哌醋甲酯治疗前后注意缺陷多动障碍儿童语义工作记忆功能MRI研究

目的:研究哌醋甲酯治疗后注意缺陷多动障碍(ADHD)儿童完成语义工作记忆任务下脑区功能状态的改变,评价fMRI用于研究ADHD治疗机制的可行性.方法:ADHD组儿童6例,男性4例,女性2例,平均年龄12.50±1.87岁,符合DSM-Ⅳ诊断标准.ADHD儿童在治疗前后(检查前3h口服哌醋甲酯,0.2～0.3mg/kg)两种情况下进行行为学评估和功能MRI检查,两次间隔2～4周.刺激任务采用N-BACK模式下的语义工作记忆任务,BLOCK设计方法.fMRI扫描采用GE 3.0T磁共振机,采用配对t检验统计方法.结果:ADHD患儿治疗后脑功能区的激活多于治疗前,1-BACK任务下左侧额中回、双侧额下回、左顶下小叶、双侧基底节等脑区激活与治疗前差异有统计学意义,在2-BACK任务下同时有左颞叶和扣带回激活不同,与认知测试成绩改善具有一定的相关性.结论:哌醋甲酯能增加ADHD患儿的工作记忆功能脑区的激活,fMRI是研究哌醋甲酯治疗ADHD机制的新方法.     

运动干预对注意缺陷多动障碍儿童执行功能的影响研究进展

注意缺陷多动障碍(ADHD)是儿童时期最常见的神经发育障碍,执行功能受损是ADHD儿童的核心缺陷.由于药物治疗存在一定的副作用及行为和心理治疗依从性较差,近些年来,运动对ADHD儿童执行功能的改善作用引起了研究者的广泛关注.本文系统回顾了近三十年来国内外相关研究,对不同运动干预方案在不同ADHD儿童中的干预实施及对不同...     

注意缺陷多动障碍儿童语义工作记忆的功能MRI研究

目的 研究注意缺陷多动障碍（ADHD）儿童在语义工作记忆任务下不同脑区的功能状态。方法 ADHD儿童与正常学龄儿童各9名，分别进行行为学评估和功能MR（MR）扫描，刺激任务采用区组（BLOCK）设计的倒退N计数（N—BACK）模式下语义工作记忆任务。MR扫描采用GE3．0 T MR记录提取阶段大脑的反应。结果 ADHD儿童在语义工作记忆任务下激活普遍低于正常组，在1-BACK任务中双侧额中回、额下回、双侧顶上小叶、顶下小叶、右基底节激活低于正常组，而在2-BACK任务中双侧额中回、额下回、双侧顶上小叶、左侧顶下小叶、右基底节及前扣带回激活低于正常组。结论 ADHD儿童的工作记忆功能区包括双侧背外侧前额叶及双侧顶叶存在功能低下，在高负荷的2-BACK任务下并有执行功能区（前扣带回）的激活降低。     

儿童注意缺陷多动障碍的脑磁共振氢谱研究

目的：观察注意缺陷多动障碍患儿脑内可能存在的神经生化异常及哌甲酯对其的影响。方法：使用无创性的磁共振氢谱检查，测量了12例患注意缺陷多动障碍儿童顿服哌甲酯10mg前后双侧苍白球内天冬氨酸（NAA）、胆碱复合物（Cho）、肌醇（mI)、α－氨基酸（glutamate plus glutamine,α-Glx)与肌酸（Cr)的比值，并与12例同龄健康儿童的结果进行比较。结果：服药前注意缺陷多动障碍患儿双侧纹状体的NAA／Cr比值较健康儿童显著降低（左侧t＝7．01，P＜0．01；右侧t＝4．95，P＜0．01）；Cho/Cr比值有单侧显著性增高（t＝2．33，P＜0．05）；mI/Cr和α-Glx-Cr比值无显著性变化。服药后NAA／Cr比值增高，但与服药前相比差异无显著性意义（左侧t＝－1．34，P＞0．05）；右侧t＝－1．04，P＞0．05），与健康儿童间差异仍有显著性意义（左侧t＝3．68，P＜0．01；右侧t＝2．50，P＜0．05）；Cho/Cr比值降至正常水平，与健康儿童间差异不再有显著性意义（t＝0．87，P＞0．05）。结论：注意缺陷多动障碍患儿双侧纹状体存在神经元神经缺失或功能障碍，胆碱能神经系统可能有轻度失常。     

