血清S100β蛋白水平与脑小血管病患者非痴呆型血管性认知障碍的相关性研究

目的 探讨血清S100β蛋白水平与脑小血管病（cerebral small vessel disease,CSVD）患者非痴呆型血 管性认知障碍（vascular cognitive impairment with no dementia,VCIND）的相关性。      

皮质下缺血性血管病患者认知功能的弥散张量磁共振研究

目的明确弥散张量成像(diffusion tensor imaging,DTI)对皮质下型血管性认知障碍的识别作用。方法42例皮质下缺血性血管病(subcortical ischemic vascular desease,SIVD)患者经过认知测试,被分为无认知障碍(no cognitive impairment,NCI)组,血管性认知障碍非痴呆(vascular cognitive impairment no dementia,VCIND)组和血管性痴呆(vascular dementia,VaD)组。分析其认知测试指标与DTI参数之间的关系。结果VCIND组、VaD组全脑白质平均弥散度(mean diffusivity,MD)分别为(0.89±0.05)×10-9m2.s-1和(0.93±0.05)×10-9m2.s-1,与NCI组(0.84±0.03)×10-9m2.s-1相比,有统计学差异(均P<0.01),VCIND组、VaD组各向异性分数(fractional anisotropy,FA)分别为(0.35±0.02)和(0.34±0.02),与NCI组(0.37±0.02)相比,亦有统计学差异(均P<0.01)。全脑白质MD与注意执行功能和记忆功能测验评分的相关系数分别为-0.538和-0.500,均P<0.01;FA值与注意执行功能和记忆功能测验评分的相关系数分别是0.439和0.411,均P<0.01。排除VaD患者后,MD与注意执行功能的相关系数为-0.401,P<0.05。结论 VCIND和VaD组的MD和FA值与NCI组有统计学差异,SIVD患者的注意执行与记忆功能与白质完整性独立相关。     

脑小血管病所致血管性认知功能障碍研究进展

正脑小血管病(cerebral small vessel diseases,CSVD)是指累及颅内各类小血管所导致的脑白质和脑深部灰质损伤的一组临床疾病,是从神经解剖学角度定义的血管性疾病,其发生率占脑血管病的1/5~([1])。CSVD常引起认知功能障碍、精神情感改变等临床症状,目前已成为国内外学者的研究热点。血管性认知功能障碍(vascular cognitive impairment,     

皮质下血管性轻度认知障碍患者的多模式磁共振研究

目的 明确对皮质下缺血性血管病（subcortical ischemic vascular disease,SIVD）患者早期认知损害较 为敏感的磁共振成像（magnetic resonance imaging,MRI）指标。 方法 32例SIVD患者经过认知测试,被分为无认知障碍（no cognitive impairment,NCI）组18例,血管性 轻度认知障碍（vascular mild cognitive impairment,VaMCI）组14例,分析其认知测试指标与MRI参数之间 的关系。 结果 NCI组、VaMCI组全脑白质（whole brain white matter,WBWM）平均弥散度（mean diffusivity,MD） 分别为（0.84±0.03）×10-9·m2·s-1和（0.89±0.05）×10-9·m2·s-1,表观正常白质（normal appearing white matter,NAWM）的MD分别为（0.87±0.04）×10-9·m2·s-1和（0.92±0.05）×10-9·m2·s-1,差异 均有显著性（P均为0.003）;NCI组、VaMCI组WBWM各向异性分数（fractional anisotropy,FA）分别为 （0.37±0.02）和（0.35±0.02）,两组有显著差异（P =0.002）,两组NAWM的FA分别为（0.35±0.02）和 （0.33±0.02）,差异亦有显著性（P =0.001）。SIVD患者WBWM的MD值、NAWM的MD值和FA值与注意- 执行均相关,相关系数分别为－0.401（P =0.031）、－0.422（P =0.023）和0.409（P =0.027）,NAWM的 MD值与记忆相关,相关系数为－0.377（P =0.044）,多元逐步回归显示仅NAWM的MD值与注意-执行 （β=－0.453,P =0.009）、记忆（β=－0.414,P =0.019）和总体认知（β=－0.410,P =0.02）独立负相 关。而常规MRI参数未显示组间差异,与认知功能亦未见相关性。 结论 MRI弥散张量成像（diffusion tensor imaging,DTI）可以作为早期识别SIVD患者认知障碍的有效 手段。NAWM的MD值在认知障碍早期即下降,并与多项认知域独立相关,是较为敏感的DTI指标。     

