帕金森病和帕金森综合征中脑黑质和纹状体质子磁共振波谱研究

帕金森病(PD)是一种病因尚未完全清楚的锥体外系慢性变性疾病,主要病变部位在中脑黑质及黑质纹状体通路.临床以震颤、肌强直和运动减少为特征性改变.     

帕金森病异质性的质子磁共振波谱研究

目的利用质子磁共振波谱(1 H-MRS)技术研究不同运动亚型原发性帕金森病(IPD)患者纹状体、额叶皮质运动区的变化,并比较其认知障碍的发生率,研究帕金森病认知障碍(PD-CIND)患者海马区的变化,探讨1 H-MRS在IPD诊断及分型诊断的价值。方法对70例IPD患者行帕金森病统一评分量表(UPDRS)运动障碍评分,并进行临床分型,依据主要运动症状分为震颤为主型IPD 38例、姿势异常、步态障碍(PIGD)型IPD 32例,同时对各运动亚型行蒙特利尔认知量表评分(MOCA),选出MOCA26分的PD-CIND患者共27例,无认知障碍IPD(MOCA≥26分)患者43例,健康对照组(HC)30例,对各组双侧纹状体,额叶皮质运动区、海马区行1 H-MRS检测,计算N-乙酰天门冬氨酸/肌酸(NAA/CR)和胆碱复合物/肌酸(CHO/CR)的比值。结果震颤为主型IPD伴发认知障碍10例。PIGD型IPD伴发认知障碍17例,2组比较有显著性差异(P0.05),IPD组纹状体、额叶皮质运动区NAA/CR比值较HC组明显下降(P0.05),震颤为主型IPD双侧纹状体、额叶皮质运动区NAA/CR比值高于PIGD型IPD(P0.05),PD-CIND组海马区NAA/CR比值低于IPD组及HC组(P0.05)。而各组CHO/CR比值差异均无统计学意义(P0.05)。结论 IPD患者双侧纹状体、额叶皮质运动区NAA/CR比值降低,尤以PIGD型IPD下降明显,同时震颤为主型PD认知障碍伴发率低于PIGD型,而IPD患者海马区NAA/CR比值降低,尤以PD-CIND患者下降明显,1 H-MRS有助于IPD的诊断及分型诊断。     

正常人丘脑质子磁共振波谱分析

背景：磁共振波谱使神经影像学从单纯形态学观察进入到分子水平上的探索,有研究利用磁共振波谱发现疾病发生时丘脑生化代谢物质与正常人存在差异。 目的：利用氢质子磁共振波谱(1H-MRS)观察正常人的丘脑代谢特点,为正常人及脑部疾患的相关治疗提供客观依据。 设计、时间及地点：自身对照,横断面调查,于2007-08/2008-08在解放军第九一中心医院影像中心完成。 对象：选择解放军第九一中心医院附近社区的精神正常的居民及学生共56名,男32名,女24名。所有受检者或其监护人均对调查方案知情同意,并签署知情同意书, 方法：采用1.5T超导型磁共振成像系统,入组24 h后采用多体素1H-MRS检测丘脑生化代谢物N-乙酰天冬氨酸、胆碱复合物与肌酸复合物。 主要观察指标：用随机软件测量N-乙酰天冬氨酸、胆碱复合物、肌酸复合物的峰下面积,以肌酸复合物峰为参照,计算机自动完成N-乙酰天冬氨酸/肌酸复合物值、胆碱复合物/肌酸复合物值、N-乙酰天冬氨酸/(胆碱复合物+肌酸复合物)值的计算。 结果：正常人丘脑1H-MRS左侧N-乙酰天冬氨酸/肌酸复合物、N-乙酰天冬氨酸/(胆碱复合物+肌酸复合物)高于右侧,胆碱复合物/肌酸复合物低于右侧,但差异但差异无显著性意义(P > 0.05)。经Pearson分析,丘脑双侧各观察指标与年龄均无相关性(P > 0.05);不同性别间比较,男性组左右两侧N-乙酰天冬氨酸/肌酸复合物、右侧胆碱复合物/肌酸复合物、左侧N-乙酰天冬氨酸/(胆碱复合物+肌酸复合物)均高于女性组,余观察指标低于女性组,但差异均无显著性意义(P > 0.05)。 结论：正常人丘脑代谢物双侧无差异,代谢物水平可能并不受性别和年龄的影响。     

