创伤性脑白质损伤的扩散张量成像研究

目的:评价扩散张量成像(DTI)在创伤性脑白质损伤(WMI)中的应用价值。方法:16例创伤性脑外伤后经临床诊断有WMI的患者通过Philips 1.5TIntera Achieva MR扫描仪行常规MRI和DTI。后处理获得部分各向异性指数(FA)、表观弥散系数(ADC)和纤维示踪成像三维图。根据T2WI及T2快速场回波图像,分别于WMI区域、同侧同名或对侧同名纤维束正常区域取感兴趣区,测量FA值和ADC值并进行比较。结果:脑外伤患者损伤脑白质中挫伤和出血、仅挫伤和仅出血区域三者之间的FA值(F=0.68,P>0.05)和ADC值(F=0.53,P>0.05)均未见明显不同。除仅出血区域的ADC值与对照区域相比差异无统计学意义(t=1.36,P>0.05),挫伤和出血(t=9.72,P<0.05)、仅挫伤(t=8.28,P<0.05)和仅出血(t=5.44,P<0.05)区域的FA值较正常对照区域明显降低,挫伤和出血(t=4.71,P<0.05)、仅挫伤(t=4.81,P<0.05)的ADC值较正常对照明显增高,纤维示踪成像显示损伤区域脑白质较正常区域稀疏、分离、缺失。结论:DTI技术能够显示患者WMI区域的异常改变,但ADC值对出血的判断有局限性。     

Visualization and analysis of white matter structural asymmetry in diffusion tensor MRI data.

This work presents a method that permits the characterization, quantification, and 3D visualization of white matter structural information contained within diffusion tensor MR imaging (DT-MRI) data. In this method, regions within the brain are defined as possessing linear, planar, or spherical diffusion. Visualization of this diffusion metric data is realized by generating streamtube and streamsurface models to represent regions of linear and planar diffusion. Quantification of differences in diffusion anisotropy between different regions of interest (ROIs) is then achieved by analyzing 2D barycentric histograms created from the complete distribution of diffusion metric values measured in each region. In four healthy volunteers, there was only a small degree of asymmetry (epsilon) in the number of linear, planar, or spherical diffusion voxels between the right and left hemispheres (epsilon approximately equal to +/- 2%). However, in a patient with a metastatic brain lesion there was marked asymmetry in both linear (epsilon approximately -10%) and planar (epsilon approximately equal to 5%) diffusion between comparable ipsilateral and contralateral regions, with a significant reduction in the number of linear diffusion voxels and an increase in the number of planar diffusion voxels in the tumor-bearing hemisphere. These results demonstrate the potential of this approach to characterize brain structure in both healthy and diseased subjects.     

DTI对HIV感染者脑白质细微结构病变的诊断研究

目的 探讨扩散张量成像(DTI)技术对人类免疫缺陷病毒(HIV)感染者脑白质细微病变的诊断和临床应用价值.方法选取80例HIV阳性者(阳性组)和83例HIV阴性者(对照组),均行MRI常规序列及DTI扫描.测定双侧内囊前支、内囊后支、内囊膝、胼胝体膝部、压部及双侧胼胝体干脑白质感兴趣区(ROI)的各向异性分数(FA)值和表观扩散系数(ADC)值,利用独立样本t检验比较2组间FA值及ADC值的差异.结果与正常对照组相比,阳性组双侧内囊前支及内囊膝、胼胝体膝部及双侧胼胝体干FA值均低于对照组,差异有统计学意义(P<0.05);阳性组双侧内囊前支、后支、膝部及双侧胼胝体干ADC值均高于对照组,差异亦有统计学意义(P<0.05).结论DTI通过FA值和ADC值的异常改变而发现HIV阳性患者内囊及胼胝体区脑白质结构的细微病变,为临床早期诊断和治疗干预提供参考依据.     

Characterization of white matter alterations in phenylketonuria by magnetic resonance relaxometry and diffusion tensor imaging.

