脑室线性结构变化与严重意识障碍疾病的相关性研究

目的评价脑室线性结构在意识障碍(DOC)患者诊断和分级中的应用价值。方法收集2015年1月至2015年12月就诊于中国人民解放军陆军总医院的20例DOC患者,由两名主治医师根据CRS-R评分量表将患者分为无反应觉醒综合征组(UWS)和微意识状态组(MCS)。另选10例健康志愿者作为对照组。分析患者MRI T_1图像的结果,测量数据并探索这些测量指标与CRS-R评分之间的相关性。结果 UWS组和MCS组的Huckman值和第三脑室宽度明显高于对照组(均P0.05),而PDI指数和脑室指数则低于对照组(均P0.05),除Evans值外其余各指标在UWS组和MCS组之间差别也具有统计学意义(均P0.05)。Huckman值和第三脑室宽度与CRS-R评分呈负相关,而PDI指数和脑室指数则相反。结论脑室线性结构测量可以用于DOC患者意识水平的评估。     

修改版昏迷恢复量表对意识障碍患者预后的评估价值

目的探讨修改版昏迷恢复量表(CRS-R)对意识障碍患者预后的评估价值。方法对29例重症脑部病变意识障碍患者进行CRS-R评分,根据评分分为植物状态(VS)和最小意识状态(MCS)。在患者出院≥3个月后进行格拉斯哥结局量表(GOS)评分;并对两个量表评分的相关性进行分析。结果本组VS患者20例、MCS患者9例,二者CRS-R评分分别为(5.15±2.35)分和(11.88±4.01)分。VS患者GOS评分≤3分(预后差)的比率(95%,19/20)显著高于MCS患者(44.4%,4/9)(P0.05)。Pearson相关分析显示,CRS-R评分与GOS评分呈正相关(r=0.558,P0.05)。CRS-R评分的子项中,运动、言语和交流与GOS评分呈正相关(r=0.663,r=0.637,r=0.424,均P0.05);而听觉、视觉和唤醒度与GOS评分无关。结论意识障碍患者CRS-R评分越高,预后越好。     

脑小血管病患者 MR 弥散张量成像的改变及与认知功能障碍的关系

目的：探讨脑小血管病患者MR弥散张量成像的改变以及与认知功能障碍间的关系。方法选取我院接受检查的小脑血管疾病患者70例,根据有无认知障碍分为非痴呆认知功能障碍（VCIND）组39例和认知功能正常（NCI）组31例。对患者进行蒙特利尔认知评估（MoCA）及MRI检查,并对弥散张力成像（DTI）进行处理,显示表观弥散系数图（ADC）以及各向异性分数图（FA）,分析MoCA与DTI的相关性。结果 VCIND组MoCA量表评分（17.54±4.31）分,NCI组为（24.01±2.02）分;VCIND组双侧半卵圆中心、双侧额叶、双侧丘脑以及左侧尾状核 FA 值明显低于 NCI组,VCIND 组左侧尾状核ADC值明显高于NCI组,差异有统计学意义（P＜0.05）。双侧半卵圆中心、双侧额叶以及左侧尾状核FA值与MoCA呈正相关（P＜0.05）。结论脑小血管疾病患者认知功能障碍与DTI的FA值呈正相关。     

视觉威胁反应在判断严重意识障碍程度的应用

目的用强弱光源作为视觉威胁刺激物,与CRS-R量表中以手指为刺激物的视觉威胁反应进行对比,比较严重意识障碍患者对不同视觉威胁刺激物的敏感性差异;在此基础上研究视觉威胁反应能否作为意识的指标。方法随机选择89例严重意识障碍(DOC)患者,采用The JFK Coma Recovery Scale-Revise(JFK改进的昏迷恢复量表,以下简称CRS-R)对其进行床边测量。对于视觉威胁反应项,分别对患者采取手指、弱光、强光刺激物进行刺激,比较反应的差异。结果植物状态(VS)和最小意识状态(MCS)患者对手指视觉威胁刺激的反应具有显著的差异(P0.001),植物状态和最小意识状态患者对强光视觉威胁刺激的反应具有显著的差异(P0.001)。最小意识障碍患者对手指、强光两种视觉威胁刺激的反应没有显著性的差异(P0.05),植物状态患者对手指、强光两种视觉威胁刺激的反应没有显著性的差异(P0.05)。结论严重意识障碍患者(n=89)对不同刺激物(手指、弱光、强光)的反应无显著性差异;视觉威胁反应(手指和光)能反映意识。     