足球练习对注意缺陷多动障碍男童执行功能的影响

目的：探讨足球练习对注意缺陷多动障碍（ADHD）男童执行功能的影响。方法：从某普通公立小学一、二年级学生中筛选ADHD男童16名,随机分为实验组和等待组各8名,按年龄相差不超过半岁标准募集正常对照组男生8名。全体被试正常参加学校各项体育活动,实验组进行为期6周的足球练习。6周前后分别采用Stroop色词测验、Rey-Osterrich复杂图形测验（CFT）和连线测验（TMT）测量被试执行功能三个子功能——抑制控制、工作记忆和认知灵活性。结果：（1）干预前,实验组和等待组Stroop测试的C、D时间、D错误数、颜色干扰时、字义干扰时以及TMT的B时间和错误数均高于正常对照组,CFT各得分均低于对照组,差异有统计学意义（P<0.05）;实验组和等待组两组之间均无显著性差异（P>0.05）。（2）干预后,实验组Stroop测试的A-D时间、D错误数、颜色干扰时和TMT各得分均显著低于等待组（P<0.05）,而上述各结果实验组与对照组均无显著性差异（P>0.05）;实验组CFT即时结构和细节记忆均显著高于等待组（P<0.05）,但实验组和等待组的CFT各项得分仍显...     

注意缺陷多动障碍的心理社会治疗

目的注意缺陷多动障碍的治疗涉及到社会、家庭、学校等诸多方面,故其治疗应是以药物、教育、心理治疗为主进行综合性治疗。心理社会治疗本身虽然存在如何对心理转变进行评估、如何维持长期的疗效以及费用昂贵等问题。但药物和心理社会联合治疗可提高疗效,减少药量。心理社会治疗的意义还为今后的临床实践提供了方向。     

整合视听连续性测试在儿童注意缺陷多动障碍中的应用

目的研究整合视听连续性行为测试(IVA-CPT)在诊断儿童注意缺陷多动障碍(ADHD)中的应用价值。方法将58例符合ADHD诊断标准的患儿列为病例组,另以1:1配对原则选58例健康儿童作对照组。两组均采用美国Braint rain公司的IVA-CPT测试软件对两组儿童进行持续性注意力测验。结果在58例ADHD儿童中,以注意缺陷为主型占36.2%,以多动冲动为主型占20.7%,混合型占43.1%。病例组综合反应控制商数(FSRCQ)和综合注意力商数(FSAQ)分别为80.53±12.73和68.00±11.12,对照组分别为111.16±11.03和104.05±8.69,两组间差异有显著统计学意义(P<0.001)。结论IVA-CPT是一种对儿童ADHD具有诊断价值的客观检查方法。     

长春市中心区6～18岁学生注意缺陷多动障碍调查

目的：调查长春市中心区6～18岁学生注意缺陷多动障碍（ADHD）的患病情况。方法：采用Conners教师评定量表对7 117名6～18岁学生进行筛查,按《精神疾病诊断与统计手册》第4版诊断。结果：检出ADHD155人（2.18%）,男36人（1.03%）,女119人（3.27%）,男女患病率之比1∶3.1,差异有统计学意义（χ^2=41.743,P=0.000）。～14岁组患病率最高,为5.31%,6～8岁组次之,患病率为1.21%,～11岁组患病率为0.80%,～18岁组患病率为0.56%,各年龄组间患病率差异具有统计学意义（χ^2=130.885,P=0.000）。结论：长春市中心区ADHD女生患病率高于男生,～14岁组患病率高。     

儿童注意力缺陷多动障碍放射冠前区的扩散张量成像研究

目的运用扩散张量成像(DTI)研究儿童注意力缺陷多动障碍(PADHD)患者大脑额叶放射冠前区(ACR)的异常改变。资料与方法 11例PADHD患者和11名年龄、性别和智商匹配的健康者通过Philips 1.5 TIntera Achieva磁共振扫描仪行DTI,后处理获得部分各向异性指数(FA)和表观扩散系数(ADC)图。分别于5个额叶层面:前联合、前联合上6、12、18和24 mm的双侧ACR选取6个感兴趣区。比较两组不同层面感兴趣区的上述DTI参数值。结果单因素方差分析显示PADHD患者额叶不同层面上ACR的FA值和ADC值均未见明显统计学差异(P>0.05);与正常对照组相比,ACR的FA值(F=47.13,P<0.01)和ADC值(F=113.25,P<0.01)则明显不同。结论 DTI能够显示PADHD患者ACR异常。FA降低和ADC增高可能源于其结构和完整性的丧失。     