A multimodal MR study including relaxometry, diffusion tensor imaging (DTI), and MR spectroscopy was performed on patients with classical phenylketonuria (PKU) and matched controls, to improve our understanding of white matter (WM) lesions. Relaxometry yields information on myelin loss or malformation and may substantiate results from DTI attributed to myelin changes. Relaxometry was used to determine four brain compartments in normal-appearing brain tissue (NABT) and in lesions: water in myelin bilayers (myelin water, MW), water in gray matter (GM), water in WM, and water with long relaxation times (cerebrospinal fluid [CSF]-like signals). DTI yielded apparent diffusion coefficients (ADCs) and fractional anisotropies. MW and WM content were reduced in NABT and in lesions of PKU patients, while CSF-like signals were significantly increased. ADC values were reduced in PKU lesions, but also in the corpus callosum. Diffusion anisotropy was reduced in lesions because of a stronger decrease in the longitudinal than in the transverse diffusion. WM content and CSF-like components in lesions correlated with anisotropy and ADC. ADC values in lesions and in the corpus callosum correlated negatively with blood and brain phenylalanine (Phe) concentrations. Intramyelinic edema combined with vacuolization is a likely cause of the WM alterations. Correlations between diffusivity and Phe concentrations confirm vulnerability of WM to high Phe concentrations.     

脑卒中后白质纤维重塑的DTI研究进展

脑卒中是发病率及致残率均较高的急性脑血管疾病,亚急性期及慢性期的白质纤维重塑可促进脑卒中后的神经功能恢复,降低致残率。扩散张量成像(DTI)是一种可无创、动态观察卒中后脑内白质纤维微观结构改变的影像学手段。就DTI用于脑卒中后脑内不同结构水平的白质纤维重塑方面的研究进展及其局限性和方法学发展进行综述。     

Diffusion anisotropy in subcortical white matter and cortical gray matter: changes with aging and the role of CSF-suppression

PURPOSE: To determine the relevance of cerebrospinal fluid (CSF)-suppression for the measurement of diffusion anisotropy in well-localized areas of the brain, particularly the subcortical white matter (WM) within the gyri and cortical gray matter (GM), in young and elderly subjects, and to assess the changes of water diffusivity in the brain with normal aging. MATERIALS AND METHODS: Quantitative measures of anisotropy in 26 regions, including subcortical WM (i.e., in the gyri), cortical GM, major deep WM, and deep GM regions of young (21-25 years, N = 8) and elderly (61-74 years, N = 10) normal volunteers, were assessed with CSF-suppressed diffusion tensor imaging (DTI) relative to standard DTI. RESULTS: CSF-suppressed DTI demonstrated significant increases in fractional anisotropy (FA) of 3-12% in the young and 2-14% in the elderly groups with the largest changes being in the subcortical WM of the gyri. Furthermore, FA decreased by 10-19% in the subcortical WM of the gyri of the elderly subjects relative to the young, primarily due to increases in the perpendicular diffusivity, lambda(3), with age. CONCLUSION: CSF-suppressed DTI yields more accurate measures of quantitative anisotropy in cortical and subcortical brain regions. Reductions of anisotropy with aging were predominantly observed in subcortical WM of the gyri.     

抑郁症患者脑白质纤维的各向异性变化

目的：探讨MRI DWI上抑郁症患者脑白质纤维的各向异性特征。方法：对9例抑郁症患者以及与患者组年龄、性别相匹配的10例志愿者（对照组）行MR扩散张量成像（DTI）。记录额叶、颞叶、枕叶和胼胝体白质的各向异性分值（FA值）。结果：抑郁症患者左右额叶上中下部、左右颞叶、胼胝体压部的脑白质FA值均低于对照组,差异有显著性意义（P〈0.05）。结论：抑郁症患者的额叶和颞叶的白质纤维束FA值比正常人低,而且左右侧不对称。     

DTI在PVL合并脑瘫患儿术后脑白质恢复中的应用价值

目的 探讨扩散张量成像(DTI)技术在脑室周围白质软化症(PVL)合并脑瘫患儿术后脑白质恢复中的应用价值.方法 收集经临床诊断为PVL合并脑瘫患儿15例作为病例组,另选相匹配的正常儿童志愿者15例作为对照组,均进行常规MRI平扫及DTI检查,并获得各向异性分数(FA)图,测量病例组治疗前后与对照组皮质脊髓束(内囊膝、内囊后肢、大脑脚及脑桥水平)、基底节区核团(尾状核、豆状核)感兴趣区的FA值差异.结果 双侧内囊膝、内囊后肢、脑桥、胼胝体压部、膝部及双侧大脑脚的FA值在病例组治疗前、后(术后1个月)与对照组间有统计学差异(P＜0.05),3组豆状核、尾状核的FA值无统计学意义.进一步两两比较,双侧内囊后肢、胼胝体压部、膝部任意2组间比较均有统计学差异,双侧内囊膝、脑桥、双侧大脑脚治疗前、后无统计学意义,双侧内囊膝、脑桥、双侧大脑脚治疗前与对照组间比较均有统计学意义(P＜0.05).结论 DTI技术可显示脑白质细微结构变化,其FA值在PVL合并脑瘫患儿术后脑白质恢复中有一定参考价值,有助于指导临床医生进一步合理治疗.     