脑小血管病患者MR弥散张量成像的改变及其与认知功能障碍的关系

目的探讨脑小血管病(SVD)患者脑部MR弥散张量成像(DTI)的改变及其与认知功能障碍的关系。方法给55例SVD患者进行神经心理学量表检查,评定认知功能状态,以及行常规MRI和DTI检查,观察感兴趣区的各向异性分数(FA)、表观弥散系数(ADC)。对DTI FA值与蒙特利尔认知评估(MoCA)量表评分的相关性用Pearson相关分析。结果本组SVD患者中认知功能正常(NCI)的患者25例,非痴呆认知功能障碍(VCIND)患者30例。与NCI组比较,VCIND组双侧半卵圆中心、丘脑、额叶及左侧尾状核的FA值显著降低(P0.05~0.001);双侧豆状核、右侧尾状核FA值的差异无统计学意义;左侧尾状核ADC值显著增高(P0.05),其他部位ADC值的差异均无统计学意义。Pearson相关分析示,双侧半卵圆中心、额叶及左侧尾状核的FA值与MoCA量表评分呈正相关(r=0.279~0.375,P0.05~0.005)。结论有认知功能障碍的SVD患者额叶及脑白质DTI的FA值明显降低,并与其认知功能障碍程度有密切的关系。     

颈髓弥散张量成像在肌萎缩性侧索硬化诊断中的应用

目的 初步探讨颈髓弥散张量成像(DTI)在肌萎缩性侧索硬化(ALS)诊断中的应用价值. 方法 选择自2000年1月至2007年1月中山大学附属第二医院骨科收治的28例ALS患者为患者组,20例同期门诊查体健康成年人为对照组,对2组成员进行常规MRI扫描及DTI检查,获取颈髓MD值及FA值的直方图,并对ALS患者颈髓DTI弥散张量值与患者ALS残损功能评分量表(ALSFRS)评分进行相关性分析. 结果 与对照组相比,患者组颈髓FA值和颈髓横断面积明显降低,差异有统计学意义(P<0.05);MD值轻微增加,差异无统计学意义(P>0.05).患者颈髓FA值与ALSFRS评分高度相关(r=0.730,P=0.000),与MD值等指标无相关关系. 结论 ALS患者颈髓DTI显像FA值显著降低,FA值可能成为ALS诊断中的神经影像学阳性支持指标:颈髓的弥散张量值与ALSFRS结合,可以更伞面反映ALS患者的病情进展.     

脑机接口技术在慢性意识障碍诊疗中的应用进展

慢性意识障碍(DOC)包括植物状态(VS)或无反应觉醒综合征(UWS)和微意识状态(MCS),目前临床鉴别诊断以及治疗仍是难题。慢性意识障碍评估,目前临床使用较多的是量表,但存在误判。为了提高诊断准确率,出现一些基于神经影像学的辅助检测方法,如脑机接口(BCI)技术。BCI主要通过脑电信号的处理用人机对话的方法检测患者是否存在指令跟随,被用于意识障碍患者意识状态的检测及康复治疗的评价。本文简述BCI技术特点及在慢性意识障碍中的应用前景。     

磁共振弥散张量成像对阿尔茨海默病脑白质损害的评估及鉴别价值

目的：应用MR弥散张量成像（DTI）观察阿尔茨海默病（AD）患者脑白质纤维束完整性。方法：健康老年志愿者为对照组（NC）组、遗忘型轻度认知障碍（aMCI）组、AD组和皮质下缺血性血管性痴呆（SIVD）组各20例,行常规MRI和DTI扫描后,测定相同感兴趣区（ROI）的各向异性分数（FA）值和表观扩散系数（ADC）值进行比较。结果：与NC组比较, AD组前额叶、颞叶、海马等部位FA值降低,颞叶、海马等部位ADC值升高（P〈0.05）;aMCI组仅扣带束FA值降低,与AD组比差异有统计学意义（P〈0.05）;SIVD组下额枕束等部位FA值下降,ADC值升高,与AD组比较差异有统计学意义（P〈0.05）。结论：DTI可以用来评估白质纤维束完整性,AD组白质损害甚于aMCI患者;扣带束FA值可以作为aMCI患者筛查的指标;根据受累部位不同可对SIVD与AD进行鉴别。     

