遗忘型轻度认知损害的全脑灰质基于体素的MRI形态分析

目的：利用优化基于体素的MRI形态分析（voxel-based morphometry,VBM）,研究遗忘型轻度认知损害（amnestic mild cognitive impairment,aMCI）和正常老年人的脑灰质体积变化。方法：选取aMCl患者20例和正常老年对照18例,MRI排除脑内其他病变,然后行高分辨率三维T1WI扫描。应用优化VBM方法处理数据,将脑组织分割成灰质、白质和脑脊液,最后应用两样本t检验比较两组被试灰质体积改变。结果：VBM结果显示与正常老年对照组比较,aMCI患者组双侧额颞叶出现广泛的灰质体积减少,具体脑区为右侧海马钩回、双侧额下回、双侧额中回、右侧额上回、双颞叶额中回、左侧颞下回、左侧颞上回、右侧顶上小叶、左侧枕中回等结构灰质体积小于对照组,差异有统计学意义（P〈0.001）。结论：VBM方法可显示aMCl患者全脑灰质萎缩情况,对临床早期诊断aMCl患者有重要价值,具有广阔的临床应用前景。     

基于体素的形态学分析在缺血性脑卒中的研究进展

缺血性脑卒中（IS）是一种严重的脑组织缺血坏死性疾病,其不同病程阶段的脑结构损伤、重塑与病人后期脑神经功能障碍的恢复及生活质量密切相关。基于体素的形态学分析(VBM)能定量分析全脑灰、白质间体积和密度的差异,在IS的病情评估、病程监测、治疗及康复方案选择等方面表现出独特优势。对VBM技术及其在IS运动功能、认知功能及卒中后抑郁研究等方面的进展进行综述。     

椎间盘源性下腰痛患者脑灰质体积改变的MRI研究

【摘要】目的：采用MR基于体素的形态学测量（VBM）技术,探讨椎间盘源性下腰痛患者大脑灰质体积的变化。方法：2016年5月-10月对本院22例椎间盘源性下腰痛患者和22例健康志愿者行3.0T MRI扫描,扫描序列包括T1WI、T2WI和三维快速扰相梯度回波序列T1WI,经图像后处理及统计分析,获得两组受试者大脑灰质形态学差异的相关信息。结果：与对照组比较,下腰痛组患者大脑皮层多个脑区灰质体积减少,包括右侧额上回、左侧额内侧回、左侧直回、右侧颞上回、右侧颞中回、右侧岛叶以及右侧额下回（P＜0.001,FWEc校正）;无灰质体积增加的区域。结论：慢性椎间盘源性下腰痛可引起广泛的脑功能区灰质体积的减少,这些脑区主要涉及感觉、认知及情绪,一定程度上揭示了慢性椎间盘源性下腰痛神经系统病变的发生机制。     

早期帕金森病患者脑灰质结构异常的MRI初步研究

目的:研究早期帕金森病(Parkinson disease,PD)患者全脑灰质体积异常脑区。方法:采集1.5TMRI高分辨T1WI,运用基于体素的形态学测量技术(voxel-based morphometry,VBM)对15例早期PD患者及15例健康老年人(对照组)的大脑灰质图像进行比较,并对2组数据的灰质体积差异采用国际通用的统计参数图表示。结果:早期PD患者与对照组比较,右侧部分脑区灰质体积萎缩,包括右侧颞叶中下回、枕中回、梭状回;左侧部分脑区体积增加,包括左侧楔叶、舌回、左海马旁回、梭状回、楔前叶及中央前回。结论:VBM方法能较全面、准确、定量地反映早期PD患者存在的脑灰质体积异常区域,为早期PD患者出现复杂的非运动症状提供影像学依据。     

基于体素的形态学测量在阿尔茨海默病研究中的应用

随着阿尔茨海默病发病率逐年提高,如何利用影像学方法进行诊断、病程监测和预后评估成为研究的热点。借助于MR图像后处理技术-基于体素的形态学测量法,对病人大脑灰质和白质体积进行测量,分析其脑质丧失及结构改变情况,可以揭示病变的发生、演变及转归。该方法自动化程度高、准确、客观且易于实现,为疾病的早期诊断和病程监测提供了有力工具,对疾病的诊疗具有一定的作用。     

基于体素的形态学测量在阿尔茨海默病研究中的应用

随着阿尔茨海默病发病率逐年提高,如何利用影像学方法 进行诊断、病程监测和预后评估成为研究的热点.借助于MR图像后处理技术一基于体素的形态学测量法,对病人大脑灰质和白质体积进行测量,分析其脑质丧失及结构改变情况,可以揭示病变的发生、演变及转归.该方法 自动化程度高、准确、客观且易于实现,为疾病的早期诊断和病程监测提供了有力工具,对疾病的诊疗具有一定的作用.     