儿童脑磁共振功能成像的研究进展

随着现代影像学技术的快速发展，功能磁共振成像技术在基础和临床方面的应用日益广泛。在成人脑功能的磁共振成像研究方面已经取得可喜的成绩，有关儿童脑的功能性磁共振成像研究的报道尚较少，但正日益受到关注，就近年来儿童脑磁共振功能成像的研究进展进行综述。     

原发性夜间遗尿症儿童注意缺陷的扩散张量成像研究

目的 评价原发性夜间遗尿症(PNE)患儿的注意/记忆水平,探讨单纯PNE患儿大脑主要投射、联络和连合纤维的扩散张量成像(DTJ)部分各项异性(FA)值与正常对照儿童的差异.资料与方法 12例右利手PNE患儿(试验组)以及12例正常对照组儿童(对照组)采用中国韦氏儿童智力量表( C-WISC)进行智力测试,计算言语智商(VIQ)、操作智商(PIQ)、总智商(FIQ)、记忆/不分心(M/C)因子等,行DTI扫描,采用基于像素的分析方法比较试验组和对照组的FA值.结果 PNE患儿FIQ、VIQ和PIQ均在正常水平,与对照组差异无统计学意义(P＞0.05).PNE患儿M/C因子显著低于对照组(P＜0.05).PNE患儿右侧胼周额部深部白质(PCF)、右侧内囊前肢(AIC)和左侧小脑中脚(MCP) FA值显著低于对照组(P＜0.05).结论 原发性夜间遗尿症儿童存在注意、记忆缺陷,右侧PCF、右侧AIC和左侧MCP功能障碍可能与这种功能缺陷有关.     

Functional MRI compliance in children with attention deficit hyperactivity disorder

PURPOSE

We aimed to test the effect of prescan training and orientation in functional magnetic resonance imaging (fMRI) in children with attention deficit hyperactivity disorder (ADHD) and to investigate whether fMRI compliance was modified by state anxiety.

METHODS

Subjects included 77 males aged 6–12 years; there were 53 patients in the ADHD group and 24 participants in the healthy control group. Exclusion criteria included neurological and/or psychiatric comorbidities (other than ADHD), the use of psychoactive drugs, and an intelligence quotient outside the normal range. Children were individually subjected to prescan orientation and training. Data were acquired using a 1.5 Tesla scanner and an 8-channel head coil. Functional scans were performed using a standard neurocognitive task.

RESULTS

The neurocognitive task led to reliable fMRI maps. Compliance was not significantly different between ADHD and control groups based on success, failure, and repetition rates of fMRI. Compliance of ADHD patients with extreme levels of anxiety was also not significantly different.