弥散张量成像在高血压性脑出血后皮质脊髓束损伤中的应用研究

目的：应用弥散张量纤维束成像（DTI）观察高血压性脑出血（HICH）皮质脊髓束（CST）的损伤,探讨DTI在HICH预后评估的临床应用价值。方法对16例HICH患者（壳核8例,丘脑7例,混合型1例）患者分别于入院时（7 d内）和发病后3个月进行DTI 检查,以及肌力测定和美国国立卫生研究院卒中量表（NIHSS）评分。用平均部分各向异性（FA）和表观弥散系数（ADC）测量血肿层面周围的双侧CST,测定血肿面（患侧）／对侧面（健侧）的FA值和ADC值比率。结果 HICH患者中发病后3个月肌力较好组（肌力4～-5级）的FA值比率与肌力较差组（肌力0～3级）比较,差异有统计学意义。而ADC比值在入院时及发病后3个月都没有差别。所有FA值比率＞0．8患者的运动功能都有改善和预后好。然而有1例患者虽然FA值比率不是很高,但运动功能的预后也很好,其ADC值明显升高。 CST完整的患者入院时和发病后3个月的肌力和NIHSS评分均比CST中断的患者好,发病后3个月是恢复最快的阶段。结论通过DTI的FA值比率可以了解基底核区HICH患者CST的损伤情况,有助于早期预测神经功能的恢复情况和指导治疗方案的制定。     

磁共振弥散张量成像在帕金森病诊断与定量分析中的应用价值

目的探讨磁共振弥散张量成像(DTI)在帕金森病(PD)诊断与定量分析中的应用价值。方法选取2017年12月-2019年10月我院收治的PD患者45例作为观察组,同期健康体检者39例作为对照组。两组均接受DTI检查,测量各向异性指数(FA)及表观扩散系数(ADC)值,进行统计学分析。结果观察组丘脑、黑质FA值均低于对照组,差异有统计学意义(P 0. 05)。两组丘脑、黑质、脑桥、小脑上脚及中脚ADC值比较差异均无统计学意义(P 0. 05)。ROC曲线分析显示:丘脑FA值、黑质FA值诊断PD的AUC分别为0. 704、0. 798(均P 0. 05)。Hoehn-Yahr中期PD患者黑质FA值低于早期,丘脑ADC值高于早期,差异有统计学意义(P 0. 05)。Pearson相关性分析显示:黑质FA值与PD患者Hoehn-Yahr分期呈负相关(r=-0. 457,P=0. 002);丘脑ADC值与PD患者Hoehn-Yahr分期呈正相关(r=0. 405,P=0. 006)。结论 DTI对PD具有定量诊断价值,且黑质FA值、丘脑ADC值与PD病情具有相关性。     

Electroencephalography quadratic phase self-coupling correlates with consciousness states and restoration in patients with disorders of consciousness

ObjectiveThe objective of this study was to explore the role for quadratic phase coupling within electroencephalography (EEG) oscillations in the diagnosis of consciousness and consciousness restoration for disorders of consciousness (DOC).MethodsFifty-one DOC patients were enrolled in this study. For each patient, a Coma Recovery Scale-Revised (CRS-R) score and 20-min resting-state EEG were recorded. Consciousness recovery was assessed with a CRS-R score at a three-month follow-up. Twenty healthy subjects were included as controls. General harmonic wavelet transform-based bicoherence was used to quantify the quadratic phase coupling characteristics of the EEG oscillations.ResultsQuadratic phase self-coupling (QPSC) at the delta (QPSC_delta), theta (QPSC_theta) and alpha (QPSC_alpha) bands were closely correlated with patient CRS-R scores. Particularly, the QPSC_theta value could significantly differentiate between vegetative state (VS) patients, minimally conscious state (MCS) patients and healthy control subjects. As compared to VS patients, patients with MCS had a lower QPSC_theta value on the left as well as a higher QPSC_alpha value in right frontal regions. The frontal QPSC_theta value showed significant differences between recovered and unrecovered patients.ConclusionQPSC characteristics could differentiate between consciousness states and show a predictive ability for the recovery of consciousness in DOC patients.SignificanceChanges in QPSC accompany consciousness injury and restoration in DOC patients. A QPSC assessment is helpful in the diagnosis and prognosis of DOC patients.     

