3T磁共振波谱分析在轻微型肝性脑病诊断中的应用

目的研究3T场强磁共振MRS对轻微型肝性脑病（MHE）患者的诊断价值。方法对33例MHE患者和46例无轻微型肝性脑病的肝硬化患者采用单体素点分辨自旋回波波谱序列进行扣带回和右侧前额叶的MRS扫描。计算N-乙酰天门冬氨酸（NAA）、肌酐（Cr）、胆碱（Cho）、肌醇（MI）和谷氨酰胺复合物（Glx）的峰下面积,计算NAA／Cr、Cho／Cr、MI／Cr、Glx／Cr,并与30例健康体检者（正常对照组）比较。33例MHE患者在MRS检查前后1周内进行了静脉血氨水平测定。结果与正常对照组相比,MHE患者扣带回和右侧前额叶的Cho／Cr、MI／Cr显著降低（P值分别〈0．01和〈0．001）,Glx／Cr比值显著升高（P〈0．005）。与无MHE的肝硬化患者间Glx／Cr与Cho／Cr有显著性差异（P〈0．01,P〈0．005）,无MHE的肝硬化患者与正常对照组比较MI／Cr有显著性差异（P〈0．001）。扣带回与右侧额叶的Glx／Cr比值与血氨浓度呈正相关,Cho／Cr和MI／Cr的比值与血氨浓度呈负相关。结论3T场强磁共振MRS检查显示MHE患者扣带回和右侧前额叶Cho、MI水平降低,Glx水平升高;扣带回与右侧额叶的MRS指标与血氨之间存在相关关系,3T场强磁共振MRS对MHE的诊断有显著价值;扣带回与右侧前额叶可作为检测肝硬化患者脑改变的敏感部位。     

超高场强磁共振波谱分析对轻微型肝性脑病

目的： 研究MRS对轻微型肝性脑病(MHE)患者的诊断价值。方法　应用3.0 MR机对33例MHE患者和46例没有轻微型肝性脑病的肝硬化患者进行了扣带回和右侧前额叶的单体素点分辨自旋回波波谱序列扫描。计算N-乙酰天门冬氨酸(NAA)、肌酐(Cr)、胆碱(Cho)、肌醇(MI)和谷氨酰胺复合物(Glx)的峰下面积,计算NAA/Cr、Cho/Cr、MI/Cr、Glx/Cr,并与30例健康体检者（正常对照组）比较。33例在 MR检查前后一周内进行了静脉血氨水平测定。结果：与正常对照组相比,有轻微肝性脑病患者扣带回和右侧前额叶的Cho/Cr、MI/Cr 显著降低（P<0.01和 P0.05）,没有轻微肝性脑病的肝硬化患者与正常对照组比较MI/Cr有显著性差异（P0.05）。扣带回与右侧额叶的Glx/Cr比值与血氨浓度呈正相关,Cho/Cr 和MI/Cr的比值与血氨浓度呈负相关。 结论：MHE患者MRS检查显示扣带回和右侧前额叶Cho、MI水平降低,Glx水平升高;扣带回与右侧额叶的MRS指标与血氨之间存在相关关系,MRS对MHE的诊断有显著价值;扣带回和额叶可作为检测肝硬化患者脑改变的一个敏感部位。     

双相抑郁患者前额叶和前扣带回皮质氢质子波谱研究

目的:研究双相抑郁患者前额叶皮质、前扣带回皮质代谢物的相对含量。方法:对30例未服药双相抑郁患者和30名健康志愿者的前额叶皮质、前扣带回皮质进行氢质子波谱(1H-MRS)扫描,双相抑郁患者经6周药物治疗后再次做1H-MRS扫描,检测N-乙酰天门冬氨酸(NAA)、胆碱(Cho)、谷氨酸复合物(Glx)、肌酸(Cr)4种代谢物。结果:双相抑郁组左侧前额叶皮质、双侧前扣带回皮质NAA/Cr值均显著低于正常对照组(P<0.05),Cho/Cr值、Glx/Cr值均显著高于正常对照组(P<0.05),双相抑郁组右侧前额叶皮质NAA/Cr、Cho/Cr、Glx/Cr值两组比较差异无统计学意义(P>0.05)。经药物治疗后,左侧前额叶皮质、双侧前扣带回皮质NAA/Cr值较治疗前升高,Cho/Cr值、Glx/Cr值较治疗前降低,差异有统计学意义(P<0.05)。结论:前额叶和前扣带回皮质NAA、Cho、Glx含量的改变与双相抑郁的发生和药物的疗效有关。     