基于体素的遗忘型轻度认知障碍和轻度阿尔茨海默病全脑白质MR扩散张量成像分析

目的 采用基于体素的分析(VBA)方法研究遗忘型轻度认知障碍(aMCI)患者和轻度阿尔茨海默病(AD)患者全脑白质微观结构改变的特点及其与灰质萎缩模式的关系.方法 选取33例aMCI患者(aMCI组)、32例轻度AD患者(轻度AD组)和31名正常老年人(健康对照组),对全脑进行3.0 T DTI及三维快速扰相梯度反转回波(3DFSPGR)脉冲序列扫描.采用统计参数图(SPM)5软件对被试者的结构图像及各向异性(FA)图进行预处理,然后采用t检验对aMCI组、轻度AD组和正常对照组的全脑灰质体积及FA值进行基于体素的统计学比较,计算出有统计学意义的脑区.结果 与正常对照组比较,aMCI组的双侧额颞叶和左侧枕叶白质、左侧扣带前部、左侧顶下小叶、右侧脑室三角区外上方白质的FA值减低;轻度AD组的双侧额颞枕叶、海马旁白质、扣带前部、胼胝体、侧脑室三角区旁白质、顶下小叶、左侧颞于、左侧丘脑、右侧楔前叶FA值减低.基于体素的形态测量学(VBM),分析发现,aMCI患者组左侧海马、海马旁回、舌回、颞上回,双侧岛叶、颞中回出现了灰质萎缩;轻度AD患者组双侧海马、海马旁回、杏仁核、丘脑、额叶、颞叶、顶叶、枕叶皮质出现了灰质萎缩.aMCI与轻度AD患者组全脑白质FA值减低的模式与灰质萎缩模式不同.aMCI组与轻度AD组比较未发现具有统计学意义的FA值减低脑区.aMCI、轻度AD患者组全脑白质FA值与简易智能精神状态检查量表(MMSE)评分没有相关性.结论 基于体素的MR DTI全脑白质分析能够较全面、客观地揭示aMCI、轻度AD的脑白质损害的模式.aMCI、轻度AD患者白质损害的模式与灰质不同,提示脑白质病变是多种病理机制导致的.aMCI患者向轻度AD进展过程中,脑白质各向异性改变不显著,脑白质FA值的改变可能无法反映患者认知功能障碍的严重程度.

Abstract：

Objective To evaluate the microstructural integrity of white matter (WM) in patients with amnestic mild cognitive impairment (aMCI) and mild Alzheimer's disease (AD) using voxel-based analysis (VBA), and investigate the relationship between WM abnormalities and gray matter(GM) atrophy.Methods Thirty-three cases with aMCI, 32 cases with mild AD and 31 normal aging volunteers as control subjects were scanned on a 3.0 T MR system using diffusion tensor imaging (DTI) and three-dimensional spoiled gradient-recalled(3DSPGR) sequences. Fractional anisotropy (FA) maps and morphological images were preprocessed by SPM5 and voxel-based comparisons between the 2 patient groups and the control group were performed by t test. Results Relative to the control group, patients with aMCI showed significantly reduced FA value in bilateral frontal, temporal and left occipital WM, left anterior part of cingulum, left inferior parietal lobule, and the W M adjacent to the triangular part of the right lateral ventricle(k≥20 voxels).In mild AD,significantly reduced FA value was found in bilateral hippocampal,inferior parietal lobular,frontal,temporal,and occipital WM,bilateral corpus callosum,anterior part of cingulums,the WM adjacent to the triaangular part of the bilateral lateral ventricles,left temporal stem,left thalamus,right precuneus(k≥20 voxels).Significantly reduced GM volume was found in left hippocampus,parahippocampal gyrus,lingual gyrus and superior temporal gyrus,bilateral insulae and middle temporal gyri in aMCl group whencompared with control group(k≥50 voxels).In mild AD,significantly reduced GM volume was found in bilateral hippoeampi,parahippocampal gyri,amygdalae,thalami,temporal,parietal,frontal,occipital cortex(k≥50 voxels).The pattern of areas with reduced FA differs;from that of the GM volumetric reduction.No areas with significantlv reduced FA was detected in aMCl compared with mild AD. There was no significant correlation between FA value of WM in patient groups and Mini-Mental State Examination(MMSE)scores.Conclusions Voxel-based MRI DTI analysis of whole brain white matter can objectively reveal widespread white matter abnormalities in early-stage AD.The difierence between WM FA reduction pattern and GM volumetric reduction pattern indicates that the pathological WM changes in earlyslage AD were caused by multiple mechanisms. FA did not vary significantly in patients pr0gressing from aMCI to mild AD and can hardly reflect the severitv of cognitive function damage in these patients.     