慢性意识障碍合并脑积水的临床特征与疗效分析

目的探讨慢性意识障碍(DOC)合并脑积水的临床特征与治疗效果。方法回顾性分析首都医科大学三博脑科医院2014年1月—2017年12月收治的43例慢性意识障碍合并脑积水患者的临床资料。分析指标主要包括:病因、临床表现、影像学表现、意识障碍程度、发生脑积水的时间及治疗效果。结果在同期收治的120例慢性意识障碍患者中,43例患者(35.8%)被诊断为脑积水接受了分流手术治疗。本组患者中,导致脑积水的原发病因主要为颅脑创伤(18例,41.8%)和蛛网膜下腔出血(11例,25.6%);意识障碍为植物状态者11例(25.6%),最小意识状态者17例(39.5%)。脑积水患者初始症状多表现为意识下降(74.4%)、消化不良(58.1%)和肌张力增高(39.5%)。不同意识障碍程度的患者出现脑积水的时间也存在差异,严重患者(CRS-R评分<6分)脑积水主要发生在1个月内(72.8%);中度患者(CRS-R评分6~9分)和轻度患者(CRS-R评分>9分)患者多发生在4~12周,分别占60.9%和48.8%,但是不同组别差异无统计学意义(P=0.1003)。分流手术后患者症状多有不同程度的改善,其中CRS-R评分总体改善患者达77.4%,消化功能改善达75%,肌张力改善达55%。结论慢性意识障碍患者合并脑积水起病隐匿,无特殊临床表现;在影像学表现方面需与脑萎缩导致的脑室扩张鉴别。分流手术能在很大程度上改善脑积水的临床预后。     

White matter integrity correlates with residual consciousness in patients with severe brain injury

Previous studies have suggested that white matter disruption plays an important role in disorders of consciousness (DOC) after severe brain injury. Nevertheless, the integrity of white matter architecture supporting consciousness and its relations with clinical severity in patients with DOC remain to be established. In this study, diffusion tensor imaging (DTI) data was collected from 14 DOC patients and 15 healthy control subjects. We combined tract-based spatial statistics (TBSS) with region of interest (ROI) analysis to examine differences of DTI metrics on white matter skeletons between DOC patients and healthy controls, and the association between white matter integrity and patients’ residual consciousness assessed by Coma Recovery Scale-Revised (CRS-R). We found that: (1) patients with DOC had widespread white matter integrity disruptions, especially in the fornix; (2) the alteration of white matter microstructure was mainly attributed to the increase in radial diffusivity, possibly reflecting demyelination; (3) the behavioral CRS-R assessment score was positively correlated with white matter integrity in the fornix, uncinate fasciculus, pontine crossing tract, and posterior limb of internal capsule. Our results suggest that despite the widespread abnormalities of white matter following severe brain injury, the impairment of consciousness is likely to result from disruptions of key pathways that link brain regions in distributed networks.     

White Matter Deficits Underlying the Impaired Consciousness Level in Patients with Disorders of Consciousness

In this study, we aimed to (1) identify white matter (WM) deficits underlying the consciousness level in patients with disorders of consciousness (DOCs) using diffusion tensor imaging (DTI), and (2) evaluate the relationship between DTI metrics and clinical measures of the consciousness level in DOC patients. With a cohort of 8 comatose, 8 unresponsive wakefulness syndrome/vegetative state, and 14 minimally conscious state patients and 25 patient controls, we performed group comparisons of the DTI metrics in 48 core WM regions of interest (ROIs), and examined the clinical relevance using correlation analysis. We identified multiple abnormal WM ROIs in DOC patients compared with normal controls, and the DTI metrics in these ROIs were significantly correlated with clinical measures of the consciousness level. Therefore, our findings suggested that multiple WM tracts are involved in the impaired consciousness levels in DOC patients and demonstrated the clinical relevance of DTI for DOC patients.     

