首发未药物治疗青少年重性抑郁障碍患者脑三维结构磁共振病例对照研究

目的:探讨首发未药物治疗青少年重性抑郁障碍患者脑灰质体积与正常对照组青少年之间的异同。方法:对18名首发未治疗青少年重性抑郁障碍患者和年龄性别匹配的18名青少年健康对照组进行脑三维结构扫描,对脑灰质体积异常变化应用基于体素的形态测量学分析方法VBM进行分析比较。结果:抑郁组相比对照组VBM灰质形态学体积增加的部位主要在右脑颞上回及双侧颞叶颞中回,尤其是BA22和BA19;抑郁组相比对照组VBM体积减少部位主要位于右脑额叶(BA11,47)、左脑顶叶(BA7,40)和右脑顶叶(BA5),左脑岛叶(BA13)及左脑颞叶(BA13)。结论:抑郁组相比对照组的灰质体积以下降为主,主要在右脑额叶及左脑顶叶、右脑顶叶、左脑岛叶和左脑颞叶。     

阴性症状为主的精神分裂症男性患者认知功能及灰质密度改变

目的:运用基于体素的脑形态测量学方法(VBM),探讨以阴性症状为主的精神分裂症男性患者大脑结构形态学的改变,及其与精神病理学症状的关系。方法:15例阴性症状为主的成年男性精神分裂症患者和15例正常对照参与实验,所有研究对象均接受威斯康星卡片分类测验(WCST)与磁共振检查,获取磁共振T1加权像和高分辨率3D图像后进行VBM分析,比较患者组和正常对照组局部脑区灰质密度的差异性。结果:在威斯康星测验中,阴性症状为主的精神分裂症患者完成测查的总应答数、错误应答数和持续性错误数显著高于正常对照组,正确应答数和完成分类数与正常对照组没有显著差异。VBM分析显示患者右侧额上回,左侧额中回,左额内侧回,右侧楔叶,左侧颞中回的灰质密度较正常对照组低,未发现患者组灰质密度有明显增高的脑区。结论:以阴性症状为主的精神分裂症患者存在显著的额叶执行功能低下;双侧额叶灰质密度的下降可能是其执行功能损害的病理生理基础。     

首发精神分裂症患者磁共振脑结构形态学研究

目的:探讨首发精神分裂症(FESZ)患者磁共振脑结构形态学变化。方法:分别采集86例FESZ患者(患者组)和86例健康人(对照组)的脑T_1高分辨图像数据。采用FSL 5.0对数据进行基于体素的形态测量法(VBM)分析。结果:FSL-VBM显示,FESZ患者与对照组相比存在广泛的大脑灰质体积减小,包括中央前回、额上回、额中回、额下回、额内侧回、中央后回、顶下小叶、顶上小叶、缘上回、颞上回、颞中回、前扣带皮层、中扣带皮层及辅助运动区;小脑灰质体积增加(P0.05, TFCE校正)。结论:FESZ患者在发病的早期阶段即可能存在广泛的脑结构形态学异常。     

2型糖尿病患者大脑灰质密度改变及其与认知受损的相关性研究

目的:利用磁共振成像技术结合基于体素的形态学分析方法,探讨2型糖尿病(T2DM)患者大脑灰质密度改变与糖尿病临床指标及认知功能受损之间的关系。方法:采集31名T2DM患者及32名正常人的大脑磁共振结构像,计算全脑体素的灰质密度,提取存在显著差异脑区的灰质密度与临床指标及认知测试结果进行相关性分析。结果:体素的形态学结果显示,与正常对照组相比,T2DM患者右侧小脑、左侧颞中回、左侧枕中回的灰质密度明显降低(P0.001)。右侧小脑及左侧颞中回的灰质密度分别与简易精神状态检查量表评分呈显著正相关。结论:T2DM患者在小脑、颞叶和枕叶会出现灰质密度降低,且这些脑区的灰质密度降低与患者认知受损有关。     