偏侧帕金森病猴模型纹状体的质子磁共振波谱研究

目的观察偏侧帕金森病（PD）猴模型纹状体质子磁共振波谱（1H-MRS）的变化,探讨1H-MRS对PD的早期诊断价值。方法对4只恒河猴经右侧颈内动脉注射1-甲基4-苯基1、2、3、6-四氢吡啶（MPTP）制备偏侧PD猴模型前后的双侧纹状体进行1H-MRS检测,对比分析制模术前和术后猴双侧纹状体N-乙酰基天门冬氨酸（NAA）/肌酸复合物（Cr）和胆碱复合物（Cho）/Cr比值的变化。结果4只猴均成功制备成偏侧PD猴模型。偏侧PD猴模型MPTP毁损侧对侧纹状体NAA/Cr和Cho/Cr比值较制模术前无明显改变（P〉0.05）;但偏侧PD猴模型MPTP毁损侧纹状体NAA/Cr比值较制模术前和对侧明显降低（P〈0.05）,Cho/Cr比值较制模术前和对侧明显增高（P〈0.05）。结论H-MRS能够早期发现偏侧PD猴模型纹状体的代谢和生化改变,间接反映偏侧PD猴模型纹状体的神经细胞病理学改变,有助于PD的早期诊断。     

脑质子磁共振波谱分析对早期帕金森病诊断价值的初步研究

目的探讨质子磁共振波谱（1H—MRS）在早期帕金森病（Parkinson’sdisease,PD）诊断中的临床应用价值。方法对20例偏侧PD患者（Hoehn-YahrI级）和20例年龄匹配正常对照者双侧纹状体进行1H-MRS检测,对比分析PD患者与正常对照者的纹状体N-乙酰基天门冬氨酸（NAA）／肌酸复合物（Cr）和含胆碱化合物（Cho）／Cr比值的变化。结果PD患者患侧肢体对侧纹状体NAA／Cr比值显著低于同侧和正常对照者（P〈0．05）,Cho／Cr比值显著高于同侧和正常对照者（P〈0．05）;但PD患者患侧肢体同侧纹状体NAA／Cr和Cho／Cr比值与正常对照者比较无显著差异（P〉0．05）。结论1H-MRS是可以为偏侧PD患者纹状体的神经细胞病理学改变提供有价值的信息的一种无创技术,有助于早期PD的诊断。     

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     

质子(1H)磁共振波谱在帕金森病诊断中的应用

磁共振波谱(MRS)可用于无损伤地进行活体定位脑组织的代谢、生化研究及定量分析,其在帕金森病的早期诊断、鉴别诊断和监测病情发展有明显的价值.文章综述了近年来1H-MRS诊断帕金森病的研究进展,显示了1H-MRS良好的临床应用前景.     

初发抑郁症患者丘脑质子磁共振波谱分析

目的探讨未用药首发抑郁症患者丘脑的脑代谢有无异常。方法利用质子磁共振波谱分析技术(1H-MRS)检测20例未用药首发抑郁症患者和20名健康志愿者丘脑的多个代谢指标,包括乙酰天门冬氨酸盐(NAA)、谷氨酰胺和谷氨酸复合物(Glx)、胆碱复合物(Cho)、肌酸-磷酸肌酸复合物(Cr)等。结果与对照组相比,患者组双侧丘脑NAA/Cr下降,但只有右侧的差异有统计学意义(t=2.923,P<0.05);两组间各代谢值、Cho/Cr和Glx/Cr的差异无统计学意义(P>0.05);轻度抑郁组和重度抑郁组间比较,各代谢值的差异均无统计学意义(P>0.05)。结论初发抑郁症患者右侧丘脑可能存在神经元受损和线粒体代谢障碍。     

