Proton magnetic resonance spectroscopy in dementia with Lewy bodies

Proton magnetic resonance spectroscopy ((1)H-MRS) provides a non-invasive, in vivo insight into the brain metabolism, and has been successfully used in several neurological conditions. Our objective was to characterise the cerebral metabolic changes in dementia with Lewy bodies (DLB) patients using (1)H-MRS. Single Voxel (1)H-MRS was performed in 12 DLB patients with mild to moderate symptoms and 11 age-matched healthy controls. Volumes of interest (VOI) were selected, including white matter (WM) in the centrum semiovale and grey matter (GM) in the parasagittal parietal cortex. Main metabolic peaks corresponding to N-acetylaspartate (NAA), glutamate/glutamine (Glx), choline-containing compounds (Cho), myo-inositol (Ins), and creatine plus phosphocreatine (Cr) were identified. These areas were measured and referred to that of the water. Metabolic ratios among the different peak areas were also calculated. In comparison with the control group, DLB patients showed significantly lower mean NAA/Cr, Glx1/Cr and Cho/Cr ratios in the WM, while their Ins/Cr and Ins/NAA ratios did not differ from those of the control group. In the GM, no significant differences were found between both groups. Correlations between age at onset, disease duration, Mini-Mental State Examination, the motor section of the Unified Parkinson's Disease Rating Scale, Hoehn and Yahr staging and metabolic ratios, both for WM and GM, were not significant in DLB patients. Our spectroscopy data show WM involvement, along with GM preservation, in DLB patients with early or intermediate stages. Hence, (1)H-MRS may provide adjunctive information in the ante-mortem diagnosis of DLB.     

阳性症状为主型精神分裂症首次发病患者前额叶和海马磁共振质子波谱成像研究

目的 探讨阳性症状为主型精神分裂症首次发病患者前额叶和海马的磁共振质子波谱(1H-MRS)变化特点,为其病因学探讨提供线索.方法 对22例首次发病精神分裂症阳性症状为主型患者(患者组)和11名年龄、性别、受教育时间均匹配的正常对照者(对照组),应用2D 1H-MRS成像技术检测2组双侧前额叶白质、前扣带回皮质、海马N-乙酰天门冬氨酸(NAA)、胆碱(Cho)、肌酸(Cr)3种代谢物,分别计算NAA/Cr和Cho/Cr的比值;采用配对t检验、独立样本t检验进行统计分析.结果 (1)患者组左侧额叶白质NAA/Cr和Cho/Cr分别为(1.63±0.30)和(1.23±0.26),均低于对照组[(2.10±0.30)、(1.54±0.25)],右侧额叶白质NAA/Cr(1.70±0.34)低于对照组(1.97±0.34),差异有统计学意义(P<0.01和P<0.05);(2)双侧前扣带回皮质NAA/Cr、Cho/Cr值与对照组差异无统计学意义(P>0.05);(3)患者组右侧海马NAA/Cr(1.59±0.27)高于对照组(1.24±0.17),差异有统计学意义(P<0.01);(4)对照组内左侧额叶白质Cho/Cr(1.54±0.25)高于右侧(1.35±0.18),左侧海马NAA/Cr(1.45±0.28)高于右侧(1.24±0.17),差异均有统计学意义(P<0.05);(5)患者组内左侧海马NAA/Cr和Cho/Cr分别为(1.43±0.27)和(1.39±0.38),均低于右侧[(1.59±0.27)、(1.56±0.39)],差异有统计学意义(P<0.05).结论 首发精神分裂症阳性症状为主型患者的1H-MRS代谢物与正常人存在差异,提示阳性症状为主型患者存在双侧前额叶白质、海马的神经功能障碍.