轻度认知障碍和阿尔茨海默病的边缘系统氢质子磁共振波谱特点

目的探讨海马和扣带回后部氢质子磁共振波谱(’H-MRS)改变在轻度认知障碍(MCI)和阿尔茨海默病(AD)早期诊断中的作用。方法应用’H-MRS技术检测15名健康老年人、15例MCI患者及15例AD患者脑内边缘系统的代谢物水平,对检测的N-乙酰天门冬氨酸(NAA)、胆碱复合物(Cho)、肌酸复合物(Cr)和肌醇(mI)波谱数据进行比较分析。结果 AD组与健康对照组和MCI组相比,海马部位的mI/Cr均升高(均P0.05),NAA/mI降低(均P0.05);随病情进展,扣带回后部的mI/Cr呈递增趋势(P0.05),NAA/mI呈递减趋势(P0.05);AD组和MCI组扣带回后部的NAA/mI与健康对照组的差别程度大于海马部位(P=0.001,P=0.019)。结论扣带回后部的mI/Cr和NAA/mI有助于鉴别健康老人和AD患者;海马部位的NAA/mI有助于鉴别痴呆和非痴呆;MRS在诊断AD和MCI方面有一定辅助作用。     

双相抑郁患者前额叶及海马磁共振质子波谱成像研究

目的探讨双相抑郁患者前额叶及海马磁共振质子波谱(proton magnetic resonance spectroscopy,1H-MRS)的代谢物变化特点,为其神经生物学研究提供线索。方法应用磁共振质子波谱成像技术检测26例双相抑郁患者(患者组)和26例单相抑郁患者及13例健康志愿者(对照组)双侧前额叶白质、前扣带回皮质、海马N-乙酰天门冬氨酸(N-Acetylaspartate,NAA)、胆碱(choline,Cho)、肌酸(creatine,Cr)3种代谢物,以Cr为参照物,分别计算双侧NAA/Cr和Cho/Cr比值。采用SPSS 13.0进行统计处理。结果患者组左侧前额叶白质NAA/Cr(1.65±0.31)低于对照组(2.37±0.36),左侧前额叶白质Cho/Cr(1.35±0.27)低于对照组(1.65±0.21),差异有统计学意义(P<0.05);右侧前额叶白质NAA/Cr、Cho/Cr值与正常对照组差异无统计学意义;患者组双侧前扣带回NAA/Cr、Cho/Cr值与正常对照组差异无统计学意义;患者组双侧海马NAA/Cr、Cho/Cr值与正常对照组差异无统计学意义;患者组与单相抑郁组的双侧额叶白质、双侧前扣带回皮质、双侧海马NAA/Cr、Cho/Cr值差异均无统计学意义。结论双相抑郁患者可能存在左侧前额叶神经元功能下降和膜磷脂代谢异常,其代谢物特点存在偏侧化。     

MRI和磁共振波谱在肝性脑病的应用价值

目的探讨MRI和磁共振波谱(1H-MRS)在肝性脑病中的应用价值。方法对6例肝性脑病患者行MRI和1H-MRS检查,检测基底节MRS的N-乙酰天门冬氨酸(NAA)、肌酸(Cr)、胆碱(Cho)、谷氨酰胺复合物(Glx)、肌醇(mI)的峰值,计算Cho、mI、NAA与Cr的比值,并与5名正常对照者比较。结果 MRI检查显示,6例肝性脑病患者双侧基底节T1WI均出现高信号,其中1例累及内囊、2例累及尾状核、1例累及中脑被盖;5例患者T2WI未见明显异常信号,1例患者因并发弥漫性脑水肿T2WI出现广泛高信号影。1H-MRS显示,肝性脑病组双侧基底节Cho峰、mI峰、Cho/Cr和mI/Cr显著低于正常对照组,Glx峰显著高于正常对照组(P<0.01～0.005);两组NAA/Cr比较差异无统计学意义。结论 MRI显示双侧基底节T1WI高信号是肝性脑病特征性改变。1H-MRS能准确地反映其脑代谢物质水平的变化。     

脑梗死磁共振波谱分析的临床应用

磁共振波谱分析能定量检测脑梗死患者脑组织的生化代谢。脑梗死灶周围的Lac升高,而NAA正常或轻度降低可作为判断缺血半暗带的指标;通过检测比较NAA/Cr、mI/Cr、Cho/Cr及NAA/mI比值可辅助诊断血管性痴呆及其预后的判断;检测Glx/Cr、Cho/Cr的比值可辅助诊断卒中后抑郁障碍及其治疗效果的评价;NAA、Cho可作为卒中后失语语言功能区生化、代谢的指标。     