精神分裂症患者前额叶和丘脑的质子磁共振波谱研究

Objective To identify the metabolite levels in prefrontal lobe and thalamus in patients with schizophrenia by proton magnetic resonance spectroscopy (1H-MRS). Methods Thirty-eighty schizophrenics and 38 normal controls were involved in this study. A multi-voxel 1H-MRS was given to all the subjects on prefrontal lobe and thalamus within 24 hours they got in hospital. The N-acetylaspartate (NAA), choline-congtaining compounds (Cho), and creatine compounds (Cr) were measured and the ratios of NAA/Cr, Cho/Cr and NAA/( Cho + Cr) were determined Results In left prefrontal lobe and bilateral thalamus, the NAA/Cr ratio in patients demonstrated lower than that in normal controls ( all P <0. 05). In left prefrontal lobe, the NAA/(Cho + Cr) ratio in patients showed lower than that in normal controls (0. 64 ±0. 13 vs. 0. 74±0. 22,t =2. 26, P<0. 05). Both in patients and in normal controls, there were no significant differences in NAA/Cr, Cho/Cr and NAA/(Cho + Cr) between the two sides (all P >0. 05). Conclusious Abnormalities in neuronal function and/or integrity are present in schizophrenics.There is no significantly lateralized asymmetry for metabolite levels such as NAA, Cho and Cr in either the schizophrenics or the controls.     

质子磁共振波谱用于帕金森病黑质代谢研究价值的探讨

目的探讨质子磁共振波谱（^1H MRS）技术在帕金森病（PD）黑质代谢变化研究中的价值。方法PD患者56例和正常对照30例行^1H MRS检查，测定双侧黑质的N-乙酰天门冬氨酸／肌酸（NAA／Cr）、N-乙酰天门冬氨酸／胆碱复合物（NAA／Cho）和胆碱复合物／肌酸（Cho／Cr）比值。结果PD患者和对照组黑质的NAA／Cr、Cho／Cr和NAA／Cho比值无显著性差异。PD患者的^1H MRS结果与UPDRS评分、H＆Y分级和病程均不存在显著相关性。结论目前的^1H MRS技术尚不能精准地反应PD患者黑质的代谢变化。     

帕金森病患者额叶磁共振波谱的改变及其临床意义

目的研究帕金森病(PD)患者额叶磁共振波谱(1H-MRS)的改变及其临床意义。方法对36例PD患者(Hoehn-YahrⅠ级14例、Ⅱ级8例、Ⅲ级8例、Ⅳ级6例)和20名年龄匹配的正常对照者的双侧额叶进行1H-MRS检测,对比分析不同Hoehn-Yahr级别PD患者与正常对照组的额叶N-乙酰基天门冬氨酸(NAA)/肌酸复合物(Cr)和含胆碱化合物(Cho)/Cr值的变化。结果Hoehn-YahrⅢ级和Ⅳ级PD患者双侧额叶的NAA/Cr值显著低于正常对照组(P<0.005,P<0.01),Cho/Cr值显著高于正常对照者(均P<0.005);Hoehn-YahrⅠ级和Ⅱ级PD患者双侧额叶的NAA/Cr和Cho/Cr值与正常对照组差异无统计学意义。结论Hoehn-YahrⅢ级和Ⅳ级PD患者额叶1H-MRS有明显异常。提示1H-MRS有助于PD病情的评估。     

Proton magnetic resonance spectroscopy in patients with ischemic stroke

Proton magnetic resonance spectroscopy (¹H-MRS) is a non-invasive technique which has proved to be useful for monitoring various brain metabolites (N-acetyl-aspartate, choline, creatine-phosphocreatine, lactate). A total of 18 patients underwent a combined magnetic resonance imaging (MRI)/¹H-MRS protocol in order to evaluate the distribution of the metabolites in the various stages of cerebral ischemia. Our results show a marked decrease of N-acetyl-aspartate and a large content of Lactate during the early phases, and a decrease in N-acetylaspartate, choline and creatine-phosphocreatine (Cr-PCr) during the chronic phase.

---

Sommario La risonanza magnetica protonica spettroscopica (¹H-RMS) è una tecnica non invasiva che si è dimostrata essere utile per il monitoraggio di alcuni metaboliti (N-Acetil-aspartato, Colina, Creatina-Fosfocreatina, Lattato) del tessuto cerebrale. Un totale di 18 pazienti è stato sottoposto ad un protocollo combinato di risonanza magnetica imaging e¹H-RMS per valutare la distribuzione dei metaboliti in differenti stati dell'ischemia cerebrale. I nostri risultati nelle fasi precoci mostrano un marcato decremento dell'N-Acetil-aspartato ed un notevole contenuto di lattato, mentre nella fase cronica un decremento dell'N-Acetil-aspartato, della Colina e Creatina-Fosfocreatina.