Abstract：

Objective To identify the possible alteration of brain functioning in prefrontal lobes and hippocampus in the first-episode positive symptoms of schizophrenia using proton magnetic resonance spectroscopy (1H-MRS). Methods 1H-MRS was performed on prefrontal white matter, anterior cingulated cortex and hippocampus in 22 patients and 11 age-, sex-, and education-matched right-handed healthy controls. The ratios of N-acetylaspartate (NAA)/creatine (Cr) and choline-containing compounds (Cho)/Cr were calculated. Results The NAA/Cr and Cho/Cr ratios in the left prefrontal white matter in patients were lower than that in normal controls (patients, NAA/Cr 1. 63 ±0. 30; Cho/Cr 1. 23 ±0. 26; controls, NAA/Cr 2. 10 ±0. 30; Cho/Cr 1. 54 ± 0. 25, P<0. 01) , and NAA/Cr in the right prefrontal white matter was lower in patients than in controls (patients 1. 70 ± 0. 34; controls 1. 97 ± 0. 34, P<0. 05). There were no significant difference in NAA/Cr, Cho/Cr for the bilateral anterior cingulated cortex between patients and controls (P>0. 05). The ratio of NAA/Cr in the right hippocampus was significantly higher in patients than that in controls (patients 1. 59 ± 0. 27; controls 1. 24 ± 0. 17, P<0. 01). In addition, in healthy controls,Cho/Cr was significantly higher in the left prefrontal white matter than in the right (left 1. 54 ± 0. 25; right 1. 35 ±0. 18, P<0. 05) , and NAA/Cr in the left hippocampus was significantly higher than in the right (left 1. 45 ± 0. 28; right 1. 24 ± 0. 17, P<0. 05). While NAA/Cr and Cho/Cr in the left hippocampus were significantly lower than in the right hippocampus in schizophrenia patients (left, NAA/Cr 1.43 ± 0. 27;Cho/Cr 1.39 ±0.38; right, NAA/Cr 1.59 ±0.27; Cho/Cr 1.56 ±0.39, P<0.05). Conclusion There is the significant difference of manifestation of 1H-MRS between schizophrenia patients with positive symptoms and normal controls, which reflects neuronal dysfunction in the prefrontal lobes and hippocampus.     

氟西汀对脑卒中后抑郁患者海马磁共振氢质子波谱影响的研究

目的探讨氟西汀对脑卒中后抑郁患者海马氢质子磁共振波谱(~1 H-MRS)影响的特点。方法以60例脑卒中后抑郁患者为研究组,研究组给予氟西汀抗抑郁治疗8周,以62名脑卒中患者为对照组。采用~1 H-MRS检测脑卒中后抑郁患者(研究组)治疗前后及脑卒中患者(对照组)双侧海马的N-乙酰基天门冬氨酸(NAA)、胆碱复合物(Cho)与肌酸复合物(Cr),以NAA/Cr值和Cho/Cr值进行统计分析。结果研究组治疗前后左右侧海马NAA/Cr值(分别为1.22±0.31和1.19±0.42,1.46±0.35和1.43±0.41)均低于对照组(分别为1.69±0.33和1.66±0.47),差异有统计学意义(均P0.05);研究组治疗前后左右侧海马Cho/Cr值(分别为1.58±0.39和1.59±0.46,1.55±0.43和1.53±0.42)高于对照组(分别为1.26±0.42和1.31±0.47),差异有统计学意义(均P0.05);研究组治疗后左右侧海马NAA/Cr值(分别为1.46±0.35和1.43±0.41)均高于治疗前(分别为1.22±0.31和1.19±0.42),差异有统计学意义(均P0.05)。结论氟西汀可能改变脑卒中后抑郁患者海马神经元的代谢异常。     

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。     

慢性精神分裂症患者双侧海马质子磁共振波谱成像研究

目的 利用质子磁共振波谱(~1H-MRS)研究慢性精神分裂症患者双侧海马生化物质的变化.方法 选择武警广东总队医院神经外科自2007年1月至2009年6月收治的慢性精神分裂症患者25例做为患者组,门诊体检正常志愿者25例为对照组,利用~1H-MRS测量2组成员双侧海马N-乙酰天门冬氨酸(NAA),胆碱复合物(Cho)和肌酸--磷酸肌酸复合物(Cr)含量,计算NAA/Cr和Cho/Cr的比值.结果 慢性精神分裂症患者双侧海马NAA/Cr的比值(左侧2.05±0.14,右侧1.98±0.17)低于正常对照组(左侧2.19±0.13,右侧2.17±0.14),差异有统计学意义(P<0.05);Cho/Cr比值(左侧1.30±0.12,右侧1.25±0.18)高于正常对照组(左侧1.04±0.15,右侧0.95±0.13),差异有统计学意义(P<0.05).结论 慢性精神分裂症患者双侧海马可能存在神经元的缺失或功能损伤,并且伴有膜磷脂代谢紊乱.     