脑小血管病病理生理机制研究进展

脑小血管病（cerebral small vessel disease,CSVD）是由于不同原因的脑小血管或微小血管发 生病理改变后导致的疾病,是临床上引起血管性认知功能障碍（vascular cognitive impairment,VCI）的 重要病因。充分认识CSVD的发生、发展,将为预防VCI提供可能。本文从脑小血管病的病理生理机制 的研究进展进行综述,以期为临床实践提供思路。     

皮质下缺血性血管病患者联络纤维的扩散张量成像分析和认知功能相关研究

【摘要】 目的 运用磁共振成像（magnetic resonance imaging,MRI）基于白质地图的扩散张量成像（diffusion tensor imaging,DTI）技术研究皮质下缺血性血管病（subcortical ischemic vascular disease,SIVD）患者联络纤维的超微结构改变,并分析DTI参数与认知功能的关系。 方法 连续入选40例SIVD患者,分为血管性认知障碍组18例,无认知障碍组22例,另设立20例正常老年人为对照组。对三组进行MRI检查并对其白质改变进行评分,对联络纤维进行基于白质地图分析（atlase based analysis,ABA）DTI成像,比较组间部分各向异性指数（fractional anisotrophy,FA）、平均扩散率（mean diffusivity,MD）差异,并对SIVD患者DTI参数与蒙特利尔认知评估量表（Montreal Cognitive Assessment,MoCA）得分进行相关性分析。 结果 无认知障碍组较正常组在右侧矢状层（下纵束/下额枕束）、右侧扣带（海马部）及左侧上额枕束的FA值减低;认知障碍组较正常组存在广泛的联络纤维FA值降低,差异均具有显著性。无认知障碍组与正常组比较,仅左侧扣带海马部及左侧上纵束MD值无显著差异,余联络纤维的MD值均显著增高;认知障碍组较正常组存在广泛的联络纤维MD值增高,差异均具有显著性。与无认知功能障碍组比较,认知功能障碍组在双侧矢状层（下纵束/下额枕束）、双侧扣带扣带回部、海马部、双侧上纵束、双侧上额枕束及双侧钩束的FA值减低,MD值增高,差异具有显著性。SIVD患者双侧矢状层（下纵束/下额枕束）、扣带扣带回部、上纵束、上额枕束及钩束和左侧扣带海马部的FA值与MoCA评分呈正相关,MD值与MoCA评分呈负相关。 结论 SIVD患者联络纤维的FA值减低,MD值增高,且DTI参数与其认知功能密切相关。     

免疫炎性反应在脑小血管病发病机制中的研究进展

正脑小血管病(cerebral small vessel disease,CSVD)是一种由于大脑小动脉、毛细血管以及小静脉受累而导致脑卒中、老年人血管性认知障碍(vascular cognitive impairment,VCI)和痴呆(dementia)等的脑血管疾病。目前其确切的发病机制尚不明确。近年来有研究发现,CSVD患者体内存在血管内皮细胞活化、血脑屏障(blood-brain barrier,BBB)破     