广泛性焦虑症首次发病患者治疗前后前额叶皮质及海马神经生化物质的变化

目的:观察广泛性焦虑症(GAD)首次发病患者坦度螺酮治疗前后双侧前额叶皮质及海马神经生化物质的变化。方法:对39例首发的GAD患者(GAD组)给予坦度螺酮治疗8周;分别于治疗前后进行汉密尔顿焦虑量表(HAMA)评分及磁共振质子波谱分析(1H-MRS)检测双侧前额叶及海马N-乙酰天门冬氨酸(NAA)、谷氨酸复合物(Glx)、胆碱复合物(Cho)、肌酸(Cr)水平;并与30名正常对照者(正常对照组)比较。结果:治疗前GAD组右侧额叶NAA/Cr、Cho/Cr值显著低于正常对照组(P0.05或P0.01),Glx/Cr值明显高于正常对照组(P0.01);治疗后右侧额叶NAA/Cr、Cho/Cr值显著高于正常对照组(P0.05或P0.01);治疗前后左侧额叶及双侧海马各代谢指标相对浓度与正常对照组差异无统计学意义。相关分析显示,GAD组HAMA总分与右侧额叶NAA/Cr呈负相关(r=-0.732),与Glx/Cr呈正相关(r=0.569)(P均0.01)。结论:GAD患者发病初期即存在右侧前额叶神经元代谢异常;坦度螺酮抗焦虑疗效可能与其调整脑组织代谢有关。     

双相障碍Ⅱ型患者前额叶白质、豆状核磁共振波谱分析

目的 探讨双相障碍Ⅱ型患者前额叶白质、豆状核的氢质子磁共振波谱(1H-MRS)特征. 方法 以自2012年9月至2013年4月在中山大学附属第三医院住院的双相障碍Ⅱ型患者30例为患者组,同期20例健康志愿者为对照组,采用多体素磁共振波谱技术检测2组研究对象前额叶白质、豆状核的代谢物质含量,包括N-乙酰天门冬氨酸(NAA)、胆碱化合物(Cho)、肌酸(Cr)、肌醇(mI),并计算NAA/Cr、Cho/Cr、mI/Cr、NAA/Cho、NAA/(Cho+Cr)的比值. 结果 患者组右侧前额叶白质NAA、Cho、mI绝对含量及NAA/Cr比值和对照组相比明显下降,差异均有统计学意义(P＜0.05);左侧前额叶白质NAA绝对含量及NAA/Cr、NAA/Cho、NAA/(Cho+Cr)比值与对照组相比明显下降,差异均有统计学意义(P＜0.05);右侧豆状核NAA、Cho绝对含量和对照组相比明显下降,差异有统计学意义(P＜0.05). 结论 双相障碍Ⅱ型患者存在双侧前额叶白质纤维受损和神经胶质细胞功能异常,以及右侧豆状核神经元缺失或功能异常.     

氟西汀干预对大鼠抑郁模型海马代谢的影响

目的探讨氟西汀干预对大鼠抑郁模型的海马代谢的影响。方法 45只SD大鼠随机分为正常对照组(n=15)以及抑郁组(n=30)。抑郁组又被分为干预亚组(n=15)及未干预亚组(n=15)。采用慢性不可预知应激及孤养的方法建立抑郁模型。在制模成功后不干预亚组大鼠腹腔注射生理盐水2.0 ml/d,干预亚组大鼠腹腔注射盐酸氟西汀溶液5.0 mg/(kg·d);均持续4周。于干预前后对各组大鼠进行氢质子磁共振波谱分析检查,并进行比较。结果抑郁组大鼠双侧海马N-乙酰天冬氨酸(NAA)/肌酸(Cr)及谷氨酸复合物(Glx)/Cr显著低于正常对照组,胆碱复合物(Cho)/Cr及肌醇(mI)/Cr显著高于正常对照组(P0.05~0.01)。干预亚组双侧海马的NAA/Cr及Glx/Cr显著高于未干预亚组双侧海马的Cho,ho/Cr及右侧海马的mI/Cr显著低于未干预亚组(P0.05~0.01)。与干预前比较,干预亚组干预后双侧海马NAA/Cr及Glx/Cr显著升高(均P0.05);未干预亚组双侧海马Cho/Cr及mI/Cr显著升高,NAA/Cr及Glx/Cr显著降低(均P0.05)。结论氟西汀能够改善海马神经细胞的谷氨酸循环及肌醇磷酸循环,恢复神经元及神经胶质细胞的功能。     