Neurochemical pathology in hippocampus in euthymic patients with bipolar I disorder

Objective: Subcortical regions such as hippocampus, thalamus and ventral putamen are assumed to be involved in the pathophysiology of mood regulation. Disturbed hippocampal neuronal function indicated by reduced N‐acetyl‐aspartate (NAA) levels in bipolar patients was shown by several studies. Results in thalamus and putamen are inconsistent. Method: N‐acetyl‐aspartate, choline (Cho), creatine (Cr) and myo‐inositol (Ins) were measured in left hippocampus, left thalamus and left putamen using proton magnetic resonance spectroscopy in 13 euthymic patients with bipolar I disorder and 13 pairwise matched healthy control subjects. Metabolic ratios NAA/Cr, NAA/Cho, Cho/Cr and Ins/Cr were calculated. Results: Patients with bipolar I disorder demonstrated significantly reduced NAA/Cr in the left hippocampus compared with healthy control subjects. No alterations were found in thalamus or putamen. Conclusion: We hypothesize that this NAA/Cr reduction might reflect neuronal dysfunction in the left hippocampus in patients with bipolar disorder.     

重复经颅磁刺激对酒依赖患者记忆功能及海马代谢的影响

目的 探讨重复经颅磁刺激(rTMS)对酒依赖患者戒断期记忆功能的影响及与海马代谢物水平变化的关系.方法 将38例男性戒断期酒依赖患者按随机数字表分为rTMS组和伪rTMS组,rTMS组给予1 Hz刺激4周,刺激部位为右侧背外侧前额叶皮质(DLPFC);伪rTMS组给予无效刺激.治疗前后分别评估言语记忆、视觉记忆,并采用氢质子磁共振波谱(1 H-MRS)检测双侧海马部位代谢物N-乙酰基天门冬氨酸(NAA)、胆碱化合物(Cho)和肌酸复合物(Cr).结果 (1)rTMS组治疗后言语记忆和视觉记忆评分较治疗前提高(P<0.05),而伪rTMS组治疗后记忆评分较治疗前差异无统计学意义(P>0.05).治疗后,rTMS组仅视觉记忆评分优于伪rTMS组,差异有统计学意义(P<0.01),而言语记忆未见明显改善(P>0.05).(2)rTMS组治疗后双侧海马NAA/Cr、Cho/Cr较治疗前升高(P<0.01),而伪rTMS组治疗前后双侧海马NAA/Cr、Cho/Cr的差异无统计学意义(P>0.05).治疗后,rTMS组双侧海马NAA/Cr、Cho/Cr高于伪rTMS组,差异有统计学意义(P<0.01).(3)左侧海马NAA/Cr、右侧海马Cho/Cr治疗后与治疗前的差值分别与言语记忆、视觉记忆评分呈正相关(P<0.01).结论 rTMS可以改善戒断期酒依赖患者的记忆功能,其可能机制与升高海马NAA/Cr和Cho/Cr有关.     

