder.     

高功能孤独症患儿全脑白质纤维的弥散张量成像研究

Objectlve To analysis the changes of white matter fiber in autistic disorder.Methods Diffusion tensor imaging(DTI)data were obtained from 18 autistic children and 10 age-,sex-and intelligent quotient matched normal controls.Voxel-based analysis Was applied to assess the fractional anisotropy(FA)in cerebral tissues.Results Compared with the controls,the FA values in autistic children were significantly decreased in the white matter of right inferior frontal gyrus,left middle frontal gyrus and right inferior temporal gyms,and increased in the white matter of left superior parietal lobule(P＜0.001).Furthermore.the white matter changes on left middie frontal gyrus were significandy correlated with the scores of Childhond Autism Rming Scale(CARS)in autistic children(r=-0.63,P=0.005).Conclusion The white matter integrity is probably disconnected in many brain regions in children with autistic disorder.     

高功能孤独症患儿全脑白质纤维的弥散张量成像研究

Objectlve To analysis the changes of white matter fiber in autistic disorder.Methods Diffusion tensor imaging(DTI)data were obtained from 18 autistic children and 10 age-,sex-and intelligent quotient matched normal controls.Voxel-based analysis Was applied to assess the fractional anisotropy(FA)in cerebral tissues.Results Compared with the controls,the FA values in autistic children were significantly decreased in the white matter of right inferior frontal gyrus,left middle frontal gyrus and right inferior temporal gyms,and increased in the white matter of left superior parietal lobule(P＜0.001).Furthermore.the white matter changes on left middie frontal gyrus were significandy correlated with the scores of Childhond Autism Rming Scale(CARS)in autistic children(r=-0.63,P=0.005).Conclusion The white matter integrity is probably disconnected in many brain regions in children with autistic disorder.     

State-dependent microstructural white matter changes in bipolar I depression

Abnormalities in fronto-limbic-striatal white matter (WM) have been reported in bipolar disorder (BD), but results have been inconsistent across studies. Furthermore, there have been no detailed investigations as to whether acute mood states contribute to microstructural changes in WM tracts. In order to compare fiber density and structural integrity within WM tracts between BD depression and remission, whole-brain fractional anisotropy (FA) and mean diffusivity (MD) were assessed in 37 bipolar I disorder (BD-I) patients (16 depressed and 21 remitted), and 26 healthy individuals with diffusion tensor imaging. Significantly decreased FA and increased MD in bilateral prefronto-limbic-striatal white matter and right inferior fronto-occipital, superior and inferior longitudinal fasciculi were shown in all BD-I patients versus controls, as well as in depressed BD-I patients compared to both controls and remitted BD-I patients. Depressed BD-I patients also exhibited increased FA in the ventromedial prefrontal cortex. Remitted BD-I patients did not differ from controls in FA or MD. These findings suggest that BD-I depression may be associated with acute microstructural WM changes.     

Altered fimbria-fornix white matter integrity in anorexia nervosa predicts harm avoidance

The eating disorder anorexia nervosa (AN) is associated with high anxiety. The brain mechanisms that drive those behaviors are unknown. In this study we wanted to test whether brain white matter (WM) integrity is altered in AN, and related to heightened anxiety. Sixteen adult women with AN (mean age 24 ± 7 years) and 17 healthy control women (CW, mean age 25 ± 4 years) underwent diffusion tensor imaging (DTI) of the brain. The DTI brain images were used to calculate the fractional anisotropy (FA) of WM tracts, which is a measure for WM integrity. AN individuals compared to CW showed clusters of significantly reduced FA (p < 0.05, corrected) in the bilateral fimbria-fornix and the fronto-occipital fasciculus, as well as the posterior cingulum WM. In the AN group, Harm Avoidance was predicted by FA in the left and right fimbria-fornix. Those findings were not due to WM volume deficits in AN. This study indicates that WM integrity is abnormal in AN in limbic and association pathways, which could contribute to disturbed feeding, emotion processing and body perception in AN. The prediction of Harm Avoidance in AN by fimbria-fornix WM integrity suggests that this pathway may be mechanistically involved in high anxiety in AN.     

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.     

Midsagittal structural differences and sexual dimorphism of the corpus callosum in obsessive-compulsive disorder

Neurobiological abnormalities in various brain regions, including the orbitofrontal cortex, basal ganglia, and thalamus, have been found in patients with obsessive-compulsive disorder (OCD), and impairment in white matter connectivity in these regions has recently been suggested. To investigate structural connectivity in OCD, we used the midsagittal area and thickness to assess the morphology of the corpus callosum (CC), the largest connecting fiber tract in the human brain. Midsagittal magnetic resonance images of the CC were acquired from 69 adult patients with OCD and 69 matched normal controls. We calculated and compared the total area and the areas of five subregions of the CC as well as the distances between 200 equidistant points on the top and bottom of lines on the surface of the CC in the two groups. The absolute total area of the CC was significantly larger in OCD patients than in controls when brain size, age, gender, and IQ were controlled. Significant enlargements in CC1, CC2, and CC5 were seen in OCD patients before correction for multiple comparisons. The thickness of the caudal part of the splenium was greater in OCD patients than in controls. The analysis according to gender showed that only male OCD patients differed from male controls with respect to the area of the CC. These findings reflect structural abnormalities in the CC, and especially in the splenium, in adult patients with OCD. Abnormal interhemispheric connectivity, including the parietotemporal and occipital areas, may affect the pathophysiology of OCD. Sexual dimorphism in the CC of OCD patients should be considered.     