基于体素的遗忘型轻度认知障碍和轻度阿尔茨海默病全脑白质MR扩散张量成像分析

Objective To evaluate the microstructural integrity of white matter (WM) in patients with amnestic mild cognitive impairment (aMCI) and mild Alzheimer's disease (AD) using voxel-based analysis (VBA), and investigate the relationship between WM abnormalities and gray matter(GM) atrophy.Methods Thirty-three cases with aMCI, 32 cases with mild AD and 31 normal aging volunteers as control subjects were scanned on a 3.0 T MR system using diffusion tensor imaging (DTI) and three-dimensional spoiled gradient-recalled(3DSPGR) sequences. Fractional anisotropy (FA) maps and morphological images were preprocessed by SPM5 and voxel-based comparisons between the 2 patient groups and the control group were performed by t test. Results Relative to the control group, patients with aMCI showed significantly reduced FA value in bilateral frontal, temporal and left occipital WM, left anterior part of cingulum, left inferior parietal lobule, and the W M adjacent to the triangular part of the right lateral ventricle(k≥20 voxels).In mild AD,significantly reduced FA value was found in bilateral hippocampal,inferior parietal lobular,frontal,temporal,and occipital WM,bilateral corpus callosum,anterior part of cingulums,the WM adjacent to the triaangular part of the bilateral lateral ventricles,left temporal stem,left thalamus,right precuneus(k≥20 voxels).Significantly reduced GM volume was found in left hippocampus,parahippocampal gyrus,lingual gyrus and superior temporal gyrus,bilateral insulae and middle temporal gyri in aMCl group whencompared with control group(k≥50 voxels).In mild AD,significantly reduced GM volume was found in bilateral hippoeampi,parahippocampal gyri,amygdalae,thalami,temporal,parietal,frontal,occipital cortex(k≥50 voxels).The pattern of areas with reduced FA differs;from that of the GM volumetric reduction.No areas with significantlv reduced FA was detected in aMCl compared with mild AD. There was no significant correlation between FA value of WM in patient groups and Mini-Mental State Examination(MMSE)scores.Conclusions Voxel-based MRI DTI analysis of whole brain white matter can objectively reveal widespread white matter abnormalities in early-stage AD.The difierence between WM FA reduction pattern and GM volumetric reduction pattern indicates that the pathological WM changes in earlyslage AD were caused by multiple mechanisms. FA did not vary significantly in patients pr0gressing from aMCI to mild AD and can hardly reflect the severitv of cognitive function damage in these patients.     