遗忘型轻度认知障碍的脑白质纤维束成像研究

目的：应用纤维束成像术研究遗忘型轻度认知功能障碍(aMCI)患者脑白质细微结构的改变。方法对30例经临床诊断的 aMCI 患者和31例正常对照(NC)组行扩散张量成像,用 dTV II 软件重建出扣带束、胼胝体、钩状束及下枕额束,并沿着白质束测量部分各向异性(FA)值。对比分析 aMCI 组与 NC 组各白质束的 FA 值,并将 aMCI 组的 FA 值与简易智能精神状态检查量表(MMSE)评分进行相关性分析。结果①aMCI 组的两侧扣带束、两侧钩状束及胼胝体 FA 值明显低于 NC 组,差异有统计学意义;左侧下枕额束 FA 值低于 NC 组,但差异无统计学意义。②右侧扣带束的 FA 值与 MMSE 评分呈正相关。结论aMCI 患者扣带束、钩状束及胼胝体 FA 值的异常改变,提示在阿尔茨海默病(AD)的前驱阶段存在与记忆相关的脑白质束的微损害,纤维束成像(tractography)技术对脑白质的早期损害具有很高的敏感性。     

Directional correlation in white matter tracks of the human brain

PURPOSE: To describe a technique for the detection of distinct brain fibers in sets of magnetic resonance (MR) diffusion tensor imaging (DTI) data. MATERIALS AND METHODS: MR-DTI can be used for a tractography of brain fibers presuming a data set of high spatial resolution and high signal to noise. A less demanding technique for the visualization of discrete brain fiber bundles involves segmentation. By using a region-growing algorithm, those voxels that have a direction similar to that of the major eigenvector in neighboring voxels of a data set can be marked. It has been shown recently by Mori et al (1) that this technique can be successfully applied to data from a single slice of a mouse brain. In this study, the segmentation technique was applied with modifications to multislice DTI data from the human brain. RESULTS: A distinct segmentation of various brain fiber bundles could be achieved by the use of a two-step algorithm. In the first step, voxels within large fiber tracts-such as corticofugal tracts (e.g., corticospinal tract) and the optic radiation-were segmented by starting the region-growing algorithm in the corpus callosum (CC) and erasing this major structure from the data set. In the second step, remaining voxels were segmented by the same algorithm; this revealed a good assignment of the similarly oriented fibers derived by segmentation to the anatomically given brain lobes. This two-step procedure was successfully applied to DTI data of six healthy volunteers. CONCLUSION: The segmentation technique for DTI data proposed by Mori et al (1) for data from mouse brains can be applied to multislice data from the human brain by using a two-step algorithm including a masking of the major fiber tracts.     

Usefulness of diffusion tensor imaging of white matter in Alzheimer disease and vascular dementia

Purpose: To evaluate the usefulness of diffusion tensor imaging in detecting the water diffusivity caused by neuropathological change in Alzheimer disease and vascular dementia.

Material and Methods: Twenty patients with Alzheimer disease, 20 with vascular dementia, and 10 control subjects were examined. Diffusion tensor imaging applied diffusion gradient encoding in six non-collinear directions. Fractional anisotropy values were compared in the genu and splenium of the corpus callosum, and anterior and posterior white matter among the three groups.

Results: In the patients with Alzheimer disease, fractional anisotropy values of the posterior white matter were significantly lower than those of controls. In patients with vascular dementia, fractional anisotropy values of the anterior white matter tended to be lower than those of the posterior white matter (P=0.07).

Conclusion: Diffusion tensor imaging reflects the neuropathological changes in the white matter, and may be useful in the diagnosis of Alzheimer disease and vascular dementia.     