血尿酸与脑小血管病患者血管性轻度认知障碍的相关性研究

目的 探讨血尿酸（uric acid,UA）与脑小血管病（cerebral small vessel disease,CSVD）患者血管性轻度 认知障碍（vascular mild cognitive impairment,VaMCI）的相关性。 方法 选择2015年10月-2017年6月于潍坊医学院附属医院就诊的87例CSVD患者和44例体检者,根据 蒙特利尔评估表（montreal cognitive assessment,MoCA）将CSVD患者分为VaMCI组47例和认知正常组40 例,用Logistic回归分析及Pearson相关分析来分析尿酸与脑小血管病患者轻度认知障碍的相关性。 结果 CSVD认知正常组及轻度认知障碍组血UA水平（[ 315.15±56.76）μmol/L,（363.32±42.58） μmol/L]高于对照组（[ 269.66±40.21）μmol/L]（均P<0.001）,且CSVD轻度认知障碍组血尿酸水平 高于认知正常组（P <0.001）。轻度认知损害组UA水平与其MoCA总分、视空间与执行能力、记忆、语 言呈负相关（r =-0.351,P =0.015;r =-0.456,P =0.001;r =-0.408,P =0.004;r =-0.329,P =0.024）。 Logistic回归分析结果显示,血UA水平[比值比（odds ratio,OR）1.020,95%可信区间（confidence interval, CI）1.009～1.032,P =0.01]是CSVD患者轻度认知障碍的独立危险因素。 结论 CSVD血管性轻度认知障碍患者血UA升高,且血UA是CSVD患者轻度认知障碍的危险因素。UA 水平与CSVD血管性轻度认知障碍患者蒙特利尔评估总分、视空间与执行能力、记忆、语言呈负相关。     

脑白质疏松症患者弥散张量成像及与认知功能的相关性

Abstract Background and aims　Diffusion tensor imaging(DTI) 技术能够检测脑白质微结构的变化, Correlation with vascular risk factors and cognitive dysfunction seems to be feasible using this technique. We aimed to应用DTI检查leukoaraiosis (LA)病灶的fraction anisotropy (FA)值 and average diffusion coefficient(Dcavg)与LA严重程度的关系,探讨常规MRI检查正常的脑白质微结构在DTI 中的变化及与认知功能的相关性。方法　对60例LA 患者和30名健康老年人行DTI 检查,测量LA病灶和正常白质区域的DCavg、FA值。采用简明精神状态量表(MMSE)进行评价认知功能。结果 LA程度越严重,DCavg值越高,呈正相关;FA 值越低,呈负相关。神经心理学测试(简易智能精神状态量表,MMSE) 与LA患者的正常脑白质区域的DCavg、FA值明显相关,尤其是前角白质、半卵圆中心的正常脑白质。结论　DTI 检查LA ,其DCavg、FA值显示出特征性的改变,DTI能够发现常规MRI检查正常的脑白质微结构改变,且这种改变与认知功能相关。     

ERP联合DTI对脑小血管病相关认知功能障碍的初步研究

目的 探讨事件相关诱发电位(Event-related potential,ERP)联合弥散张量成像(Diffusion tensor imaging,DTI)在脑小血管病(Cerebral small vessel disease,CSVD)相关认知功能障碍评估中的应用价值。方法 选取2020年1月-2021年1月本院收治的CSVD患者100例,采用蒙特利尔认知评估量表(Montreal cognitive assessment scale,MoCA)对患者的认知功能进行评估,根据MoCA评分将患者分为认知功能障碍组(MoCA<26分,n=50)和对照组(MoCA≥26分,n=50); 所有患者均接受ERP和DTI检查,比较2组患者的一般资料、实验室指标水平、ERP和DTI相关参数水平的差异,评估ERP,DTI及其联合检测对CSVD相关认知功能障碍的诊断价值。结果 认知功能障碍组的高血压病的发生率明显高于对照组,MoCA、简易精神状态量表(Mini-mental state examination,MMSE)评分明显低于对照组,血清碱性磷酸酶(Alkaline phosphatase,ALP)、同型半胱氨酸水平明显高于对照组(P<0.05)。认知功能障碍组患者的P300潜伏期明显长于对照组,P300波幅明显小于对照组(P<0.05); 认知功能障碍组双侧半卵圆中心、双侧额叶、胼胝体膝部和胼胝体压部的各向异性分数(Fractional anisotropy,FA)值均明显小于对照组(P<0.05),双侧半卵圆中心、双侧额叶的平均弥散率(Mean diffusivity,MD)值明显大于对照组(P<0.05); 患者P300潜伏期、双侧半卵圆中心、双侧额叶、胼胝体膝部和胼胝体压部的FA值与MoCA,MMSE评分呈正相关(r≥0.203,P<0.05); P300波幅、双侧半卵圆中心、双侧额叶的MD值与MoCA,MMSE评分呈负相关(r≤-0.038,P<0.05); 患者双侧额叶FA值与P300潜伏期呈负相关(r=-0.274、-0.318,P<0.05),与P300波幅呈正相关(r=0.248、0.256,P<0.05); 双侧额叶MD值与P300潜伏期呈正相关(r=0.213、0.207,P<0.05),与P300波幅呈负相关(r=-0.327、-0.318,P<0.05)。结论 CSVD患者认知功能障碍的发生与脑微结构病变及电生理改变有关,ERP联合DTI检查或可作为CSVD相关认知功能障碍早期诊断的定量评估指标。     