     

Proton magnetic resonance spectroscopy of patients with parkinsonism

We studied cerebral metabolism in 82 patients with nonfamilial parkinsonism, including Parkinson's disease (PD; n = 23), progressive supranuclear palsy (PSP; n = 12), corticobasal degeneration (CBD; n = 19), multiple systemic atrophy (MSA; n = 18) and vascular parkinsonism (VP; n = 10) by using proton magnetic resonance spectroscopy ((1)H-MRS), which allowed noninvasive measurement of signal intensities from N-acetylasparate (NAA), choline-containing compounds (CHO) and creatine plus phosphocreatine (CRE). As compared to normal controls, patients with PSP, CBD, MSA and VP, but not PD, had significant reduction of the NAA/CRE ratio in the frontal cortex, whereas patients with PSP, CBD, MSA and PD, but not VP, had significant reduction of the NAA/CRE ratio in the putamen. Patients with CBD had significant reduction of the NAA/CRE ratio in the frontal cortex and putamen as compared to patients with PD, MSA and VP. Patients with PSP showed a significant reduction of the NAA/CRE ratio in the putamen as compared with patients with PD and MSA. Patients with CBD showed clear asymmetry in the putamen as compared to controls and other patients. The reduction of the NAA/CRE ratio in the putamen correlated well with the severity of parkinsonism. (1)H-MRS may be useful in monitoring patients with various types of parkinsonism.     

Proton magnetic resonance spectroscopy (1H-MRS) of hippocampus, basal ganglia, and vermis of cerebellum in schizophrenia associated with idiopathic unconjugated hyperbilirubinemia (Gilbert's syndrome)

OBJECTIVE: Whether patients with schizophrenia-associated idiopathic unconjugated hyperbilirubinemia (Gilbert's syndrome, GS) have specific changes in brain metabolism was examined in this study. METHOD: This study applied proton magnetic resonance spectroscopy (1H-MRS) to the hippocampus, basal ganglia, and vermis of the cerebellum of schizophrenic patients with GS (n=15) or without GS (n=15), all diagnosed according to DSM-IV criteria, and healthy subjects (n=15). RESULTS: In the hippocampus, schizophrenic patients with GS showed a significant decrease of N-acetyl aspartate/creatine-phosphocreatinine (NAA/Cr) and myoinositol/creatine-phosphocreatinine (mI/Cr) ratios compared to healthy subjects and schizophrenic patients without GS, while schizophrenic patients without GS showed only a significant decrease of NAA/Cr compared to healthy subjects. In the basal ganglia, schizophrenic patients with GS showed a significant decrease of ml/Cr compared to schizophrenic patients without GS and healthy subjects, and schizophrenic patients with GS showed a significant decrease of NAA/Cr compared to healthy subjects. In the vermis of the cerebellum, schizophrenic patients with GS showed only a significant decrease of ml/Cr compared to healthy subjects, although schizophrenic patients without GS did not show a significant decrease of ml/Cr compared to healthy subjects. CONCLUSION: The findings suggest that schizophrenia with GS is a more severe sub-type with regard to brain metabolism.     

Proton magnetic resonance spectroscopy and transcranial magnetic stimulation for the detection of upper motor neuron degeneration in ALS patients

Transcranial magnetic stimulation (TMS) was compared to proton magnetic resonance spectroscopy (¹H-MRS) for the detection of upper motor neuron loss or dysfunction in 49 ALS patients classified according to the El Escorial criteria. Abnormal NAA/Cho ratios were detected in 53% of ALS patients. Abnormal TMS results (i.e. cortical inexcitability or prolonged CMCT's) were obtained in 63% of ALS patients. If one or both methods were considered for diagnosis of upper motor neuron degeneration/dysfunction, the percentage of abnormal findings was 77%, whilst in 39% of all patients both methods produced abnormal results. Compared to TMS, ¹H-MRS detected more patients with upper motor neuron involvement in the suspected El Escorial subgroup (42% versus 25%), whereas TMS detected more patients with upper motor neuron involvement in the possible (81% versus 50%), probable (71% versus 57%) and definite El Escorial subgroup (71% versus 64%). We conclude that the combined use of ¹H-MRS and TMS increases diagnostic accuracy for the detection of upper motor neuron involvement in ALS patients.     

