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皮质下血管性认知障碍患者弥散张量成像和脑血流量的研究
引用本文:支楠,柴文,卢东,赵薇,耿介立,糜建华,俞羚,曹雯炜,周滟,徐群.皮质下血管性认知障碍患者弥散张量成像和脑血流量的研究[J].中国卒中杂志,2017,12(2):105-111.
作者姓名:支楠  柴文  卢东  赵薇  耿介立  糜建华  俞羚  曹雯炜  周滟  徐群
作者单位:200127.上海上海交通大学医学院附属仁济医院神经内科
基金项目:科技部国家重点研发项目(2016YFC1300600)上海市科委西医引导项目(14411964400)
摘    要:目的明确脑小血管病(cerebral small vessel disease,CSVD)患者白质完整性、脑血流量及其认知障碍之间的关系。方法连续招募严格定义的CSVD患者58例,分为无认知障碍(no cognitive impairment,NCI)11例、血管性轻度认知障碍(vascular mild cognitive impairment,VaMCI)29例和血管性痴呆(vascular dementia,VaD)18例三组,评定脑室旁(periventricular,PV)及放射冠(corona radiate,CR)白质的弥散张量成像(diffusion tensor imaging,DTI)参数,即平均弥散率(mean diffusivity,MD)和各向异性分数(fractional anisotropy,FA)。应用CT灌注(CT perfusion,CTP)成像对PV和CR区进行脑血流量(cerebral blood flow,CBF)测定。对DTI参数、CBF和认知评分进行相关性分析。结果 1三组间PV区的CBF及MD值比较,差异均有显著性(P0.01),其中MD值与CBF以及注意执行功能间均呈显著相关性(P0.01),但CBF和认知功能间未见相关性。三组间FA值比较,差异均无显著性,FA值亦未显示与CBF以及认知功能的相关性。2三组间CR区的CBF和MD、FA值比较,差异均无显著性,仅CR区MD和注意执行功能有一定相关性(P0.05),CBF与DTI参数以及认知功能间均未见相关性。结论脑室旁白质完整性的破坏是CSVD患者认知损害的重要影像学标志,且与低灌注密切相关。

关 键 词:脑小血管病  血管性认知障碍  弥散张量成像  脑血流量  
收稿时间:2016-11-07

Diffusion Tensor Imaging and Cerebral Blood Flow Study of Patients with Subcortical Vascular Cognitive Impairment
ZHI Nan,CHAI Wen,LU Dong,ZHAO Wei,GENG Jie-Li,MI Jian-Hua,YU Ling,CAO Wen-Wei,ZHOU Yan,XU Qun.Diffusion Tensor Imaging and Cerebral Blood Flow Study of Patients with Subcortical Vascular Cognitive Impairment[J].Chinese Journal of Stroke,2017,12(2):105-111.
Authors:ZHI Nan  CHAI Wen  LU Dong  ZHAO Wei  GENG Jie-Li  MI Jian-Hua  YU Ling  CAO Wen-Wei  ZHOU Yan  XU Qun
Abstract:Objective To investigate the correlation between white matter integrity, cerebral blood lfow and cognitive impairment in patients with cerebral small vessel disease (CSVD).
Methods A total of 58 patients with CSVD were consecutively recruited and categorized into 3 groups, no cognitive mild impairment (NCI,n=11) group, vascular mild cognitive impairment (VaMCI,n=29) group and vascular dementia (VaD,n=18) group. White matter diffusion tensor imaging (DTI) parameters including mean diffusivity (MD) and fractional anisotropy (FA) of periventricular (PV) and corona radiate (CR) regions were evaluated. Cerebral blood lfow (CBF) were also measured by CT perfusion (CTP) imaging at these areas. Correlation between DTI parameters, CBF and cognitive function were then analyzed.
Results① CBF and MD within PV region differed signiifcantly among the three groups (P<0.01), where MD was significantly correlated with CBF as well as with the executive function (mean P<0.01). However, there was no correlation between CBF and cognitive function. FA showed no statistical difference among the groups. There was no correlation between FA with CBF or cognitivefunction.② CBF, MD and FA within CR region showed no statistical differences among the three groups. However, MD within CR region was found to be correlated with the attention executive function (P<0.05). There was no statistically signiifcant correlation between CBF with DTI parameters and cognitive function.
Conclusion White matter dysintegrity within PV region is an important imaging marker of cognitive impairment in patients with CSVD. Hypoperfusion may play an important role in PV white matter dysfunction.
Keywords:Cerebral small vessel disease  Vascular cognitive impairment  Diffusion tensor imaging  Cerebral blood lfow
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