多发性硬化和视神经脊髓炎的脑灰质结构分析

目的 利用基于体素的形态学测量(VBM)和基于皮层的脑形态学测量(SBM)方法对多发性硬化(MS)和视神经脊髓炎(NMO)患者脑灰质体积及皮层厚度进行比较分析,探讨这两种疾病的脑灰质结构变化的差异。方法 对21例MS患者,16例NMO患者以及19例健康对照者行磁共振常规序列扫描,基于Matlab2014a平台的统计参数工具SPM12以及SPM12下的小工具CAT12,对VBM和SBM方法处理的数据进行分析。结果 MS组与正常对照(NC)组相比,经高斯随机场(GRF)校正后,MS组在左侧枕上回、左侧楔叶、左侧距状皮质、左侧楔前叶、左侧中央后回、左侧中央旁小叶、右侧楔叶、左侧额中回、左侧额上回和左侧额内侧回灰质体积显著性减少(P<0.05);经族系错误(FWE)法校正后,MS组在左侧中央旁小叶、左侧额上回和左侧楔前叶皮层厚度显著性减少(P<0.05)。NMO组与NC组相比,经GRF校正后,NMO组在左侧中央后回、左侧中央前回、左侧顶下小叶、右侧中央前回和右侧额中回灰质体积显著性增加(P<0.05);NMO组在左侧枕中回、左侧枕上回、左侧颞下回、右侧枕中回、左侧额上回眶部、...     

正常人和精神分裂症患者脑灰质体积分析的性别效应

目的:通过比较男性和女性正常人、男性和女性精神分裂症患者之间的脑灰质体积差异,探讨脑结构分析中的性别效应。方法:采集60例正常人(30例男性)和96例精神分裂症患者(48例男性)的高分辨率三维脑结构磁共振图像,运用基于体素的形态测量法(VBM)进行分析,获得每一个体的脑灰质体积图像。采用两样本t检验分别比较男性和女性正常人,男性和女性精神分裂症患者之间的脑灰质体积差异。结果:与女性正常人相比,男性正常人左侧的颞中回和额中回、右侧的边缘叶和颞中回的灰质体积较大(P<0.001),而左侧尾状核和右侧海马的灰质体积较小(P<0.001)。与女性精神分裂症患者相比,男性患者双侧的颞下回和海马、左侧的颞上回和颞中回的灰质体积较大(P<0.001),而未发现灰质体积较小的脑区。结论:性别效应是影响正常人或精神分裂症患者脑结构分析的重要因素。     

精神分裂症和强迫障碍患者的全脑灰质体积及静息态脑功能局部一致性

目的:应用磁共振成像(MRI)技术探讨精神分裂症和强迫障碍(OCD)患者大脑灰质体积及静息态脑功能局部一致性(ReHo)的特征性表现。方法:选取符合精神障碍诊断与统计手册第4版(DSM-IV)诊断标准的22例精神分裂症患者、20例OCD患者及23例性别、年龄、受教育程度匹配的正常对照。所有研究对象先后完成高分辨率结构磁共振成像及静息态功能磁共振成像扫描,在全脑范围内基于体素分析精神分裂症和OCD患者灰质体积及ReHo的异常改变,同时探索精神分裂症和OCD共同的脑结构和功能异常特征。结果:精神分裂症与OCD共同表现为,前扣带回灰质体积低于正常对照(蒙特利尔神经科学研究所坐标(P0.001,未校正),左侧楔叶ReHo值比正常对照低(P0.001,未校正),左侧内侧额上回ReHo值比正常对照高(P0.001,未校正)。结论:精神分裂症和OCD患者具有共同的脑结构和功能异常特征,该改变一定程度上可作为两种疾病临床相似之处的解释。     