基于纤维束示踪的空间统计分析对脑小血管病合并阻塞性睡眠呼吸暂停患者脑微结构改变的研究

目的 采用弥散张量成像（diffusion tensor imaging,DTI）基于纤维束示踪的空间统计分析（tract-based spatial statistics,TBSS）方法探讨脑小血管病（cerebral small vessel disease,CSVD）合并阻塞性睡眠呼吸暂停（obstructive sleep apnea,OSA）患者的大脑微结构变化特点。方法 纳入于2018年9月—2020年6月在中山大学附属第一医院神经内科病房住院的CSVD患者,收集人口学信息、临床资料、认知功能评估量表评分、睡眠质量量表评分、CSVD常规影像学资料以及DTI、多导睡眠监测（polysomnography,PSG）参数等。以呼吸暂停低通气指数（apnea hypopnea index,AHI）5次/小时为界,分为OSA组（AHI≥5次/小时）与不伴OSA组（AHI＜5次/小时）,通过TBSS方法计算大脑白质存在差异的区域及其各向异性分数（fractional anisotropy,FA）和平均扩散系数（mean diffusivity,MD）,并对MD与睡眠监测参数、认知功能评分、CSVD影像标志物和CSVD负荷进行相关性分析。结果 本研究共纳入CSVD患者39例,其中7例因缺乏MRI数据/参数不一致/图像质量差而被排除,最终纳入32例患者。OSA组21例,平均年龄为（64.14±11.57）岁,男性18例（85.7%）;不伴OSA组11例,平均年龄为（67.64±8.95）岁,男性6例（54.5%）。TBSS分析显示,与不伴OSA组相比,OSA组在双侧丘脑前放射、双侧皮质脊髓束、双侧扣带回、双侧海马、大钳、小钳、双侧额枕下束、双侧上/下纵束、双侧钩束等部位的MD增加（P＜0.001）。双变量相关性分析发现,OSA组MD增加与脑白质高信号相对体积（r=0.646,P＜0.05）和Fazekas 2～3级（r=0.458,P<0.05）呈正相关,与MoCA评分呈负相关（r=-0.374,P＜0.05）,与MMSE评分、阿尔茨海默病评估量表-认知亚量表评分、睡眠质量评估量表、AHI、PSG参数、其他CSVD影像标志物及CSVD负荷之间无相关性（P＞0.05）。结论 CSVD合并OSA患者存在更为广泛的脑白质纤维损害,且大脑微结构广泛损害和脑白质高信号及认知功能障碍密切相关。     