CONCLUSION

The fMRI compliance of ADHD children is typically lower than that of healthy children. However, compliance can be increased to the level of age-matched healthy control children by addressing concerns about the technical and procedural aspects of fMRI, providing orientation programs, and performing on-task training. In patients thus trained, compliance does not change with the level of state anxiety suggesting that the anxiety hypothesis of fMRI compliance is not supported.Functional magnetic resonance imaging (fMRI), which uses blood oxygen level-dependent contrast, is a noninvasive procedure for imaging regional brain activity. MRI exhibits high spatial resolution; even 1.5 Tesla (T) imaging used in standard clinical practice (spatial resolution of 2–4 mm) yields robust functional signal changes (1). MRI can be performed without the ethical concerns associated with the other available imaging techniques and can thus be used in children and in healthy populations. In healthy volunteers, fMRI has produced reproducible findings across scanning sites and age groups with respect to the localization and development of cognitive processes (2). Its capacity for noninvasive imaging of the brain in vivo during cognitive processing has made fMRI an exciting tool for laboratory research, as well as clinical studies and clinical practices that involve diagnosis, follow-up, and presurgical mapping (3, 4).A disorder that attracts a great deal of attention in children is attention deficit hyperactivity disorder (ADHD). This focused attention is partly due to the high incidence (0.2%–12.2%) of ADHD, which is also the most frequent diagnosis in children referred to child psychiatry departments (5–7). From the neuropsychological point of view, ADHD is associated with deficits in executive functions (8, 9). Nevertheless, as the number of theories on the subject demonstrates, ADHD remains an unresolved issue, especially with respect to its biological basis and brain correlates (10).With its many merits, fMRI would be a valuable tool for studying the etiology, diagnosis, and follow-up of ADHD patients. However, MRI is movement-sensitive, and movement artifacts impair the diagnostic quality of the examination and can even render the scans unusable. A meta-study involving 21 000 cases, reported an overall artifact frequency of 40% (11). Normal body pulsations accounted for 7%–12% of the artifacts, but at least 10% were due to motoric unrest or restlessness. In another study, artifacts other than normal body pulsations were reported in 12.8% of the scans and 6.4% of the scans were impaired in diagnostic quality (12).The symptoms of ADHD include hyperactivity, impulsivity, and inattention (13). Of these symptoms, the first two directly challenge the immobility requirement of MRI, and the third poses a problem for the task-appropriate responses that cognitive tasks require for functional imaging. Not unexpectedly, the fMRI compliance of ADHD patients is poor. In 7–12-year-old unmedicated ADHD patients, the frequency of successful runs was 77%, and the success rate for the completion of the total fMRI battery was 50%, while the values for age-matched healthy volunteers were 96% and 88%, respectively (14).Artifacts other than those caused by organ pulsations have been associated with anxiety or anxiety-sensitivity (15). Medium-to-severe anxiety was reported in 25%–37% of adults undergoing MRI (16, 17). Up to 30% exhibited anxiety-related reactions that ranged from apprehension to a reaction level severe enough to interfere with performance (18). MRI artifacts were also related to the degree of fear and/or panic and anxiety disorders such as claustrophobia (16, 19).A group of studies rejected the contribution of anxiety and proposed another set of causal factors for the artifacts and the resulting fMRI incompliance. According to these studies, patient distress can be predicted from the degree of claustrophobia but not from anxiety sensitivity per se (16). An analytical study (12) measured state anxiety using the Spielberger State-Trait Inventory (STAI), a tool commonly used for measuring state anxiety (20). In their study, state anxiety did not account for the development of movement artifacts. The artifacts were found to be associated with prescan concerns about the technical apparatus and with the procedural aspects of imaging; these concerns were focused on the narrowness of space, noise, immobility, and scan duration. The concerns, which were rated as hardly bearable, were identified in 70.6% of all individuals developing movement artifacts.An approach for meeting the concerns about the technical and procedural aspects focuses on patient comfort and cooperation. In ADHD patients, the effect of individualized prescan preparation was investigated using operant-contingency-based procedures where immediate verbal feedback was provided on response accuracy and where positive reinforcement (verbal praise) was delivered upon criterion achievement (21). This prescan preparation reduced the extent of head movements in both ADHD patients and healthy controls. However, the approach was time-consuming and, due to the sample size (n= 4), too small to be generalizable. Another approach adopted a systematically administered prescan orientation and training program (22). The study reported an overall success rate of approximately 80% in normal children and adolescents (age range, 5–18 years). Based on these findings, the study concluded that it is feasible to conduct large-scale fMRI studies in children. To our knowledge, the effect of such prescan preparations on fMRI compliance has not yet been investigated in children with ADHD.In this study we aimed to demonstrate whether prescan training and orientation affect fMRI compliance of children with ADHD and determine whether this compliance is modified by state anxiety. The study used a well-known cognitive task in the neuropsychology literature, with well-documented activation patterns in the brain.     

国人汉字书写神经基础的脑功能成像

目的:利用功能磁共振成像技术(fMRI),研究正常国人汉字书写功能的神经基础.材料和方法:采用GE公司Signa1.5T磁共振成像系统,对10名健康右利手母语为汉语的志愿者进行默读、复杂对指运动、抄写三个任务期间的功能活动进行了全脑扫描.数据经过空间平滑、头动矫正、卷积分析等处理,获得抄写减去默读、抄写减去对指之后脑功能激活图,统计出两者间共同的激活区.结果:主要共同激活区位于额顶叶皮质,包括左侧额中回,双侧顶上小叶,双侧顶下小叶,两侧额内侧回,左侧中央前、后回.结论:汉字的书写是双脑协同的过程,右侧大脑半球对汉字的书写尤其重要;书写功能涉及较多的皮质及皮质下结构,利用功能磁共振成像可以揭示这些结构在书写过程中的作用.     