单、双相抑郁障碍患者大脑灰质体积比较

目的:检测单、双相抑郁组、健康对照组的脑灰质体积差异,为鉴别单、双相抑郁障碍提供参考。方法:入组单相抑郁患者17例、双相抑郁患者19例及健康对照28例,以基于体素形态学分析对脑结构磁共振图像进行预处理。结果:与健康对照比较,单、双相抑郁障碍显示了右小脑前叶灰质体积显著减少;与另两组被试比较,单相抑郁障碍显示右颞上回灰质体积显著减少;相关分析显示双相抑郁障碍右小脑前叶灰质体积与抑郁量表得分呈负相关。结论:单、双相抑郁障碍以右小脑前叶灰质体积下降为共同特征,而右颞上回灰质体积差异显示了两种疾病神经解剖结构差异。     

未服药的强迫障碍患者脑灰质体积异常的MRI研究

目的:应用脑磁共振成像(MRI)基于体素的形态测量学(VBM)比较未服药的强迫障碍患者脑灰质体积与正常人群间的差异,并探讨强迫障碍患者脑灰质体积的改变与临床现象之间的相关性。方法:纳入符合美国精神障碍诊断与统计手册第4版(DSM-Ⅳ)诊断标准的20例未服药的强迫障碍门诊患者,以及20名性别、年龄和受教育程度相匹配的健康对照。所有被试均接受头部磁共振扫描。采用VBM的分析方法,比较强迫障碍患者与健康对照之间脑灰质体积的差异。采用耶鲁-布郎强迫量表(Y-BOCS)、汉密顿抑郁量表(HAM D)、汉密顿焦虑量表(HAM A)评估临床症状。在控制焦虑、抑郁症状的前提下,分析强迫障碍患者异常的脑灰质体积与临床现象之间的关系。结果:与对照组相比,强迫障碍组的眶额回、颞上回、颞下回、小脑、楔前叶、辅助运动区及中央后回的灰质体积减少(P0.05,Al-phaSim校正);眶额回灰质体积的减少与Y-BOCS量表总分呈负相关(r=-0.49,P0.05)。结论:本研究结果提示眶额-纹状体-丘脑环路中的眶额回在强迫障碍的发生中起重要的作用,其他脑区如颞叶和小脑灰质体积减少,可能也参与了强迫障碍的发生。     

经历丧子事件所致创伤后应激障碍患者的脑结构磁共振研究

目的:探讨经历丧子这一特殊创伤性事件后出现创伤后应激障碍(PTSD)患者脑内结构形态学的改变。方法:选取经历过丧子事件所致PTSD的患者15例(PTSD组)和性别、年龄、受教育程度均与PTSD组相匹配的正常健康人15例(对照组),在取得知情同意后进行功能性磁共振脑扫描,采用基于体素的形态学测量方法(VBM)对图像进行后处理,比较两组脑结构中灰质、白质体积的异同。结果:以性别、年龄、全脑体积作为协变量,使用Matlab 7.1及SPM 5软件包来分析处理高分辨率的MRI结构图,定量检测脑结构组织成分的浓度;分析发现PTSD组患者与对照组相比,右侧中央前回的皮质运动前区(t=3.88,Z=3.44)、右侧额中回(t=3.95,Z=3.49)、左侧楔前叶(t=4.44,Z=3.83)、右侧丘脑背内侧核(t=4.10,Z=3.60)的灰质体积有明显缩小,差异均具有显著统计学意义(P0.001),两组其他脑区的灰质或白质体积的差异无统计学意义。结论:PTSD组患者的右侧中央前回的皮质运动前区、右侧额中回、左侧楔前叶、右侧丘脑背内侧核的灰质体积较正常对照组有明显缩小,提示这些脑区的结构存在病理性改变。     

武汉地区167例先天性唇腭裂临床分析

目的探讨先天性唇腭裂的临床流行病学特征,了解先天性唇腭裂的发病情况,为先天性唇腭裂的深入研究提供数据。方法对我院2008年1月至2013年6月在我院引产及分娩的先天性唇腭裂畸形儿病例进行回顾性分析,并进行统计学处理。结果单纯唇裂、唇裂合并腭裂性别、单双侧比较差异有统计学意义。唇腭裂左右侧比较无统计学意义。唇腭裂城乡分布无统计学意义。唇腭裂家族发病亲缘关系、三种类型比较,差异均无统计学意义。唇腭裂伴发畸形性别比较无统计学意义。结论唇裂合并腭裂最常见。唇腭裂各类型中除单纯腭裂外男性多于女性,单侧多于双侧。唇腭裂家族发病情况与亲缘关系的远近无关。唇腭裂伴发畸形无性别差异。     