双相抑郁患者前额叶及海马磁共振质子波谱成像研究

目的探讨双相抑郁患者前额叶及海马磁共振质子波谱(proton magnetic resonance spectroscopy,1H-MRS)的代谢物变化特点,为其神经生物学研究提供线索。方法应用磁共振质子波谱成像技术检测26例双相抑郁患者(患者组)和26例单相抑郁患者及13例健康志愿者(对照组)双侧前额叶白质、前扣带回皮质、海马N-乙酰天门冬氨酸(N-Acetylaspartate,NAA)、胆碱(choline,Cho)、肌酸(creatine,Cr)3种代谢物,以Cr为参照物,分别计算双侧NAA/Cr和Cho/Cr比值。采用SPSS 13.0进行统计处理。结果患者组左侧前额叶白质NAA/Cr(1.65±0.31)低于对照组(2.37±0.36),左侧前额叶白质Cho/Cr(1.35±0.27)低于对照组(1.65±0.21),差异有统计学意义(P<0.05);右侧前额叶白质NAA/Cr、Cho/Cr值与正常对照组差异无统计学意义;患者组双侧前扣带回NAA/Cr、Cho/Cr值与正常对照组差异无统计学意义;患者组双侧海马NAA/Cr、Cho/Cr值与正常对照组差异无统计学意义;患者组与单相抑郁组的双侧额叶白质、双侧前扣带回皮质、双侧海马NAA/Cr、Cho/Cr值差异均无统计学意义。结论双相抑郁患者可能存在左侧前额叶神经元功能下降和膜磷脂代谢异常,其代谢物特点存在偏侧化。     

急性脑梗死患者脑组织磁共振波谱研究

目的研究基底节区急性脑梗死患者脑组织磁共振波谱(MRS)的改变。方法应用MRS检测50例一侧基底节区梗死患者(脑梗死组)及50例其他疾病患者(对照组)双侧基底节区的N-乙酰天冬氨酸(NAA)、胆碱复合物(Cho)、肌酸复合物(Cr)和乳酸(Lac)水平及NAA/Cr、Cho/Cr比值。结果脑梗死组病灶侧Cho及Cr水平均显著低于非病灶侧(均P<0.05),NAA、Lac水平及NAA/Cr、Cho/Cr比值的差异无统计学意义。脑梗死组病灶侧及非病灶侧Cho、NAA及Cr水平均明显低于对照组病灶对应区(P<0.001～0.05),而Lac水平明显高于对照组病灶对应区(均P<0.05)。与对照组病灶对应区比较,脑梗死组病灶侧Cho/Cr比值显著升高,非病灶侧NAA/Cr比值显著降低(均P<0.05)。结论基底节区梗死急性期病灶侧及对侧脑组织均有明显的代谢障碍,且病灶区代谢异常较对侧更明显。     

Measures of hippocampal volumes, diffusion and 1H MRS metabolic abnormalities in temporal lobe epilepsy provide partially complementary information

We assessed whether interictal measures of hippocampal volume, hippocampal diffusion and metabolic abnormalities yield correlated or complementary information about hippocampal pathology in patients with temporal lobe epilepsy (TLE). Volumes, apparent diffusion coefficients (ADC) and ratios of N-acetyl-aspartate (NAA) to Creatine/Phosphocreatine (Cr) and Choline (Cho) were measured from each hippocampus during one magnetic resonance imaging (MRI) session in patients with TLE. Structural MRI showed unilateral hippocampal sclerosis (HS) in 13 patients and was normal in the remaining nine patients. Pearson's correlation (two-tailed) between ADC values and NAA/(Cr + Cho) ratios was significant (P = 0.04, r = -0.45) for the hippocampus ipsilateral to the epileptogenic zone as determined on the basis of interictal and ictal scalp EEG recordings. This finding was driven by a very high correlation between the two measures in the presence of HS (P < 0.001, r = -0.96). Furthermore, ipsilateral ADC values but not NAA/(Cr + Cho) ratios were correlated with disease duration (P = 0.001, r = 0.67). Hippocampal volumes did not correlate with either ADC values, NAA/(Cr + Cho) ratios or disease duration. These data suggest that hippocampal volumes, NAA/(Cr + Cho) ratios and ADC values capture partially complementary aspects of hippocampal pathology.     

