脑白质高信号与DCE-MRI血脑屏障通透性相关性研究

目的探究脑白质高信号(WMH)严重程度与动态增强磁共振成像(DCE-MRI)血脑屏障通透性的相关性。方法前瞻性分析2017年9月至2018年5月在中国医科大学附属第一医院行DCE-MRI并诊断为WMH 55例患者的资料,按照Fazekas评分分为Ⅰ级17例、Ⅱ级20例、Ⅲ级18例。头部常规磁共振扫描及DCE-MRI扫描,利用Omni-Kinetics分析软件计算容积转运常数(K^trans)值。比较三组患者WMH区域及正常脑白质(NAWM)区域的K^trans值差异,分析WMH严重程度与血脑屏障通透性的相关性。结果不同级别WMH区域及NAWM区域的K^trans值分别为Ⅰ级WMH患者为(0.055±0.009)×10^-2min^-1、(0.120±0.028)×10^-2min^-1、Ⅱ级WMH患者为(0.060±0.008)×10^-2min^-1、(0.167±0.029)×10^-2     

fMRI对可能血管源性脑白质高信号与认知功能障碍关系的研究进展

可能血管源性脑白质高信号（WMH）是中老年人脑内常见的影像表现。WMH可导致认知功能下降,最终可能发展成为痴呆。本文对WMH与认知障碍的关系以及多模态功能磁共振在WMH与认知功能障碍中的应用进行综述,以进一步了解WMH与认知功能障碍的关系。     

飞行员与普通人脑白质高信号检出率及分布比较

目的：比较飞行员和普通人脑白质高信号（white matter hyperintensities,WMHs）的发病情况。方法收集2002年1月—2014年12月来空军总医院健康体检进行头颅MRI检查的现役飞行员290例、普通人910例进行回顾性分析,比较WMHs的发病情况。结果飞行员WMHs者40例,检出率为13.79%;普通人WMHs者83例,检出率为9.12%。飞行员和普通人WMHs年龄差异无统计学意义。本组飞行员和普通人WMHs分布部位类似,差异无统计学意义。本组40例WMHs飞行员蒙特利尔量表评分均≥26分。8例连续执行飞行任务飞行员6个月后WMHs体积增加,差异有统计学意义。结论本组飞行员WMHs的检出率高于普通人。飞行员和普通人WMHs分布部位类似主要位于额叶。飞行员点状WMHs对认知不受影响。飞行员WMHs的体积会随着飞行时间的增加而增加。     

非痴呆老年人脑白质高信号进展的危险因素分析

目的 探讨非痴呆老年人脑白质高信号(WMHs)进展的危险因素.方法 从阿尔茨海默病神经影像学倡议(ADNI)-1队列中筛选完成基线及3年随访T2 FLAIR扫描的非痴呆老年人263例,根据WMHs是否进展分为进展组(n=66)与非进展组(n=197).比较两组基线人口学资料、心血管疾病史、载脂蛋白E(apoE)基因型、...     

飞行员脑白质高信号的飞行相关危险因素分析

<正>脑白质高信号(white matter hyperintensity,WMH),又称脑白质疏松症,常见于健康老年人、阿尔茨海默病、血管性痴呆、宾斯旺格病、脑血管病、一氧化碳中毒、脑外伤、糖尿病和轻度认知障碍等疾病。WMH在颅脑磁共振上表现为皮质下液体衰减反转恢复(fluid attenuated inversion recovery,FLAIR)序列多发斑点状、小片状高信号,部分病灶可融合为斑片状。有研究表明,现役飞行人员经颅脑MRI检查可见分布及数量存在特异性的WMH[1]。     

飞行员与普通人脑白质高信号患病率和分布的比较研究

目的比较战斗机飞行员和普通人脑白质高信号(white matter hyperintensity signal,WMHS)的发病情况。方法收集某医院健康体检进行头颅MR检查的战斗机飞行员120例、普通人200例进行回顾性分析,比较飞行员与普通人WMHS的患病率及部位分布。结果飞行员WMHS者18例,患病率为15%;普通人WMHS者15例,患病率为7.5%。两组患病率有明显差异(P0.05)。结论本组飞行员WMHS的患病率高于普通人。两组WMHS分布相似,主要位于额叶。     