Voxel-based assessment of gray and white matter volumes in Alzheimer's disease

Using the study-specific templates and optimized voxel-based morphometry (VBM), this study investigated abnormalities in gray and white matter to provide depiction of the concurrent structural changes in 13 patients with Alzheimer's disease (AD) compared with 14 age- and sex-matched normal controls. Consistent with previous studies, patients with AD exhibited significant gray matter volume reductions mainly in the hippocampus, parahippocampal gyrus, insula, superior/middle temporal gyrus, thalamus, cingulate gyrus, and superior/inferior parietal lobule. In addition, white matter volume reductions were found predominately in the temporal lobe, corpus callosum, and inferior longitudinal fasciculus. Furthermore, a number of additional white matter regions such as precentral gyrus, cingulate fasciculus, superior and inferior frontal gyrus, and sub-gyral in parietal lobe were also affected. The pattern of gray and white matter volume reductions helps us understand the underlying pathologic mechanisms in AD and potentially can be used as an imaging marker for the studies of AD in the future.     

Gray matter differences between pediatric obsessive-compulsive disorder patients and high-risk siblings: A preliminary voxel-based morphometry study

Neuroimaging studies have identified alterations in frontostriatal circuitry in obsessive-compulsive disorder (OCD). Voxel-based morphometry (VBM) allows for the assessment of differences in gray matter density across the whole brain. VBM has not previously been used to examine regional gray matter density in pediatric OCD patients and the siblings of pediatric OCD patients. Volumetric magnetic resonance imaging (MRI) studies were conducted in 10 psychotropic naïve pediatric patients with OCD, 10 unaffected siblings of pediatric patients with OCD, and 10 healthy controls. VBM analysis was conducted using SPM2. Statistical comparisons were performed with the general linear model, implementing small volume random field corrections for a priori regions of interest (anterior cingulate cortex or ACC, striatum and thalamus). VBM analysis revealed significantly lower gray matter density in OCD patients compared to healthy in the left ACC and bilateral medial superior frontal gyrus (SFG). Furthermore, a small volume correction was used to identify a significantly greater gray matter density in the right putamen in OCD patients as compared to unaffected siblings of OCD patients. These findings in patients, siblings, and healthy controls, although preliminary, suggest the presence of gray matter structural differences between affected subjects and healthy controls as well as between affected subjects and individuals at risk for OCD.     

Distinct Patterns of Brain Atrophy associated with Mild Behavioral Impairment in Cognitively Normal Elderly Adults

A cross-sectional study was conducted to evaluate patterns of gray matter changes in cognitively normal elderly adults with mild behavioral impairment (MBI). Sixteen MBI patients and 18 healthy controls were selected. All the participants underwent a neuropsychological assessment battery, including the Mini-mental State Examination (MMSE), Geriatric Depression Scale (GDS), Self-rating Anxiety Scale (SAS), and Chinese version of the mild behavioral impairment-checklist scale (MBI-C), and magnetic resonance imaging (MRI) scans. Imaging data was analyzed based on voxel-based morphometry (VBM). There was no significant difference in age, gender, MMSE score, total intracranial volume, white matter hyperdensity, gray matter volume, white matter volume between the two groups (p > 0.05). MBI group had shorter education years and higher MBI-C score, GDS and SAS scores than the normal control group (p < 0.05). For neuroimaging analysis, compared to the normal control group, the MBI group showed decreased volume in the left brainstem, right temporal transverse gyrus, left superior temporal gyrus, left inferior temporal gyrus, left middle temporal gyrus, right occipital pole, right thalamus, left precentral gyrus and left middle frontal gyrus(uncorrected p < 0.001). The grey matter regions correlated with the MBI-C score included the left postcentral gyrus, right exterior cerebellum, and left superior frontal gyrus. This suggests a link between MBI and decreased grey matter volume in cognitively normal elderly adults. Atrophy in the left frontal cortex and right thalamus in MBI patients is in line with frontal-subcortical circuit deficits, which have been linked to neuropsychiatric symptoms (NPS) in dementia. These initial results imply that MBI might be an early harbinger for subsequent cognitive decline and dementia.     