人脑注意网络神经基础的功能MRI研究

目的采用事件相关功能MRI(event-related functional MRI，ER-fMRI)方法确认前后注意网络的神经基础以及两者的相互关系。方法对8例右利手的健康志愿者进行了视觉定向中返回抑制效应与Stroop色词干扰任务相结合的实验测试，同时采用Siemens Sonata 1．5T成像系统，采集其脑部的fMRI数据，通过功能神经成像分析(analysis of functional neuroimage，AFNI)软件进行统计分析得到脑功能活动的图像。结果8例受试者中6例的资料符合研究条件而被采用。(1)标识前注意网络(AAN)的Stroop色词任务和标识后注意网络(PAN)的返回抑制(IOR)任务的相关脑组织激活区与有关实验结果类似；(2)提示位置相关脑组织激活区见于左侧顶下小叶(BA40)、MT／V5区、右侧背外侧前额叶(BA9)和左侧前扣带回(ACC)；非提示位置相关脑组织激活区见于右侧顶上小叶(BA7)和双侧MT／V5区。结论AAN对PAN起调节作用，同时PAN也影响AAN作用的充分发挥，AAN和PAN是相互联系、相互作用的2个注意子网络；ER-fMRI是合理修正原有的关于认知活动模型和理论的一种有效手段。     

磁共振弥散张量成像及脑功能成像在涉及运动通路脑肿瘤中的初步联合应用

目的:初步探讨联合磁共振弥散张量成像(DTI)及脑功能成像(Bold-fMRI)在涉及运动通路脑肿瘤的应用价值,观察肿瘤与功能区及邻近锥体束的关系.材料和方法:采用GE3.0TMRI成像系统,对12例临近运动皮质及锥体束的肿瘤(Ⅲ-Ⅳ级胶质瘤5例,II级胶质瘤3例,海绵状血管瘤2例,脑膜瘤2例)进行检查,均行Bold-fMRI及DTI序列,fMRI应用手的对掌运动或足背屈运动作为任务刺激.所有数据进行离线后处理,应用SPM99软件处理fMRI图像,观察运动皮质激活,DTI采用DTV1.5软件进行纤维束的成像.结果:12例肿瘤FA图显示良好,肿瘤区FA值较健侧比较有明显下降(P<0.05).纤维束重建后7例可见锥体束的消蚀破坏,其中5例伴有变形及移位;3例可见锥体束的单纯变形及受压移位;2例锥体束未见破坏及移位;11例肿瘤患侧手或足运动均可见对侧初级运动皮质(M1)的激活(1例因肢体瘫痪而失败),其中7例并有辅助运动区(SMA)及同侧M1的激活.比较fMRI及纤维束重建图发现肿瘤、功能区及白质束三者之间关系可以清楚显示.3例肿瘤DTI及fMRI联合用于外科神经导航系统,成功的指导手术.结论:DTI及Bold-fMRI联合应用可以更好的观察瘤体、功能区及白质纤维三者关系,辅助术前手术方案的制定,指导手术切除.     

Functional Neuroanatomy in Depressed Patients with Sexual Dysfunction: Blood Oxygenation Level Dependent Functional MR Imaging

Objective

To demonstrate the functional neuroanatomy associated with sexual arousal visually evoked in depressed males who have underlying sexual dysfunction using Blood Oxygenation Level Dependent-based fMRI.

Materials and Methods

Ten healthy volunteers (age range 21-55: mean 32.5 years), and 10 depressed subjects (age range 23-51: mean 34.4 years, mean Beck Depression Inventory score of 39.6±5.9, mean Hamilton Rating Scale Depression (HAMD)-17 score of 33.5±6.0) with sexual arousal dysfunction viewed erotic and neutral video films during functional magnetic resonance imaging (fMRI) with 1.5 T MR scanner (GE Signa Horizon). The fMRI data were obtained from 7 oblique planes using gradient-echo EPI (flip angle/TR/TE=90°/6000 ms/50 ms). The visual stimulation paradigm began with 60 sec of black screen, 150 sec of neutral stimulation with a documentary video film, 30 sec of black screen, 150 sec of sexual stimulation with an erotic video film followed by 30 sec of black screen. The brain activation maps and their quantification were analyzed by SPM99 program.

Results

There was a significant difference of brain activation between two groups during visual sexual stimulation. In depressed subjects, the level of activation during the visually evoked sexual arousal was significantly less than that of healthy volunteers, especially in the cerebrocortical areas of the hypothalamus, thalamus, caudate nucleus, and inferior and superior temporal gyri. On the other hand, the cerebral activation patterns during the neutral condition in both groups showed no significant differences (p < 0.01).

Conclusion

This study is the first demonstration of the functional neuroanatomy of the brain associated with sexual dysfunction in depressed patients using fMRI. In order to validate our physiological neuroscience results, further studies that would include patients with other disorders and sexual dysfunction, and depressed patients without sexual dysfunction and their treatment response are needed.     

功能磁共振成像的脑能量代谢机制

fMRI在脑生理刺激下所测得的信号来自于神经元(谷氨酸盐的释放)与星形胶质细胞(糖酵解)之间代谢和信号的交换,这是脑功能成像技术的细胞学和分子学理论基础.