MRI changes in schizophrenia in late life: a preliminary controlled study

The aim of this pilot study was to compare cerebral changes on magnetic resonance imaging (MRI) scans in elderly schizophrenic subjects with those in psychiatric and normal control subjects. We compared the MRIs of 19 subjects with schizophrenia, 19 age- and gender-matched subjects with recurrent major depression, and 19 age- and gender-matched nonpsychiatric control subjects. Deep white matter hyperintensities (DWMH) in right posterior regions were significantly more prominent in the schizophrenic group than in the two comparison groups. Total ratings of MRI abnormalities were significantly related to age in both the normal control and schizophrenic groups, but not in the depressive group. Age of onset was positively associated with total ratings in the depressive group, but not in the schizophrenic group. Thus, a subset of elderly patients with schizophrenia appear to have cerebral white matter abnormalities; such abnormalities may not be confined to lage-onset schizophrenia. Systematic MRI studies of early- and late-onset schizophrenia in late life are needed to resolve this question.     

Neural correlates of delusion in bipolar depression

Approximately one-half of all patients affected by bipolar disorder present psychotic features at least in one occasion. This factor worsens the personal and social burden of the disease. Several studies find an altered brain activity in mesolimbic and prefrontal regions in relation to aberrant attribution of salience to stimuli in delusional patients. The aim of the present study is to investigate gray matter (GM) structural correlates of the past history of delusions in a sample of bipolar patients. The sample includes 34 delusional and 39 non-delusional bipolar patients. Brain-imaging volumetric sequences were acquired on a 3.0 T scanner. Voxel based morphometry (VBM) was performed comparing delusional and non-delusional patients. VBM analysis found significant (p=0.001) differences in prefrontal areas and in the insula where delusional patients show lower GM volume compared to non-delusional patients. The main finding of the present study is a reduction of gray matter volume in the dorsolateral prefrontal cortex and in the insula of delusional patients. This result supports the hypothesis of abnormalities in salience and executive-control networks of delusional patients, which could be associated with an aberrant assignment of salience to the elements of one's own experience that is linked to delusion and psychotic symptoms.     

Voxel-based analysis of white matter during adolescence and young adulthood

Purpose: To evaluate differences in age-related brain white matter by voxel-based analysis of healthy adolescents and young adults. Materials and methods: Echo-planar diffusion-tensor magnetic resonance (MR) imaging was performed in healthy subjects of 3 groups (aged 11–13, 16–18 and 23–25, respectively). Linear correlative analyses were applied to determining age-related fractional anisotropy (FA) and mean diffusivity (MD), and t-test was performed to compare FA and mean diffusion maps between different age groups. Results: Significant positive correlation of FA with age was found in the internal capsule, the external capsule, the frontal white matter, and the body and genu of the corpus callosum. Compared with the 11–13 age group, FA in the 16–18 age group increased in the internal capsule, the frontal white matter, the body and the splenium of the corpus callosum. Compared to the 16–18 age group, FA in the 23–25 age group increased in the frontal white matter, the posterior limb of internal capsule, and the genu of the corpus callosum. Statistically significant negative correlation of the mean diffusion with age was found in the frontal and parietal white matter. Compared with the 11–13 age group, MD in the 16–18 age group decreased in the prefrontal and the temporo-parietal white matter. Compared with the 16–18 age group, MD in the 23–25 age group decreased in the frontal white matter. Conclusion: Diffusion-tensor MR imaging results indicate that white matter maturation assessed at different ages involves increases in FA and decreases in mean diffusion of the white matter during adolescence and young adulthood. FA and mean diffusion may reflect different physiologic processes in healthy adolescents and young adults. Taken together, these data show that maturation of white matter is an important part of brain maturation during adolescence and young adulthood.     

基于体素的形态测量法分析高功能孤独性障碍患儿的脑组织密度

目的 分析学龄孤独性障碍患儿脑组织密度.方法 对17例智能正常的孤独性障碍患儿(病例组)以及15名年龄、性别、智商与之相匹配的健康儿童(对照组)进行T1加权三维磁共振成像扫描,应用基于体素的形态测量法(VBM)比较两组脑灰质及脑白质密度的差异.结果 与对照组相比,孤独性障碍患儿右侧小脑前叶的脑灰质密度低.右前扣带回、右额中回区域的脑白质密度低,双侧顶下小叶、右缘上回、右中央后回、右颞上回、右小脑后叶、左楔前叶、左楔叶的脑灰质密度高(P<0.001).结论 智力正常的学龄孤独性障碍患儿脑组织密度异常明显,且部位广泛.