Epidemiology of orofacial clefts in a Danish county over 35 years – Before and after implementation of a prenatal screening programme for congenital anomalies

In 2004 the Danish National Board of Health changed its screening recommendations. Since 2005 a first trimester screening for Down syndrome and a prenatal ultrasound screening for congenital anomalies in the second trimester of pregnancy has been offered to all pregnant women.The aim of this study was to describe the prevalence of cleft lip with or without cleft palate and cleft palate in a Danish area and to describe associated anomalies and the development in prenatal diagnosis over time. The study was based on data from the EUROCAT Registry for Funen County. The registry is based on multiple data sources and includes information about live births, fetal deaths with a gestational age >20 weeks and terminations of pregnancy after prenatal diagnosis of severe fetal anomaly. The study included all fetuses/infants out of a population of 182,907 births diagnosed with orofacial clefts born between 1980 and 2014. There were 271 cases diagnosed with cleft lip with or without cleft palate and 127 cases diagnosed with cleft palate, giving a prevalence of 14.8 per 10,000 births for cleft lip with or without cleft palate and 6.9 per 10,000 births for cleft palate. There were no significant changes in prevalence over time for the two anomalies, calculated with and without inclusion of genetic and chromosomal cases. Overall 66 cases were diagnosed prenatally (17% of total). For isolated cleft lip with or without cleft palate none of the 157 cases born before 2005 were diagnosed prenatally compared to 34 of 58 cases (59%) born in 2005–2014 (p?<?0.01). The proportion of liveborn infants with multiple congenital anomalies also changed after 2005 with 15% (39/266) of all liveborn infants with orofacial clefts born 1980–2004 having multiple anomalies compared to 7% (7/96) in 2005–2014 (p?<?0.05).The implementation of the new screening programme in 2005 has given a major change in prenatal detection rate and reduced the proportion of liveborn infants with orofacial clefts classified as multiple congenital anomaly cases. The prevalence of cleft lip with or without cleft palate was higher than reported from many other countries.     

实时三维超声在胎儿唇腭裂畸形产前早期诊断中的应用价值

目的探讨实时三维超声对胎儿唇腭裂畸形的早期诊断价值。方法应用GE Volusion E8 Expert三维容积探头对2008年8月以来在我院行实时三维超声检查的2290例18～37周胎儿唇部进行观察。结果 2290例中应用三维超声能观察到胎儿唇部的有2287例,看不到胎儿唇部的有3例,总检出率998%,胎儿面部正常2244例,唇裂畸形43例,其中有32例伴牙槽突裂及腭裂,1例单纯腭裂漏诊,畸形率1.92%,畸形检出率97.7%,漏诊率0.04%。以上畸形病例均在我院生产或引产后得到证实。结论常规二维超声产前对胎儿颜面部大部分表面结构及深部骨性结构均能清楚显示,实时动态三维超声能更加详细全面且直观地提供胎儿形态信息及运动状况,可对二维超声加以补充,在胎儿产前唇腭裂早期诊断中具有重要的应用价值。     

Prefrontal gray matter increases in healthy individuals after lithium treatment: a voxel-based morphometry study