胼胝体网络连接性与脑白质疏松认知功能损害的相关性

目的 通过弥散张量成像（diffusion tensor imaging,DTI）研究脑白质疏松（leukoaraiosis,LA）患者胼 胝体网络连接性改变,并探讨其与认知功能损害的关系。 方法 本研究为前瞻性单中心研究。纳入30例法泽卡斯量表（Fazekas scale）评分为2～3级的LA患 者及20例头部磁共振成像正常的对照组。依据是否存在认知功能损害将LA组再分为认知正常与轻 度认知功能损害2个亚组。所有被研究对象均进行脑血管危险因素登记、血液生化检查、认知功能 评估筛查及3.0T头部磁共振成像检查及DTI检查。认知评估采用中文版蒙特利尔认知评估（Montreal Cognitive Assessment,MoCA）量表及简易智力状况检查（Mini-mental State Examination,MMSE）量表。使 用PANDA软件处理DTI数据,提取胼胝体膝部、体部及压部的部分各向异性（fractional anisotropy,FA） 和平均扩散系数（mean diffusivity,MD）数值。采用Pearson相关分析研究DTI数据变化与认知功能损害 的关系。 结果 LA组与对照组的性别、年龄、受教育情况、脑血管病常规危险因素及血生化之间差异无 显著性,P >0.05。LA组的MMSE及MoCA分值低于对照组,P值分别为0.002和0.008。LA组胝体膝部 （P =0.000）、体部（P =0.000）、压部（P =0.026）3个部位的FA值均低于对照组,而MD值高于对照组,P 值分别为0.013、0.006及0.007。LA组MMSE及MoCA分值降低与胼胝体膝部、体部、压部的FA下降均成 正相关,但相关系数从膝部（r =0.78）到压部（r =0.41）呈现逐渐递减趋势。 结论 LA存在胼胝体网络连接性改变,胼胝体FA下降与认知功能损害密切相关。     

Cognitive functions correlate with white matter architecture in a normal pediatric population: a diffusion tensor MRI study

A possible relationship between cognitive abilities and white matter structure as assessed by magnetic resonance diffusion tensor imaging (DTI) was investigated in the pediatric population. DTI was performed on 47 normal children ages 5-18. Using a voxelwise analysis technique, the fractional anisotropy (FA) and mean diffusivity (MD) were tested for significant correlations with Wechsler full-scale IQ scores, with subject age and gender used as covariates. Regions displaying significant positive correlations of IQ scores with FA were found bilaterally in white matter association areas, including frontal and occipito-parietal areas. No regions were found exhibiting correlations of IQ with MD except for one frontal area significantly overlapping a region containing a significant correlation with FA. The positive direction of the correlation with FA is the same as that found previously with age, and indicates a positive relationship between fiber organization and/or density with cognitive function. The results are consistent with the hypothesis that regionally specific increased fiber organization is a mechanism responsible for the normal development of white matter tracts.     

在体磁共振波谱及扩散张力成像观察肌萎缩性侧索硬化的病理变化的研究

目的结合磁共振波谱成像(MRSI)以及扩散张力成像(DTI)技术及磁共振影像(MRI)对肌萎缩性侧索硬化(ALS)进行对照研究,评价MRSI、DTI、MRI在ALS诊断中的作用。方法采用MRSI、DTI及MRI技术对ALS患者及对照组进行扫描,观察沿皮质脊髓束(CST)走行区域包括中央前回皮层下(SWM)、半卵圆中心(CS)、侧脑室旁白质(PV)、内囊后肢(PIC)、大脑脚(CP)的各向异性比(FA)以及平均扩散率(MD),以及SWM、PV、PIC平面氮乙酰门冬胺酸(NAA)与肌酸(Cr)比值在对照组及ALS患者的改变,并比较不同扫描序列在ALS诊断的作用。结果ALS的总FA较对照组明显降低(P<0.001),在CST走行区的SWM、CS、PV和PIC平面,ALS组的FA较对照组明显降低(P<0.05),MD在ALS组有升高的趋势,但无统计学差异。ALS组的NAA/Cr较对照组明显降低(P<0.05),在SWM和PV平面ALS组的NAA/Cr较对照组降低明显(P<0.05)。对T1WI、T2WI与FLAIR序列判断结果显示,对照组与ALS组间MRI的表现无明显差异。结论MRSI与DTI结合能够早期定量探测ALS患者CST的轴索损伤,SWM、CS、PV和PIC平面的FA,在SWM和PV的NAA/Cr为有效的指标。ALS与对照组MRI的表现则无明显差异。     