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。     

老年抑郁症患者脑磁共振波谱成像研究

目的 应用磁共振波谱成像(MRS)研究老年抑郁症患者脑内神经环路物质代谢异常,探讨其发病机制.方法 对23例老年抑郁症患者(抑郁症组)及18名老年健康志愿者(正常对照组)行常规磁共振及三维磁共振氢质子波谱(<'1>H-MRS)检查,测量双侧额叶背外侧白质、前部扣带回皮质、杏仁核、海马、丘脑的N-乙酰天门冬氨酸(N从)、胆碱(Cho)与肌酸(Cr)的比值,对两组各部位的比值分别进行独立样本t检验.结果 (1)抑郁症组额叶背外侧白质(2.28±0.32)、前部扣带回皮质(2.19 ±0.39)、杏仁核(1.95 ±0.22)、海马的Cho/Cr比值(2.38 ±0.30)均高于正常对照组(分别为1.88 ±0.40、1.68±0.30、1.66±0.24、2.00±0.34),差异有统计学意义(P＜0.01～0.05);而丘脑Cho/Cr比值与对照组的差异无统计学意义(P＞0.05).(2)抑郁症组前部扣带回皮质(2.08 ±0.26)、杏仁核(2.20 ±0.27)、海马的NAA/Cr比值(2.10 ±0.27)低于正常对照组(分别为2.58 ±0.35、2.52±0.22、2.44±0.24),差异有统计学意义(P＜0.01～0.05);而额叶背外侧白质及丘脑未见明显变化(P＞0.05).结论 老年抑郁症患者额叶背外侧白质、前部扣带回皮质、杏仁核、海马的Cho/Cr比值明显高于对照组,提示边缘系统-皮质-纹状体-苍白球-丘脑环路的功能受到影响,该神经环路在老年抑郁症发病机制中可能起一定作用.     

老年期抑郁症患者海马磁共振质子波谱研究

目的:探讨老年期抑郁症患者海马的磁共振质子波谱(1H-MRS)特点。方法:应用1H-MRS成像技术检测11例晚发性抑郁症患者(患者组)予文拉法辛缓释剂治疗6周前后两侧海马头、体、尾部N-乙酰天门冬氨酸(NAA)、胆碱(Cho)和肌酸(Cr)3种代谢物,计算NAA/Cr和Cho/Cr比值。并且与15名健康对照者(对照组)的检测结果进行比较。结果:治疗前后患者组右侧海马头部NAA和Cho含量及左侧海马头部Cho含量均显著低于对照组(P<0.05或P<0.01)。患者组右侧海马头部Cho/Cr治疗前显著低于对照组(P<0.05),治疗后较治疗前显著升高(P<0.05),并且与对照组的差异无显著统计学意义(P>0.05)。患者组右侧海马体部Cho含量治疗前显著低于对照组(P<0.05),治疗后右侧海马体部NAA/Cr和Cho/Cr显著高于治疗前,与对照组的差异无显著统计学意义(P>0.05)。结论:老年期抑郁症患者可能存在左右两侧海马头部细胞膜代谢异常,右侧海马头部神经元活力下降。     

多体素H-MRS在脑胶质瘤术前评价中的应用

目的运用多体素二维磁共振波谱法（H-MRS）分析脑胶质瘤周围区域。H-MRS代谢物改变特点,评价H-MRS在脑胶质瘤术前的应用价值。方法收集经手术及病理证实的28例胶质瘤患者,所有患者在术前均行磁共振头颅常规检查和。H-MRS检查。分别测量不同区域的N-乙酰天门冬氨酸（NAA）、肌酸（Cr）、胆碱（Cho）峰下面积,计算出NAA／Cr、Cho／Cr及NAA／Cho比值,并进行统计学分析。结果低／高级别胶质瘤肿瘤组织和对侧正常脑组织的NAA／Cr、Cho／Cr及NAA／Cho比值存在显著性差异;低／高级别胶质瘤肿瘤组织和远瘤周区域的NAA／Cr、Cho／Cr及NAA／Cho比值存在显著性差异;低级别胶质瘤远瘤周区域和对侧正常脑组织的NAA／Cho比值存在显著性差异,NAA／Cr、Cho／Cr比值不存在显著性差异;高级别胶质瘤远瘤周区域和对侧正常脑组织的Cho／Cr、NAA／Cho比值存在显著性差异,但NAA／Cr比值不存在显著性差异。结论多体素H-MRS可帮助临床医生在术前评价胶质瘤的浸润范围,并制定最佳的治疗方案。     