基于体素的遗忘型轻度认知障碍和轻度阿尔茨海默病全脑白质MR扩散张量成像分析

Objective To evaluate the microstructural integrity of white matter (WM) in patients with amnestic mild cognitive impairment (aMCI) and mild Alzheimer's disease (AD) using voxel-based analysis (VBA), and investigate the relationship between WM abnormalities and gray matter(GM) atrophy.Methods Thirty-three cases with aMCI, 32 cases with mild AD and 31 normal aging volunteers as control subjects were scanned on a 3.0 T MR system using diffusion tensor imaging (DTI) and three-dimensional spoiled gradient-recalled(3DSPGR) sequences. Fractional anisotropy (FA) maps and morphological images were preprocessed by SPM5 and voxel-based comparisons between the 2 patient groups and the control group were performed by t test. Results Relative to the control group, patients with aMCI showed significantly reduced FA value in bilateral frontal, temporal and left occipital WM, left anterior part of cingulum, left inferior parietal lobule, and the W M adjacent to the triangular part of the right lateral ventricle(k≥20 voxels).In mild AD,significantly reduced FA value was found in bilateral hippocampal,inferior parietal lobular,frontal,temporal,and occipital WM,bilateral corpus callosum,anterior part of cingulums,the WM adjacent to the triaangular part of the bilateral lateral ventricles,left temporal stem,left thalamus,right precuneus(k≥20 voxels).Significantly reduced GM volume was found in left hippocampus,parahippocampal gyrus,lingual gyrus and superior temporal gyrus,bilateral insulae and middle temporal gyri in aMCl group whencompared with control group(k≥50 voxels).In mild AD,significantly reduced GM volume was found in bilateral hippoeampi,parahippocampal gyri,amygdalae,thalami,temporal,parietal,frontal,occipital cortex(k≥50 voxels).The pattern of areas with reduced FA differs;from that of the GM volumetric reduction.No areas with significantlv reduced FA was detected in aMCl compared with mild AD. There was no significant correlation between FA value of WM in patient groups and Mini-Mental State Examination(MMSE)scores.Conclusions Voxel-based MRI DTI analysis of whole brain white matter can objectively reveal widespread white matter abnormalities in early-stage AD.The difierence between WM FA reduction pattern and GM volumetric reduction pattern indicates that the pathological WM changes in earlyslage AD were caused by multiple mechanisms. FA did not vary significantly in patients pr0gressing from aMCI to mild AD and can hardly reflect the severitv of cognitive function damage in these patients.     

应用全脑逐像素形态学自动分析方法研究阿尔茨海默氏病的灰质缺失

目的采用计算机处理核磁共振图像(magnetic resonance imaging,MRI),研究阿尔茨海默氏病(Alzheime's disease,AD)患者的灰质萎缩区域。方法采用逐像素形态学(voxeI-based morphometry,VBM)方法。结果和正常老年人对照组相比,AD病人的海马、海马旁回、内嗅皮层、杏仁体、尾状核头部、颞中回、扣带回、顶下小叶、岛叶和前额叶背外侧区双侧萎缩；右侧丘脑枕、颞上回、顶上小叶不同程度萎缩,而感觉运动皮层、小脑和枕叶相对保持完好。结论 VBM方法克服了以往使用人工勾画感兴趣区(ROI)方法的可重复性差,费时等缺点,可以客观、自动和全面地分析AD的灰质减少,具有良好的临床应用前景。     

脑灰质异位的MRI诊断

目的:分析脑灰质异位的MRI表现,探讨MRI对HGM的诊断价值,以加深对本病的认识,减少漏诊及误诊。材料和方法:回顾分析我院自1996年至2004年21例HGM的MRI表现,并对HGM的病因、分型、常见并发畸形及不同MRI扫描序列与病灶检出率的关系等加以讨论。结果:21例中,病变为双侧4例,单侧17例,多病灶6例,共见异位灰质病灶33个;结节型病灶19个,板层型病灶6个,桥带型病灶8个;病灶位于室管膜下区10个,额叶白质内6个,顶叶白质内5个,枕叶白质内3个,颞叶白质内1个;8个桥带型病灶自室管膜下区通过白质区直达表层灰质区;最小病灶约0.2cm×0.2cm,最大病灶约3.8cm×9.5cm。脑裂畸形11例,胼胝体发育不良4例,巨脑回2例,微脑回1例,透明隔缺如1例,神经上皮囊肿1例,多发性硬化1例。脑室受压变形4例。T1WI、T2WI和PDWI对HGM检查的敏感性分别为47.4%、84.2%和68.4%;准确性分别为39.1%、76.2%和65%。结论:HGM具有特征性的MRI表现,PDWI和T2WI相结合是HGM定量诊断的最佳手段。     