不同类型偏头痛患者脑白质病变与认知功能障碍的相关性分析

目的 探讨不同类型偏头痛患者脑白质病变与认知功能障碍的相关性.方法 分析2018年4月-2019年4月收治的偏头痛患者47例临床资料,将无先兆偏头痛23例患者纳入A组,将先兆头痛24例患者纳入B组.所有患者首先接受头颅磁共振成像(MRI)检查,并采用操作化定义的年龄相关的白质改变(OD-AR-WMC)量表及Mattis...     

扩散张量成像辨别脑白质高信号异质性的研究

目的 探讨使用扩散张量成像(DTI)辨别不同类型的脑白质高信号(WMH).方法 对73例WMH患者和18例健康志愿者(对照组)行DTI检查,比较额叶、枕叶、顶叶脑室旁和额顶叶半卵圆中心正常脑白质和WMH的各DTI参数.结果 不同部位DTI参数的变化幅度有差异,与正常脑白质相比,额叶Fazekas 1级WMH的部分各向异...     

血管内皮生长因子在高原暴露下血脑屏障通透性改变中的作用及其与脑水肿的关系

目的:探讨血管内皮生长因子(VEGF)在高原暴露下血脑屏障(BBB)通透性改变中的作用及与脑水肿的关系。方法:将大鼠暴露于高原不同海拔下,应用RT-PCR测定脑组织内VEGFmRNA转录水平和双抗体夹心ELISA法测定脑内VEGF蛋白含量,应用比色法测定伊文思蓝(EB)的透过率以确定BBB通透性的变化,脑湿干比重法测定脑含水量百分率。结果:高原暴露下,大鼠脑内VEGF和VEGFmRNA的表达随着海拔增高而增高,随着时间延长而增高,以暴露于5 000 m的特高海拔区第9天增高最明显。与此同时,脑内EB含量和脑内含水量增高。脑内VEGF活性与脑内EB含量和脑含水量之间明显相关。结论:VEGF是高原环境下BBB通透性增高的重要因素。     

缺血性脑卒中患者急性期认知功能状况调查与分析

目的:调查了解缺血性脑卒中患者急性期认知功能状况。方法:采用简易精神状态检查量表(MMSE)及蒙特利尔认知评估量表(MoCA)对缺血性脑卒中48例发病7天内的认知功能状况进行测评。结果:58.3%的缺血性脑卒中患者存在认知功能障碍;视空间与执行功能、命名、语言重复及流畅得分与MoCA总分显著相关(P<0.05),其余各项得分与MoCA总分无显著相关性(P>0.05);视空间与执行功能、命名、计算力及抽象能力标准化回归系数与总分显著相关(P<0.05),按照标准化回归系数高低排序依次为视空间与执行功能、命名、计算力及抽象能力。结论:58.3%的缺血性脑卒中患者存在认知功能障碍,应进行有针对性的干预。     

老年男性脑白质病变患者认知功能特点的研究

目的 探讨老年男性脑白质病变患者认知功能的改变特点.方法 采用蒙特利尔评估量表(MoCA)对64例老年男性脑白质病变患者的认知状况进行评估.结果 不同部位及不同程度脑白质病变老年男性患者MoCA总分及各分项评分随病情加重呈降低趋势.按脑室旁脑白质病变(PVL)分组时,中重度组(PVL=2或3)MoCA总分与对照组(PVL=0)、轻度组(PVL=1)相比,轻、中重度组定向力得分与对照组相比,中重度组延迟回忆得分与对照组相比差异均有统计学意义(P＜0.05),轻度组注意力得分与中重度组相比差异有统计学意义(P＜0.05),但与对照组相比差异无统计学意义.按深部脑白质病变(DWML)分组时,中重度组(DWML=2或3)MoCA总分与命名得分与对照组(DWML=0)相比差异有统计学意义(P＜0.05),其余各项目得分差异均无统计学意义(P＞0.05).结论 老年男性患者脑白质病变与认知功能减退有关,且脑室旁脑白质病变对认知功能的影响较深部脑白质病变明显.     