The objective of this study was to test the hypothesis that 4 weeks of lithium administration would be associated with changes in brain gray and white matter volumes in healthy individuals. Thirteen right-handed healthy volunteers (6 females, mean age=25.9+/-10.0 years) were studied. 3D SPGR MRIs (TR=25 ms, TE=5 ms, slice-thickness=1.5 mm) were acquired using a 1.5 T GE Signa Imaging System, at baseline and after 4 weeks of lithium administration at therapeutically relevant doses. Optimized voxel-based morphometry (VBM) analyses were conducted. Left and right dorsolateral prefrontal cortex and left anterior cingulate gray matter volumes increased significantly following lithium administration. Total white matter volume was increased, whereas total brain volume and total gray matter volume were not significantly changed following 4 weeks of lithium. Lithium treatment resulted in prefrontal regional gray matter volume increases in healthy volunteers, as well as increases in total white matter volume. Whether these changes are mediated by neurotrophic/neuroprotective or osmotic effects remains unknown.     

White matter hyperintensities-related cortical changes and correlation with mild behavioral impairment

PurposeThe aim of this study was to analyze cortical thickness and gray matter volume (GMV) changes in white matter hyperintensities (WMH) which were associated brain regions and their association with mild behavioral impairment (MBI) by means of voxel- and surface-based morphology (VBM and SBM).MethodsA total of 60 patients underwent 3T MRI scan and MBI checklist (MBI-C) assessment and were divided into two groups: lower WMH (LWMH) and higher WMH (HWMH). After adjusting for confounding factors i.e. age, gender, education, and total intracranial volume, we found a GMV decrease in the left anterior insula (AIns), right middle frontal gyrus, right central operculum, right fusiform gyrus, left cerebellum exterior, and thalamus proper in the HWMH group based VBM, while in the HWMH group based SBM we found cortical thickness decrease in the left lingual, right posterior cingulate cortex (rPCC), right precentral, left superior frontal, right medial orbitofrontal gyrus, and left pars opercularis.ResultsThe HWMH group had higher MBI-C scores. The GMV in the left AIns and thalamus proper and the thickness of rPCC negatively correlated with the MBI-C scores. The mediation analysis suggested that WMH may partially mediate MBI-C scores by reducing the GMV and cortical thickness of the mentioned brain regions.ConclusionsIn WMH patients, the occurrence of MBI is associated with atrophy of gray matter and cortex. The occurrence of MBI may be partially mediated by WMH through gray matter and cortical atrophy. It provides a new insight into the relationship between WMH and dementia.     

超声诊断胎儿唇腭裂畸形漏诊原因及对策

目的探讨超声诊断胎儿唇腭裂畸形漏诊原因及对策。方法对超声诊断并经引产证实的10例胎儿唇腭裂畸形的超声图像进行回顾性分析。结果复习文献,结合病例,找到超声诊断胎儿唇腭裂的影响因素（1）胎龄的影响;（2）胎位的影响;（3）合并其它因素的影响等。结论总结经验提出防漏诊的对策：（1）正确选择超声筛查时机;（2）掌握正常胎儿唇腭部的超声图像;（3）多切面、多角度、多体位仔细检查以防漏诊;（4）可疑病例复查后诊断。     

单侧完全性唇腭裂胎儿宫内手术修复的解剖学基础

目的　为单侧性唇腭裂胎儿宫内手术修复提供解剖学基础。 方法 制作和观察21～32周正常和单侧完全性唇腭裂胎儿头颈部血管铸型标本,比较他们唇腭部血供的来源及吻合情况。 结果 ①正常胎儿唇腭部的血供主要由上唇动脉、鼻翼下缘动脉和腭大动脉组成。两侧上唇动脉在中线附近吻合成上唇动脉弓,并在鼻中隔前下部形成浅深两层血管网,且上唇动脉鼻中隔支也与腭大动脉穿支相互吻合;②单侧完全性唇腭裂胎儿唇腭部血供由于患侧裂隙的阻隔,导致左右上唇动脉不能吻合成弓,患侧腭大动脉穿过骨残端与患侧鼻腔内的血管相吻合。 结论 单侧完全性唇腭裂胎儿唇腭部血管非常丰富,尤以上唇动脉和腭大动脉为血供主干。