Neuronal metabolic changes in the cortical region after subcortical infarction: a proton MR spectroscopy study

OBJECTIVES: To investigate whether proton magnetic resonance spectroscopy ((1)H MRS) can detect neuronal metabolic changes in the cortical region in patients with cortical dysfunction after subcortical infarction. METHODS: Fifteen patients with subcortical large (diameter>/=20 mm) infarcts were studied; nine patients with cortical dysfunction (group A), and six without (group B). Seven patients with lacunar infarction served as controls. Infarct volume was measured on T2 weighted images with an image analyser. (1)H MRS data were obtained in three regions; high signal intensity area on T2 weighted image, overlying cortex with a normal T2 MRI appearance, and contralateral homologous cortical region. RESULTS: Infarct volume was not different between groups A and B. N-acetylaspartate (NAA)/creatine+phosphocreatine (Cr) ratios in the cortical region overlying subcortical infarcts in group A were significantly lower than those in group B and the control group (p=0.002). The NAA/Cr ratios in the overlying cortex were significantly lower than those in the contralateral normal cortex in group A on the initial (p=0. 015) and follow up (p=0.028) (1)H MRS, but these differences were not found in group B and the control group. CONCLUSIONS: The results support the idea that the cerebral cortex is a responsible location for cortical dysfunction after subcortical infarctions. (1)H MRS can be used as a sensitive method for the detection of a neuronal metabolic damage, which is not demonstrated by conventional MRI.     

质子磁共振波谱对帕金森病的诊断价值

目的　探讨质子磁共振波谱 (1 H MRS)对帕金森病 (PD)的诊断价值。方法　通过对 1 5例PD患者和 5名年龄匹配健康对照者双侧基底节区1 H MRS观测 ,分析其基底节区N 乙酰天冬氨酸 /肌酸 (NAA/Cr)和胆碱 (Cho) /Cr比值的变化。结果　PD患者基底节区NAA/Cr含量显著低于对照组 (P <0 0 5)。结论　1 H MRS是研究PD患者基底节区神经元是否遭受破坏的一种无创技术     

Thalamic proton magnetic resonance spectroscopy in vegetative state induced by traumatic brain injury

OBJECTIVES: To determine whether proton magnetic resonance spectroscopy (MRS), a newer radiographic technology, would be useful in the evaluation of the thalamus of patients in vegetative states resulting from traumatic brain injury. METHODS: 14 victims of severe traumatic brain injury who were in the vegetative state and whose magnetic resonance images of the thalamus were normal underwent bilateral thalamic proton (MRS) studies. The N-acetyl aspartate to creatine (NAA:Cr) and choline to creatine (Cho:Cr) ratios were obtained for each patient. The proton thalamic MRS findings of patients who were in a persistent vegetative state (n = 8) and in patients who had regained awareness after being in the vegetative state (n = 6) were compared with proton thalamic MRS findings in five healthy volunteers. RESULTS: While conventional magnetic resonance imaging suggested that each patient had a normal thalamus, proton MRS indicated that the thalamus of each patient in the series was damaged. The NAA:Cr ratio was significantly lower in the thalami of both the patients who remained in a persistent vegetative state for the duration of the study and in those who regained awareness after being in the vegetative state (p < 0.001). In addition, NAA:Cr ratios were lower in the group of patients who remained in a persistent vegetative state than in the group of patients who regained awareness after being in the vegetative state (p < 0.001). CONCLUSIONS: Results suggest that the NAA:Cr ratio within the thalamus is significant and that thalamic MRS may be helpful when attempting to determine the degree of severity of neuronal and axonal injury in patients in the vegetative state.     

脑干及小脑病变的质子磁共振波谱研究

目的探讨质子磁共振波谱（^1HMRS）分析对脑干及小脑病变的诊断价值。方法对15例健康志愿者和18例脑干及小脑病变患者分别进行^1HMRS采集,定量分析N-乙酰天门冬氨酸（NAA）、肌酸（Cr）和胆碱（Cho）代谢物的变化。结果肿瘤组NAA／Cr、NAA／（Cho＋Cr）的比值低于非肿瘤组,且两者都低于对照组,有显著的统计学差异（P〈0．05）;肿瘤组Cho／Cr的比值高于非肿瘤组,且两者都高于对照组,有显著的统计学差异（P〈0．05）。结论^1HMRS对脑干和小脑病变的定性诊断及预后评估有重要价值。     