Discriminating between silent cerebral infarction and deep white matter hyperintensity using combinations of three types of magnetic resonance images: a multicenter observer performance study

INTRODUCTION: We attempted to determine the most appropriate combination of magnetic resonance (MR) images that can accurately detect and discriminate between asymptomatic infarction and deep white matter hyperintensity (DWMH); these lesions have different clinical implications and are occasionally confused. MATERIALS AND METHODS: We performed an observer performance analysis using cerebral MR images of 45 individuals with or without asymptomatic small white matter infarction and/or mild DWMH who participated in a physical checkup program at four institutions. Six observers interpreted whether infarction and/or DWMH existed in combinations of two or three image types of the T1-weighted images (T1WI), T2-weighted images (T2WI), and fluid-attenuated inversion recovery (FLAIR) images. The observers' performance was evaluated with a receiver operating characteristic (ROC) analysis. RESULTS: The averaged area under the ROC curve (Az) for detecting a infarction was significantly larger in the combination of all the three image types (0.95) than that in any combinations of the two image types (T1WI and FLAIR images, 0.87; T2WI and FLAIR images, 0.85; T1WI and T2WI, 0.86). The Az for detecting DWMH was significantly smaller in the combination of T1WI and T2WI (0.79) than that in other image combinations (T1WI and FLAIR, 0.89; T2WI and FLAIR, 0.91; T1WI, T2WI, and FLAIR, 0.90). CONCLUSION: The combination of T1WI, T2WI, and FLAIR images is required to accurately detect both small white matter infarction and mild DWMH.     

Vascular volume and blood-brain barrier permeability measured by dynamic contrast enhanced MRI in hippocampus and cerebellum of patients with MCI and normal controls

PURPOSE: To measure the cerebrovascular volume and blood-brain barrier (BBB) permeability indices in hippocampus and cerebellum of patients with mild cognitive impairment (MCI) using dynamic contrast-enhanced MRI (DCE-MRI), and compare to that of normal controls. MATERIALS AND METHODS: A total of 11 MCI subjects and 11 healthy elderly controls participated in this prospective study. DCE-MRI was performed to measure the contrast enhancement kinetics. The early enhancement percentage (at 50 seconds after injection) was defined as the vascular volume index, and the ratio between the four to five-minute enhancement relative to the 50-second enhancement was defined as the BBB permeability index. RESULTS: The enhancement kinetics measured from hippocampus of MCI individuals demonstrated a lower magnitude and slower decay than healthy controls, suggesting that they had a smaller vascular volume (significant in the right side; P <0.001) and a higher BBB permeability (not reaching significance level). The vascular volume index was significantly correlated with naming ability (P 0.05). CONCLUSION: These results suggest that changes in cerebrovasculature may occur in hippocampus of MCI. DCE-MRI may provide a noninvasive means to measure the subtle BBB leakage associated with the cerebrovascular pathology commonly found in Alzheimer's disease.     

Serial diffusion tensor imaging to characterize radiation-induced changes in normal-appearing white matter following radiotherapy in patients with adult low-grade gliomas