DTI correlates of distinct cognitive impairments in Parkinson's disease

The spectrum of cognitive symptoms in Parkinson's disease (PD) can span various domains, including executive function, language, attention, memory, and visuospatial skills. These symptoms may be attributable to the degradation of projection fibers associated with the underlying neurodegenerative process. The primary purpose of this study is to find microstructural correlates of impairments across these cognitive domains in PD using diffusion tensor imaging (DTI). Sixteen patients with PD with comprehensive neuropsychological evaluation and DTI data were retrospectively studied. Fractional anisotropy (FA) and mean diffusivity (MD) were assessed using regions‐of‐interest (ROI) analysis and confirmed with a voxel‐based approach. Executive function directly correlated with FA and inversely correlated with MD in mostly frontal white matter tracts, especially the anterior limb of the internal capsule and genu of the corpus callosum. Likewise, language and attentional performance demonstrated correlations with DTI parameters in the frontal regions, but the attention domain additionally recruited regions widespread throughout the brain, with the most significant correlation identified in cingulate gyrus (cingulum). Lastly, memory impairment mainly involved MD alterations within the fornix. No significant correlations were found between visuospatial skills and DTI measures. Despite some overlap, unique patterns of white matter diffusivity underlie impairments in distinct cognitive domains in patients with PD. DTI combined with neurocognitive tests may be a valuable biomarker for identifying cognitive impairments in PD. Hum Brain Mapp 35:1325–1333, 2014. © 2013 Wiley Periodicals, Inc.     

Diffusion tensor imaging measures of normal appearing white matter in patients who are aging,or have amnestic mild cognitive impairment,or Alzheimer’s disease

To evaluate whether cerebral white matter integrity is related to cognitive function, and whether diffusion tensor imaging (DTI) could differentiate amnestic mild cognitive impairment (aMCI) from Alzheimer’s disease (AD), 12 patients with AD, 12 with aMCI, and 12 controls were recruited for this study. Cognitive functions of all subjects were assessed using the Mini-Mental State Examination (MMSE) and AD Assessment Scale – Cognitive Subscale (ADAS-Cog). DTI studies were acquired, and fractional anisotropy (FA) and mean diffusivity (MD) values of normal-appearing white matter (NAWM) in multiple brain regions were obtained. Results showed that MMSE and ADAS-Cog subscores were significantly associated with white matter integrity of the temporal-parietal lobes. A decrease in FA values and an increase in MD values in multiple cortical regions were confirmed in patients with AD compared to controls. MD values in the posterior region of the corpus callosum in aMCI differed from those of early AD. Significant reductions of FA values in the NAWM of the parietal lobe was observed in aMCI compared to controls. Our data indicate that the microstructural white matter integrity in the temporal-parietal lobes is gradually impaired in the progressive process of AD, and that splenium MD values could be used as a biomarker differentiating aMCI from AD.     

A primary study of diffusion tensor imaging-based histogram analysis in vascular cognitive impairment with no dementia

Purpose

This study performed diffusion tensor imaging (DTI) histogram analysis and voxel-based analysis (VBA) to detect white matter (WM) damage in patients with vascular cognitive impairment with no dementia (VCIND) and to determine correlations between DTI histogram-derived measures and cognitive dysfunction in these patients.

Materials and methods

Among patients with subcortical ischemic vascular disease, 18 patients with VCIND were selected along with 18 age- and sex-matched cognitive-normal subjects. Both groups underwent magnetic resonance and DTI scans, and fractional anisotropy (FA) changes in VBA between the two groups were assessed. Further, mean diffusivity (MD) and FA histograms of WM and normal-appearing WM (NAWM) in each subject were evaluated.

Results

Compared to control, the VCIND group showed lower FA values throughout the brain. FA and MD histogram patterns of WM and NAWM were significantly different between the groups. Significant differences were found in all DTI histogram-derived measures, except in the mean FA peak height of WM and mean MD peak location of NAWM. Neuropsychological results (z-scores) were found to be significantly correlated with mean FA peak location, average MD, mean MD peak location of WM, and mean FA peak height, average MD, mean MD peak location of NAWM.

Conclusions

Results of VBA and diffusion tensor imaging-based histogram analysis suggest that VCIND patients have more severe damage in WM and NAWM than the control. Thus, the severity of damage in WM and NAWM may be related with cognitive dysfunction in VCIND patients, and DTI histogram analysis can help in further understanding VCIND.