Proton magnetic resonance spectroscopy (H-MRS) of the thalamus in schizophrenia

This study applied ¹H-MRS in the thalamus of schizophrenic patients and healthy subjects.There were no differences in the metabolite ratios (NAA/Cr, Cho/Cr or mI/Cr) between the two groups. Relationships were noted between NAA/Cr and age in patients with a trend toward this correlation in controls, suggesting an effect of age on the metabolism of the thalamus.     

Neurochemical correlates of cognitive dysfunction in patients with leukoaraiosis: a proton magnetic resonance spectroscopy study

Abstract

Objectives: Leukoaraiosis (LA) is a common radiological finding in the elderly and may reflect cerebral small vessel disease (SVD). Although SVD has been identified as a major cause of vascular cognitive impairment or vascular dementia, the mechanisms for this association remain unclear. We therefore aimed to measure brain metabolites in LA using proton magnetic resonance spectroscopy (¹H-MRS) as to determine the relationship between cognitive function and neurochemical white matter profile.

Methods: We recruited 23 patients with LA and 23 age- and sex-matched healthy controls consecutively. Multi-voxel ¹H-MRS was performed with a volume of interest located in centrum semiovale that contained mainly white matter voxels. Three main ratios of N-acetyl aspartate (NAA)/Cr, choline (Cho)/Cr and NAA/Cho were obtained. Spearman rank correlation coefficients were calculated between the cognitive function and the measured metabolite ratios.

Results: We found significantly lower levels of NAA/Cho and NAA/Cr ratios in lesioned white matter in patients with LA than healthy controls (P<0·05). The ratios of NAA/Cho and NAA/Cr in normal appearing white matter (NAWM) were higher than lesioned white matter and lower than controls, but this difference was not significant (P>0·05). There was a positive relationship between Mini-Mental State Examination (MMSE) and NAA/Cho in NAWM (r?=?0·417, P?=?0·048), and also a positive relationship between MMSE and NAA/Cr in lesioned white matter (r?=?0·551, P?=?0·006) in patients with LA. A positive relationship between the Z scores of the executive function and NAA/Cho in lesioned white matter (r?=?0·557, P?=?0·006) was also found.

Conclusion: The main finding of this study was a significant reduction in the ratios of NAA/Cr and NAA/Cho in lesioned white matter, which indicates a marker of neuronal loss or dysfunction in patients with LA, which was correlated with cognitive function. This relationship between cognitive function and metabolic changes suggests that ¹H-MRS can be explored as a marker for cognitive dysfunction in patients with LA.     

多体素氢质子磁共振波谱对颞叶癫(癎)定位作用的临床研究

目的研究多体素氢质子磁共振波谱（1H-MRS）对颞叶癫癎的致癎灶定位作用。方法对36例颞叶癫癎病人和15例正常人进行MRI扫描和1H-MRS成像,采样容积为8.8mm×8.8mm×8.0mm,选取海马前部相邻3个体素,取平均值,比较病侧、健侧以及对照组氮-乙酰天门氨酸（NAA）/肌酸＋胆碱复合物（Cr＋Cho）等比值的差异。并分析MRI与1H-MRS在定位致癎灶方面的差异。结果与对照组比较,病侧NAA/（Cr＋Cho）明显降低,差异具有统计学意义。MRS定位率50%,联合应用MRI与1H-MRS定位准确率可达到83.3%;MRI阴性病例中45.5%的病人MRS为阳性。结论1H-MRS可有效定位颞叶致癎灶,尤其是MRI阴性表现的颞叶癫癎。联合应用MRI与1H-MRS可提高定位致癎灶的比例。     

Proton magnetic resonance spectroscopy detects a relative decrease of N-acetylaspartate in the hippocampus of patients with dementia with Lewy bodies.

BACKGROUND AND PURPOSE: To characterize the cerebral metabolic changes in dementia with Lewy bodies patients. METHODS: The metabolic ratios of NAA/Cr and Cho/Cr in bilateral hippocampus were determined by proton magnetic resonance spectroscopy in 8 patients and 8 age-matched healthy controls. RESULTS: Dementia with Lewy bodies patients showed significantly lower NAA/Cr ratios in bilateral hippocampus, while the Cho/Cr ratio did not differ from the control group. CONCLUSIONS: Our data show relatively decrease of N-acetylaspartate in the hippocampus of patients with early or intermediate stage DLB. Hence, damage of neurons seems to be an early alteration in DLB.