肌萎缩侧索硬化38例弥散张量成像及磁共振波谱表现

目的 研究肌萎缩侧索硬化(ALS)的弥散张量成像(DTI)和磁共振波谱(MRS)特点,并对ALs的病理生理机制进行初步探讨.方法 ALS患者38例,单纯下运动神经元受累疾病患者8例,混合型颈椎病5例和健康对照34名,行常规头颅MRI、DTI和1H-MRS测定.结果 21%(8/38)的ALS患者可见T2 FLAIR序列双侧锥体束走行异常高信号,强度高于皮质灰质.ALS组和健康对照组相比,中央前回(ALS组0.492±0.059,健康对照组0.552 4-0.045,F=17.150,P<0.01)、内囊后肢(分别为0.679 ±0.048、0.727±0.031,F=19.481,P<0.01)、大脑脚(左侧0.740±0.038、0.761±0.024,F=4.290;右侧0.720±0.044、0.746±0.034,F=3.264,均P<0.01)的部分各向异性(FA值)显著降低;ALS组上述部位的N-乙酰大冬氨酸/肌酸(NAA/Cr)值和健康对照组相比亦存在显著降低.AKS组各部位FA值降低百分率分别为10.9%、6.6%、2.8%～3.5%,以中央前回处最为显著;内囊前肢、枕叶处的FA值亦有不同程度降低.结论 DTI和MRS枪测不仪有助于ALS患者:运动神经元高位受累的确认和ALS的诊断和鉴别诊断,而且还可促进对ALS病理机制和病损分布的了解.

A combined study of diffusion tensor magnetic resonance imaging and magnetic resonance spectroscopy on amyotrophic lateral sclerosis

Objective To investigate the diffusion tensor imaging(DTI)and magnetic resonance spectroscopy(MRS)changes in amyotrophic lateral sclerosis(ALS)and to study on the physiopathology of ALS.Methods Thirty-eight AIS patients,8 patients with pure lower motor neuron involvement and 5 patients with mixed-type cervical spondylosis and 34 healthy controls were enrolled and examined with the conventional brain MRI,DTI and 1H-MRS.Results T2-weighted and T2 FLAIR images revealed abnormal high signals in bilateral pyramidal tract positions in 21%(8/38)of ALS patients,which was higher than that in the coaex When compared with the control group,the values of FA in the precentral gyms(0.492±0.059 vs 0.552±0.045,F=17.150,P<0.01),the posterior limb of the internal capsule(0.679±0.048 vs 0.727 4-0.031.F=19.481.P<0.01)and the cerebral peduncle(1eft:0.740 4-0.038 vs 0.761 4±0.024.F=4.290;right:0.720 ±0.044 vs 0.746 ±0.034,F=3.264,both P<0.01)of the ALS group were decreased significantly.so were the values of NAA/Cr.And the FA reduction rate was 10.9%,6.6% and 2.8%-3.5% respectively.There was also a significant decrease in FA in the anterior limb of the internal capsule and the occipital lobe in the ALS group.Conclusion Not only does the application of DTI and MRS help to demonstrate upper motor neuron involvement in the brain and facilitate the diagnosis and differential diagnosis of ALS,but also increases the understanding of the lesion distribution and physiopathology in ALS.