帕金森病患者不同脑区质子磁共振波谱研究

目的:探讨~1H-MRS对早期PD的诊断价值。方法:采用~1H-MRS技术检测早期PD、晚期PD、帕金森综合征、偏侧ET以及年龄匹配的正常对照组基底节区和皮质运动区感兴趣区的NAA/Cr和Cho/Cr比值。结果:早期或晚期PD、偏侧ET及帕金森综合征患者受累较重基底节区或运动皮质区NAA/Cr及Cho/Cr比值与受累较轻侧相比无显著性差异;上述各组患者受累较重基底节区或运动皮质区NAA/Cr及Cho/Cr比值与正常对照组相应感兴趣区NAA/Cr及Cho/Cr比值相比也均无显著性差异。结论:~1H-MRS无助于早期PD的诊断。     

Regional N-acetylaspartate reduction in the hippocampus detected with fast proton magnetic resonance spectroscopic imaging in patients with Alzheimer disease

OBJECTIVE: To detect regional metabolic changes that resemble the expected spatial pattern of neuronal loss in patients with Alzheimer disease (AD). METHODS: Thirty-four patients with AD and 22 healthy control subjects were included in the study. Single-slice fast proton spectroscopic imaging was performed in parallel angulation to the temporal lobes. Proton spectra were selected from the hippocampus, the lateral temporal lobe, and the occipital lobe of both hemispheres to determine metabolite concentration of N-acetylaspartate (NAA), total creatine (tCr), including phosphocreatine and creatine, and choline-containing compounds (Cho). The metabolic ratios of NAA/tCr and Cho/tCr were calculated and compared between patients with AD and healthy volunteers. RESULTS: The NAA/tCr ratios were significantly reduced in the left (F(1,1) = 4.34, P =.04) and right hippocampus (F(1,1) = 9.96, P =.003) in patients with AD. The Cho/tCr ratios remained unchanged in both hippocampi. There was no significant change of either NAA/tCr or Cho/tCr in the lateral temporal and occipital lobes of patients with AD. CONCLUSION: This study provides evidence that fast proton spectroscopic imaging may detect the regional pattern of disturbed neuronal integrity in patients with AD with high spatial resolution in a short acquisition time.     

癫痫复杂部分性发作患者认知功能与海马质子磁共振波谱改变相关性分析

目的 探讨癫痫复杂部分性发作(CPS)患者认知功能损害的特点以及磁共振波谱(MRS)检查与认知功能的相关性.方法 对45例癫痫CPS患者和16例健康对照组进行临床记忆量表、瑞文标准推理测验的测评,~1H-MRS检测双侧海马,比较2组间2项测验分值及~1H-MRS结果,并对记忆商、智商与海马~1H-MRS结果进行相关性分析.结果 CPS组多项量表分值、记忆商、智商明显低于对照组,差异有统计学意义(P<0.05),CPS组N-乙酰天门冬氨酸(NAA)及NAA/[胆碱(Cho)+肌酸(Cr)]明显低于对照组,Cr、Cho明显高于对照组,差异有统计学意义(P<0.05).CPS组记忆商、智商与NAA浓度、NAA/(Cho+Cr)均呈正相关(P<0.05),与Cho浓度呈负相关(P<0.05),与Cr浓度无明显相关性(P>0.05).结论 CPS患者存在短时记忆功能障碍和抽象思维、判断推理能力的下降,其认知功能障碍与海马NAA、Cho浓度及NAA/(Cho+Cr)的相关性表明~1H-MRS检查可成为早期发现CPS患者认知功能情况的一项重要检查,其与神经心理学测验联合应用可早期、准确地发现CPS患者的认知功能障碍.     