Influence of Mild White Matter Lesions on Voxel-based Morphometry

Purpose:The aim of this study was to investigate whether the detectability of brain volume change in voxel-based morphometry (VBM) with gray matter images is affected by mild white matter lesions (MWLs).Methods:Three-dimensional T₁-weighted images (3D-T₁WIs) of 11 healthy subjects were obtained using a 3T MR scanner. We initially created 3D-T₁WIs with focal cortical atrophy simulated cortical atrophy in left amygdala (type A) and the left medial frontal lobe (type B) from control 3D-T₁WIs. Next, the following three types of MWL images were created: type A + 1L and type B + 1L images, only one white matter lesion; type A + 4L and type B + 4L images, four white matter lesions at distant positions; and type A + 4L^* and type B + 4L^* images, four white matter lesions at clustered positions. Comparisons between the control group and the other groups were performed with VBM using segmented gray matter images.Results:The gray matter volume was significantly lower in the type A group than in the control group, and similar results were observed in the type A + 1L, type A + 4L, and type A + 4L^* groups. Additionally, the gray matter volume was significantly lower in the type B group than in the control group, and similar results were observed in the type B + 1L, type B + 4L, and type B + 4L^* groups, but the cluster size in type B + 4L^* was smaller than that in type B.Conclusion:Our study showed that the detectability of brain volume change in VBM with gray matter images was not decreased by MWLs as lacunar infarctions. Therefore, we think that group comparisons with VBM should be analyzed by groups including and excluding subjects with MWLs, respectively.     

先天性耳聋患者脑基于体素的形态测量学研究

目的应用基于体素的形态测量学方法(VBM)研究先天性耳聋患者的灰质和白质变化情况。资料与方法对18例先天性耳聋患者和22名健康自愿者全脑进行三维磁共振成像数据采集,应用(diffeomorphic anatom-ical registration through exponential lie algebra,DARTEL)对灰质和白质进行VBM分析。以簇体积>100个体素,且P<0.001为差异有统计学意义。结果与健康自愿者相比,耳聋患者灰质体积增大的脑区为左侧颞横回和双侧小脑(P<0.001);灰质体积减小的脑区为双侧楔回、左侧梭状回和右侧中央前回(P<0.001);白质体积减小的脑区为双侧前扣带回、左侧胼胝体、左侧舌回和右侧额中回(P<0.001)。结论先天性耳聋患者灰质和白质发生改变,反映了脑可塑性重组及患者使用手语交流导致脑结构发生的改变。     

脑灰质异位症MRI诊断

目的探讨脑灰质异位症(GMH)的MR I诊断及鉴别诊断。方法10例GMH患者均行MR回波序列扫描,其中男7例,女3例,年龄7~32岁,平均15岁。1例行MR增强扫描。结果10例共发现病灶14个,分为3种类型:室管膜下型5例、皮质下型3例、带状型2例。表现为侧脑室旁或白质区内的结节状或不规则状团块影,与大脑皮层灰质及灰质核团信号一致,单发7例、多发3例,单侧发病8例,双侧发病2例,大小1~5 cm不等,无水肿及占位效应,2例带状型灰质异位对称分布于皮层灰质与侧脑室间,内外均有白质带,与灰质信号一致。结论GMH的MR I表现具有特异性。     

灰质异位的功能磁共振成像研究(附3例报告)

目的:对灰质异位进行运动功能的功能磁共振成像研究,探讨异位灰质的神经生理功能及功能磁共振成像在神经外科中的作用。方法:采用功能磁共振成像技术对3例拟行手术治疗的灰质异位且伴癫痫症状的患者进行对指运动任务下的脑区反应观察。结果:2例顶叶灰质异位患者在对侧手指运动时异位灰质内出现明显的反应信号,否定外科手术治疗计划。1例额叶的灰质异位患者异位灰质内未出现反应。结论:异位的灰质可以具有运动中枢功能,对于靠近主要功能中枢的灰质异位患者在手术计划的拟定时要考虑异位灰质是否具有功能。功能磁共振成像可以用于评价灰质异位的神经生理,有助于治疗方法的选择。     