Diffusion tensor eigenvector directional color imaging patterns in the evaluation of cerebral white matter tracts altered by tumor

PURPOSE: To categorize the varied appearances of tumor-altered white matter (WM) tracts on diffusion tensor eigenvector directional color maps. MATERIALS AND METHODS: Diffusion tensor imaging (DTI) was obtained preoperatively in 13 patients with brain tumors ranging from benign to high-grade malignant, including primary and metastatic lesions, and maps of apparent diffusion coefficient (ADC), fractional anisotropy (FA), and major eigenvector direction were generated. Regions of interest (ROIs) were drawn within identifiable WM tracts affected by tumor, avoiding grossly cystic and necrotic regions, known fiber crossings, and gray matter. Patterns of WM tract alteration were categorized on the basis of qualitative analysis of directional color maps and correlation analysis of ADC and FA. RESULTS: Four basic patterns of WM alteration were identified: 1) normal or nearly normal FA and ADC, with abnormal tract location or tensor directions attributable to bulk mass displacement, 2) moderately decreased FA and increased ADC with normal tract locations and tensor directions, 3) moderately decreased FA and increased ADC with abnormal tensor directions, and 4) near isotropy. FA and ADC were inversely correlated for Patterns 1-3 but did not discriminate edema from infiltrating tumor. However, in the absence of mass displacement, infiltrating tumor was found to produce tensor directional changes that were not observed with vasogenic edema, suggesting the possibility of discrimination on the basis of directional statistics. CONCLUSION: Tumor alteration of WM tracts tends to produce one of four patterns on FA and directional color maps. Clinical application of these patterns must await further study.     

首发精神分裂症幻听患者的全脑白质变化研究

目的 探讨首发精神分裂症(SCH)幻听患者的全脑白质微细结构的改变.方法 分别对25例首发SCH幻听患者和25例正常对照者行扩散张量成像(DTI)扫描,采用基于纤维束示踪的空间统计分析(TBSS)方法分析2组全脑各向异性(FA)图,使用非参数的随机排列检验(random permutation test)对2组全脑DTI的FA值进行统计分析比较,得出有差异的脑区.结果 与正常组相比,首发SCH幻听组左侧额眶回与顶下小叶的白质FA值明显降低,差异具有统计学意义(P＜0.05).结论 TBSS方法能较全面、准确地分析首发SCH幻听患者早期脑白质细微结构的改变.     

In vivo DTI evaluation of white matter tracts in rat spinal cord

PURPOSE: To determine whether differences in specific spinal cord white matter (WM) tracts can be detected with in vivo DTI. MATERIALS AND METHODS: In vivo DTI was performed on six rats at the lower thoracic region using a 4.7T magnet. Axial diffusion images were obtained with diffusion gradients applied in six independent directions, with low and high b-values equal to 0 and 692 seconds/mm(2), respectively. Regions of interest (ROIs) were selected corresponding to the major spinal cord tracts, including the dorsal cortical spinal tract (dCST), fasciculus gracilis (FG), rubrospinal tract (RST), vestibulospinal tract (VST), and reticulospinal tract (ReST). RESULTS: ANOVA demonstrated overall differences between tracts for all of the DTI parameters, including fractional anisotropy (FA), trace diffusion (Tr), longitudinal diffusivity (EL = lambda(1)), and transverse diffusivity (ET = (lambda(2) + lambda(3))/2). Similarly to previous ex vivo analyses, the spinal cord tract with the largest and most widely spaced axons (VST) had the largest EL and ET. CONCLUSION: The principal diffusivities appear to reflect axon morphologic differences between the WM tracts that are not as well appreciated with FA and Tr.     

正常成人不同年龄段大脑白质纤维各向异性差异研究

目的:探讨正常成人不同年龄大脑白质纤维磁共振弥散张量各向异性的差异。方法:62名正常志愿者大脑白质纤维不同部位,包括外囊、内囊前肢、内囊后肢、胼胝体膝部和胼胝体压部的FA值和ADC值。结果:胼胝体膝部(F=3.113,P=0.024)和豆状核(F=3.229,P=0.020),在各年龄组之间FA值差异有显著性意义;内囊前肢(F=3.093,P=0.024)和豆状核(F=3.824,P=0.009),ADC值差异有显著性意义。FA值呈正相关的部位有内囊前肢(r=0.293,P=0.0349)、胼胝体膝部(r=0.322,P=0.0202),ADC值呈现正相关的部位只有外囊(r=0.365,P=0.00925)。结论:不同年龄段大脑白质纤维的FA值和ADC值是不同的,随着年龄增大,FA值呈现下降趋势,ADC值则有增高的趋势。