弥散峰度成像定量评估一氧化碳中毒迟发脑病白质损伤的研究

目的探讨弥散峰度成像(DKI)对一氧化碳(CO)中毒迟发脑病(DNS)白质损伤的定量评估价值。方法收集自2016年11月至2019年2月就诊于兰州大学第一医院神经内科的CO中毒迟发脑病患者28人,设为DNS组;同期30名健康志愿者设为对照组。所有患者均于发病后7 d内行DKI扫描并获得脑白质9个感兴趣区(ROI)相关参数值,即平均峰度(MK)值、轴向峰度(AK)值和径向峰度(RK)值,采用受试者工作特征(ROC)曲线比较其诊断效能。采用简易精神状态检查量表(MMSE)、Barthel指数、言语流畅性测试(VFT)和数字广度测试(DST)对2组成员进行神经认知评估,并应用多元回归分析明确神经认知评分与各ROI AK值间的统计学关系。结果与对照组相比,DNS组各感兴趣区MK、AK及RK值均呈升高趋势,其中半卵圆中心前部(ACS)、后部(PCS)及额叶(FL)升高最明显,差异有统计学意义(P<0.05)。胼胝体膝部(CCG)、干部(CCB)及顶叶(PL),DNS组AK值均大于对照组,差异有统计学意义(P<0.05)。除颞、枕叶外,其余ROI AK值诊断DNS的ROC曲线下面积均大于RK、MK值,其中半卵圆中心前部(0.802,P=0.000)及后部(0.785,P=0.000)、胼胝体膝部(0.730,P=0.003)及干部(0.654,P=0.045)、额叶(0.749,P=0.001)、顶叶(0.699,P=0.009)AK值诊断效能明显优于RK、MK,差异有统计学意义(P<0.05)。多元回归分析结果显示DST(倒序)是半卵圆中心前部、胼胝体膝部及顶叶AK值的独立影响因素,VET(蔬菜)是胼胝体干部AK值的独立影响因素,年龄是半卵圆中心后部、胼胝体压部、额叶、颞叶及枕叶AK值的独立影响因素,教育是颞叶AK值的独立影响因素。结论DKI可以定量评估DNS脑白质损伤微结构改变,AK值升高与患者神经认知功能下降相关。

Quantitative assessment of white matter damage caused by delayed neuropsychiatric sequelae after carbon monoxide poisoning with diffusion kurtosis imaging

Objective To investigate the value of quantitative evaluation in white matter damage caused by delayed neuropsychiatric sequelae(DNS)after carbon monoxide poisoning(CO)with diffuse kurtosis imaging(DKI).Methods A prospective study was conducted from November 2016 to February 2019 in 28 patients diagnosed as having DNS after CO poisoning and 30 healthy controls in our hospital.DKI scans were performed within 7 d of onset and DKI-derived parameters(9 regions of interest),including mean kurtosis(MK),axial kurtosis(AK),and radial kurtosis(RK),were obtained.Mini Mental State Examination Scale(MMSE),Barthel Index,Verbal Fluency Test(VFT),and Digital Breadth Test(DST)were performed on both subjects to conduct neurocognitive assessment;multivariate regression analysis was performed to determine the statistical relations of scores of above neurocognitive scales with AK values of ROIs.Results As compared with those in the control group,the MK,AK and RK values in all ROIs showed an increased trend in DNS group;among which,the anterior semioval center,posterior semioval center and frontal lobe enjoyed the most obvious increase,with significant differences(P<0.05).In the genu of corpus callosum,body of corpus callosum and parietal lobe,the AK value of DNS group was significantly higher than that in the controls(P<0.05).Except for temporal lobe and occipital lobe,area under the curve(AUC)of AK value of other ROIs in diagnosing DNS was larger than that of RK and MK values of other ROIs;AK value of anterior semioval center(AUC=0.802,P=0.000),posterior semioval center(AUC=0.785,P=0.000),frontal lobe(AUC=0.749,P=0.001),genu of corpus callosum,(AUC=0.730,P=0.003),parietal lobe(AUC=0.699,P=0.009)and body of corpus callosum(AUC=0.654,P=0.045)had better performance than RK and MK in diagnosing DNS,with statistically significant differences(P<0.05).Multivariate regression analysis results show that the DST value(reverse)is the independent influencing factors of AK values of anterior semioval center,genu of corpus callosum,and frontal lobe;VET(vegetable)is the independent influencing factors of AK values of body of corpus callosum,age is the independent influencing factors of AK values of posterior semioval center,splenium of corpus callosum,and frontal,temporal and occipital lobes;and education is the independent influencing factors of AK values of temporal lobe.Conclusion DKI can quantitatively evaluate the microstructural damage of white matter caused by DNS,and the increase of AK is related to the decrease of neurological function in patients with DNS.