帕金森病脑深部灰质核团MR T_2值的初步研究

目的探讨脑深部灰质核团MRT2值在帕金森病(PD)中的诊断价值及意义。资料与方法选取PD患者20例和对照组10名,分别对黑质、红核、尾状核、壳核、丘脑进行MRI扫描,根据Block方程求T2值,对两组各核团T2值采用成组设计定量资料是否呈正态分布、方差是否齐性,选择t检验、近似t检验;PD患侧黑质T2值与疾病分期进行相关分析;采用随机成组设计对不同分期(1～2期、2.5～3期、4期)PD组患侧感兴趣区(ROI)T2值进行组间比较,P<0.05有统计学意义。结果(1)20例PD组患侧黑质与10名对照组黑质T2值比较有统计学意义(P<0.05),PD组黑质T2值(29.65±3.41)较对照组黑质T2值(32.45±1.78)明显减低;PD组患侧红核、尾状核、壳核及丘脑ROI与对照组ROI无明显统计学意义(P>0.05)。(2)PD组患侧黑质T2值与疾病不同分期呈负相关性(r=-0.733)。(3)不同分期(1～2期、2.5～3期、4期)PD组患侧黑质T2值有统计学意义(P<0.05),且T2值逐渐减低;壳核在2.5～3期与4期有统计学意义(P<0.05),且表现为2.5～3期T2值减低(31.74±2.80),...     

首发抑郁症患者基于体素的脑形态学MRI研究

目的:探讨首发抑郁症患者基于体素的全脑形态改变特点.方法:采用3.0T磁共振机,研究32例抑郁症患者及32例性别、年龄相匹配的正常志愿者.运用SPM2分析软件,采用基于体素的形态学方法,进行全脑比较分析.结果:抑郁症患者右侧海马、右侧杏仁核及右侧枕中回体积较正常对照组缩小(P<0.05,FDR-correct-ed).结论:首发抑郁症患者右侧海马、右侧杏仁核及右侧枕中回体积有明显缩小倾向.     

阿尔茨海默病脑铁沉积的3.0 T磁共振T2*测量研究

目的 比较阿尔茨海默病(AD)患者和正常对照者多个脑结构的T2*值,以探讨T2*值测量的临床应用价值. 资料与方法 19名 AD患者及17名年龄相匹配的健康对照者均在3.0 TMR系统中进行头部检查.所有AD患者均有轻度到中度认知功能缺损.采用一个多回波快速场回波序列获得T2*图,测量双侧海马、颞叶皮层、枕叶皮层、丘脑、壳核及苍白球所画感兴趣区的T2*值,并计算相应的R2*值. 结果 与正常对照组比较,AD患者组海马、颞叶皮层及苍白球的T2*值减低,颞叶皮层及苍白球的R2*值明显升高,差异具有统计学意义(P<0.05).结论 通过对T2*值的测定可以估测AD患者脑内的铁沉积,这将为AD的活体诊断及病情监测提供一定的帮助.     

Alzheimer病和健康老人的脑容积和脑代谢变化的MRI和MRS分析研究

目的：探讨Ａｌｚｈｅｉｍｅｒ病（ＡＤ）患者与健康对照组脑组织容积和脑组织内Ｎ－乙酰天门冬氨酸（ＮＡＡ）、胆碱（Ｃｈｏ）及肌－肌醇（Ｍｉ）的特征及异同。材料和方法：对临床确诊的１３例ＡＤ患者和１３例健康老人进行ＭＲＩ脑组织分割分析，定量研究两组脑实质容积的变化。对两组各１１例同时进行了磁共振波谱检查，定量分析两组的ＮＡＡ、Ｃｈｏ及Ｍｉ的水平。结果：ＭＲＩ脑组织分割分析显示ＡＤ组较对照组有明显的脑灰质丢失，两组脑白质的容积无明显差异。磁共振波谱分析（ＭＲＳ）显示ＡＤ组ＮＡＡ水平较对照组降低，Ｍｉ水平较对照组升高，两组的Ｃｈｉ水平无显著差异。结论：脑组织分割分析能够准确的反映ＡＤ患者脑灰质萎缩的范围；ＭＲＳ能够准确提供ＡＤ患者脑部ＮＡＡ、Ｃｈｏ和Ｍｉ的代谢情况，两者结合有助于ＡＤ的诊断。