Neuronal dysfunction of the frontal lobe in schizophrenia

Localized in vivo proton magnetic resonance spectroscopy (MRS) was performed to evaluate metabolic alterations in the right and left frontal lobe before and after antipsychotic treatment of schizophrenic patients (n=24) and a group of healthy normal subjects (n=20). Proton metabolic ratios obtained from the 8 cm3 voxels in the right and left frontal lobes were compared with the clinical assessment for each subject. There was no significant difference in the metabolic ratios between the right and the left frontal lobes in either the schizophrenic group or the control group, indicating no laterality. Compared with those of the normal control group, NAA/Cr ratio of the schizophrenic patients showed significantly lower value. The NAA/Cr ratio of the schizophrenic patients was not changed after antipsychotic treatment. The present study supports the 'hypofrontality' hypothesis of schizophrenia.     

Merosin-negative congenital muscular dystrophy: magnetic resonance spectroscopy findings

Congenital muscular dystrophies (CMD) are heterogeneous group of muscle disorders with autosomal recessive inheritance. Merosin deficiency has been identified in some patients with CMD all of whom also had white matter abnormalities on MRI. In postmortem studies, the brain showed extensive myelin pallor with a spongy appearance of white matter and moderate astrocytosis or demyelination. Direct assessment of neuropathologic aspects of MN-CMD such as demyelination is possible with MR spectroscopy (MRS). Although previous reports have described several neuro-imaging findings of this disease, MRS findings have not been reported in literature. In this case, we report MRS features of a 4-year old girl with MN-CMD. MRS of brain demonstrated that N-acetylaspartate (NAA)/Creatine (Cr) ratio was normal. Increased Choline (Cho)/Cr and Myo-inositol (MI)/Cr ratios were obtained. These findings were interpreted as demyelination and gliosis of white matter.     

轻微型肝性脑病磁共振扩散加权成像和扩散张量成像的定量研究

目的通过磁共振扩散加权成像(DWI)和扩散张量成像(DTI)定量分析轻微型肝性脑病(MHE)患者脑功能的异常改变,探讨DWI和DTI在MHE中的应用价值。方法30例肝硬化患者经神经心理测试评分量表测试后,分为MHE组16例和无MHE单纯肝硬化组14例,同时选取15例健康志愿者为正常对照组。所有受试者均行DWI与DTI扫描,选取脑内8个部位为感兴趣区,计算各部位的表观扩散系数(ADC)值和各向异性分数(FA)值。结果18例肝硬化患者于T1WI图像上可见到双侧内囊、苍白球对称性高信号。额叶、枕叶白质、胼胝体膝部、胼胝体压部、内囊前肢、内囊后肢、尾状核头部由正常组、单纯肝硬化组至MHE组ADC值逐渐增加,且MHE组的ADC值较肝硬化组和正常组增加,差异有统计学意义(P<0.05);胼胝体膝部和压部的FA值由正常组、单纯肝硬化组至MHE组逐渐降低,差异有统计学意义(P<0.05)。结论DWI与DTI联合应用能够预测肝硬化患者MHE的进展程度,具有潜在的临床价值。     

Reduction in hypothalamic 1H-MRS metabolite ratios in patients with cluster headache

OBJECTIVE: To determine the 1H-MR spectroscopic (MRS) findings in the hypothalamus in patients with episodic cluster headache. METHODS: 47 patients were recruited with episodic cluster headache (35 in cluster period and 12 in remission), 21 normal controls, and 16 patients with chronic migraine. The hypothalamic 1H-MRS metabolite ratio changes in patients with cluster headache were evaluated and compared with results in the normal controls as well as patients with chronic migraine. Seven patients in the cluster period group underwent a follow up hypothalamic MRS study five to six months after remission. RESULTS: In patients with cluster headache, the hypothalamic N-acetylaspartate (NAA)/creatine (Cr) and choline (Cho)/Cr ratios were similar between those in cluster period and in remission. As a group, both NAA/Cr and Cho/Cr levels were significantly lower in patients with cluster headache in comparison with either the control or chronic migraine groups. In those with a follow up MRS study, the levels of metabolite ratios did not differ between the cluster and remission periods. CONCLUSIONS: This study provides evidence of persistent biochemical change of the hypothalamus in patients with episodic cluster headache. Low levels of NAA/Cr and Cho/Cr suggest that cluster headache might be related to both neuronal dysfunction and changes in the membrane lipids in the hypothalamus.