多发性硬化患者智能改变与头颅磁共振成像测量及弥散张量成像研究

目的　研究多发性硬化 (MS)患者认知功能障碍的发生情况及认知改变的病理解剖基础。方法　对 70例MS患者进行韦氏智力量表测查及头颅MRI检查 ,对其中 5 0例患者的头颅MRI成像进行了定量测量 ;7例患者进行了弥散张量成像 (DTI)扫描。结果　智能测试发现MS组全量表智商低于正常 (<90分 )者为 4 0 % (2 8/ 70 ) ,与正常组比较差异有非常显著意义 (P <0 0 1)。智能测试与MRI测量中的两侧尾状核比率相关性最显著 ,其次为胼胝体指数。DTI显示病灶周围看似正常组织、看似正常白质及灰质较对照组相应部位脑组织的表观扩散系数增高 ,各向异性值减低。结论　MS患者中存在认知障碍。病灶的范围及其严重程度 ,包括看似正常白质中的微小病灶的数量和严重程度决定认知障碍的程度。灰质功能障碍也与认知改变有关。

Changes on cognitive function, brain magnetic resonance imaging and diffusion tensor imaging in patients with multiple sclerosis

Objective To investigate the association of cognitive impairment with the brain structure changes in multiple sclerosis (MS). Methods 70 patients with MS were tested with the Wechsler Intelligence Scale and brain MRI. Analysis was performed to the brain MRI in 50 patients and diffusion tensor imaging (DTI) in 7 patients. Results The rate of the patients whose full intelligence quotient (FIQ) were less than 90 scores was 40% (28/70), which were higher than that of the normal group (P<0.01). Spearman analysis between IQ and MRI parameters showing bicaudate ratio(BCR)was the best parameters (P<0.01),then the corpus callosum brain ratio (CCR, P<0.05). The DTI of seven patients showed the apparent diffusion coefficients (ADCs) of periplaque white matter (PWM), the normal-appearance white matter (NAWM) and the normal-appearance gray matter (NAGM) were higher, and the fractional anisotropys (FAs) of PWM, NAWM, NAGM were lower than that of the white or gray matter regions in control subjects. Conclusion Cognitive impairment was a common occurrence in MS. The diffusion and severity of lesions, as well as the lesions in the NAWM were contributed to the severity of cognitive dysfunction in MS. The lesions in gray matter were also correlated with cognitive dysfunction.