无痴呆型血管性认知障碍患者多体素质子磁共振波谱的诊断价值

目的 探讨多体素质子磁共振波谱(1H-MRS)在无痴呆型血管性认知障碍(VCIND)早期诊断中的价值.方法 入选2008年12月至2009年9月本院门诊及住院患者共78例,完成成套神经心理学测验,包括北京版蒙特利尔认知量表(MoCA)、听觉词语学习测验(AVLT)、数字广度测验(DST)、Rey-Osterrieth复杂图形测验(CFT)、语义与语音流畅试验、数字符号编码测验(DSCT)、连线测验(TMT)、画钟测验(CDT)和Stroop色词测验(SCWT).根据测验成绩分为VCIND组和认知正常对照组,从中选择性别、年龄、文化程度匹配者各18例,利用多体素1H-MRS检测双侧额、颞、顶叶及丘脑灰质区N-乙酰天冬氨酸(NAA)、肌酸(Cr)、胆碱(Cho)水平,比较两组间NAA/Cr、Cho/Cr比值的差别;同时,对VCIND组患者MoCA总分及其有认知损害的子项评分与NAA/Cr、Cho/Cr比值进行相关分析.所有入选对象对试验方案均知情同意,本试验通过伦理委员会批准.结果 VCIND组患者左、右两侧丘脑灰质区NAA/Cr比值与对照组比较均明显下降(左侧1.56±0.49、1.89±0.48,F=11.222,P=0.002;右侧1.63±0.45、1.86±0.33,F=5.358,P=0.027);两组间额、颞、顶叶NAA/Cr比值以及所有区域Cho/Cr比值均无统计学意义.VCIND组患者左、右两侧NAA/Cr下降程度与MoCA评分(r=0.54、0.44)及记忆力(r=0.61、0.49)、注意力(r=0.43、0.36)、语言功能(r=0.39、0.31)、视空间与执行能力(r=0.29、0.33)等子项评分均呈正相关(均P＜0.05或P＜0.01).结论 VCIND患者认知功能损害可能与双侧丘脑神经元代谢异常有关,多体素1H-MRS在VCIND早期诊断和病情进展监测中起着重要的作用.     

Proton magnetic resonance spectroscopy of the motor cortex in 70 patients with amyotrophic lateral sclerosis

OBJECTIVE: To evaluate proton magnetic resonance spectroscopy for detection and monitoring of upper motoneuron degeneration in patients with amyotrophic lateral sclerosis. METHODS: Seventy patients with amyotrophic lateral sclerosis according to the El Escorial criteria were compared with 48 healthy control subjects. Single-volume proton magnetic resonance spectroscopy (echo time, 272 milliseconds; repetition time, 2000 milliseconds) was performed in both motor cortices for detection of N-acetylaspartate (NAA), phosphocreatine + creatine ([P]Cr), and choline-containing compounds (Cho) to calculate the metabolite ratios NAA/Cho, NAA/(P)Cr, and Cho/(P)Cr. In addition, absolute metabolite concentrations of NAA, (P)Cr, and Cho were obtained in 30 patients and 15 controls with the unsuppressed water signal used as an internal reference. RESULTS: Absolute concentrations of NAA (P<.001) and (P)Cr (P<.05) were reduced in motor cortices of patients, whereas Cho concentrations remained unchanged. The NAA/Cho and NAA/(P)Cr ratios were reduced in all El Escorial subgroups (P<.001). The Cho/(P)Cr ratio was elevated in patients with definite amyotrophic lateral sclerosis (P<.05). Metabolite ratio changes corresponded to the lateralization of clinical symptoms and were weakly correlated with disease duration and disease severity. In follow-up observations of 16 patients during a mean (+/-SD) of 12.1 +/- 8.7 months, NAA/Cho dropped by 9.1% (P<.01), and Cho/(P)Cr increased by 7.0% (P<.01). Changes of metabolite ratios were significantly correlated with progression of disease severity. CONCLUSIONS: Measurement of NAA concentrations and NAA/Cho ratios appear to be most suitable for detection of motor cortex degeneration by single-volume proton magnetic resonance spectroscopy. Reduced NAA/Cho ratios correspond to aspects of the clinical presentation and reflect disease progression in follow-up measurements.     

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.