Purpose The aim of this study was to ascertain whether diffusion tensor imaging (DTI) metrics—fractional anisotropy (FA), mean diffusivity (MD), linear case (CL), planar case (CP), spherical case (CS)—can characterize a threshold dose and temporal evolution of changes in normal-appearing white matter (NAWM) of adults with low-grade gliomas (LGGs) treated with radiation therapy (RT). Methods and materials Conventional and DTI imaging were performed before RT in 5 patients and subsequently, on average, at 3 months (n = 5), 8 months (n = 3), and 14 months (n = 5) following RT for a total of 18 examinations. Isodose distribution at 5-Gy intervals were visualized in all the slices of fluid attenuated inversion recovery (FLAIR) and the corresponding DTI images without diffusion sensitization (b0DTI). The latter were exported for relative quantitative analysis. Results Compared to pre-RT values, FA and CL decreased, whereas CS increased at 3 and 8 months and recovered partially at 14 months for the dose bins > 55 Gy and 50–55 Gy. For the 45–50 Gy bin, the FA and CL decreased with an increase in CS at 3 months; no further change was seen at 8 or 14 months. For the >55 Gy and 50–55 Gy bins, CP decreased and MD increased at 3 months and returned to baseline at 8 months following RT. Conclusion Radiation-induced changes in NAWM can be detected at 3 months after RT, with changes in FA, CL, and CS (but not CP or MD) values seen at a thresh-old dose of 45–50 Gy. A partial recovery was evident by 14 months to regions that received doses of 50–55 Gy and >55 Gy, thus providing an objective measure of radiation effect on NAWM.     

缺血性脑血管病患者脑白质病变的危险因素探讨:417例回顾性分析

目的 分析脑白质病变(WMLs)的危险因素,尤其是高血压、高血糖、高血脂、吸烟等脑血管病与WMLs发生的相关性.方法 收集北京军区总医院神经内科417例患者的头颅核磁共振(MRI)检查并给予脑白质病变评分,收集相关临床资料.采用logistic回归分析其独立危险因素.结果 多因素有序logistic回归分析显示:年龄(P=0.000)、高血压程度(P=0.007)、同型半胱氨酸(P=0.010)、糖尿病患病时间10年以内(P=0.033)、吸烟40年以上(P=0.003)是WMLs的独立危险因素.年龄(P=0.006)、高血压程度(P=0.028)、吸烟史(P=0.000)是缺血性脑血管病患者WMLs的独立危险因素.结论 年龄、同型半胱氨酸值、高血压等级是影响WMLs程度的独立危险因素(P＜0.05);年龄越大,高血压程度越重,同型半胱氨酸值越高的患者WMLs程度越重;年龄越大,高血压程度越重,吸烟40年以上者吸烟时间越长的缺血性脑血管病患者WMLs程度越重.     

血管性抑郁患者脑白质改变及其对药物的反应性

 目的 探讨血管性抑郁患者脑白质改变及其对药物的反应性,为临床诊治提供指导。方法 选取2017-04至2018-12北京市隆福医院就诊年龄大于65岁的血管性抑郁患者,采用抑郁自评量表进行抑郁评估(SDS),采用蒙特利尔认知评价量表进行认知评估(MoCA),并进行头部MRI检查。对受试者抑郁量表评分SDS与MRI白质高信号评分、MoCA评分进行相关性分析,并给予艾司西酞普兰治疗12周后,复查SDS,观察治疗效果。结果 (1)SDS分别与MRI侧脑室白质评分、深部白质评分、Fazekas评分均具有明显正相关性,相关系数r分别为0.719、0.651、0.700,P值均为0.000。SDS与MoCA有明显负相关性,相关系数r为-0.696,P=0.000。(2)艾司西酞普兰治疗后SDS评分降低,治疗前后有统计学差异(t=12.899,P=0.000)。结论 头部MRI白质高信号与血管性抑郁明显相关,是抑郁的危险因子;艾司西酞普兰对血管性抑郁治疗效果较好。     

多模式CT预测评估缺血性卒中患者血脑屏障完整性和侧支循环的价值分析

目的 探讨多模式CT对评估缺血性卒中患者血脑屏障完整性和侧支循环的价值.方法 选取我院收治的确诊为缺血性卒中的患者76例,行多模式CT检查,包括CT平扫(NCCT)、CT灌注成像(CTP)及CT血管成像(CTA)等模式.分析灌注范围的分布并绘制感兴趣区(ROI),测定脑血流量(CBF)、脑血容量(CBV)、平均通过时间...