Subcortical microstructural diffusion changes correlate with gait impairment in Parkinson's disease

BackgroundGait impairments are common in Parkinson's Disease (PD) and are likely caused by degeneration in multiple brain circuits, including the basal ganglia, thalamus and mesencephalic locomotion centers (MLC). Diffusion tensor imaging (DTI) assesses fractional anisotropy (FA) and mean diffusivity (MD) that reflect the integrity of neuronal microstructure. We hypothesized that DTI changes in motor circuits correlate with gait changes in PD.ObjectiveWe aimed to identify microstructural changes of brain locomotion control centers in PD via DTI and their correlations with clinical and quantitative measures of gait.MethodsTwenty-one PD patients reporting gait impairment and 15 controls were recruited. Quantitative gait and clinical tests were recorded in PD subjects’ medication ON and OFF states. Region of Interest (ROI) analysis of the thalamus, basal ganglia and MLC was performed using ExploreDTI. Correlations between FA/MD with clinical gait parameters were examined.ResultsMicrostructural changes were seen in the thalamus, caudate and MLC in the PD compared to the control group. Thalamic microstructural changes significantly correlated with gait parameters in the pace domain including the Timed Up and Go in the ON state. Caudate changes correlated with cadence and stride time in the OFF state.ConclusionsOur pilot study suggests that PD is associated with a characteristic regional pattern of microstructural degradation in the thalamus, caudate and MLC. The DTI changes may represent subcortical locomotion network failure. Overall, DTI ROI analyses might provide a useful tool for assessing PD for functional status and specific motor domains, such as gait, and potentially could serve as an imaging marker.     

Resting-state EEG study of comatose patients: a connectivity and frequency analysis to find differences between vegetative and minimally conscious states

The aim of this study was to look for differences in the power spectra and in EEG connectivity measures between patients in the vegetative state (VS/UWS) and patients in the minimally conscious state (MCS). The EEG of 31 patients was recorded and analyzed. Power spectra were obtained using modern multitaper methods. Three connectivity measures (coherence, the imaginary part of coherency and the phase lag index) were computed. Of the 31 patients, 21 were diagnosed as MCS and 10 as VS/UWS using the Coma Recovery Scale-Revised (CRS-R). EEG power spectra revealed differences between the two conditions. The VS/UWS patients showed increased delta power but decreased alpha power compared with the MCS patients. Connectivity measures were correlated with the CRS-R diagnosis; patients in the VS/UWS had significantly lower connectivity than MCS patients in the theta and alpha bands. Standard EEG recorded in clinical conditions could be used as a tool to help the clinician in the diagnosis of disorders of consciousness.     

The thalamic ultrastructural abnormalities in paroxysmal kinesigenic choreoathetosis: a diffusion tensor imaging study

Paroxysmal kinesigenic choreoathetosis (PKC) is a rare neurologic disorder. There are not apparent morphological changes in patients with idiopathic PKC. The purpose of this study is to determine whether ultrastructural changes are in the brain of patients with idiopathic PKC using diffusion tensor imaging. From May 2007 to August 2008, seven patients with idiopathic PKC were included. The mean age at initial onset was 11.7 ± 3.1 (range 8–17) years, and the mean disease duration was 6.9 ± 5.1 (range 1–14) years. Seven subjects of an age- and sex-matched control group were recruited. DTI data were obtained with a 3-T scanner. Fractional anisotropy (FA) and mean diffusivity (MD) were obtained in eight brain regions of interest. Patients with idiopathic PKC had significantly higher FA values than controls in the right thalamus (P < 0.05 Bonferroni corrected). Patients also had lower MD values than controls in the left thalamus (P < 0.05 Bonferroni corrected). FA and MD values were not significantly correlated with age of onset, gender, frequency of attack and duration of the disease. The results showed that in patients with idiopathic PKC, diffusion tensor imaging discloses distinct ultrastructural abnormalities in the thalamus. DTI is a sensitive neuroradiologic technique for detecting cerebral alterations in patients even without visible lesions on conventional MRI.     

Disentangling disorders of consciousness: Insights from diffusion tensor imaging and machine learning

Previous studies have suggested that disorders of consciousness (DOC) after severe brain injury may result from disconnections of the thalamo‐cortical system. However, thalamo‐cortical connectivity differences between vegetative state (VS), minimally conscious state minus (MCS?, i.e., low‐level behavior such as visual pursuit), and minimally conscious state plus (MCS+, i.e., high‐level behavior such as language processing) remain unclear. Probabilistic tractography in a sample of 25 DOC patients was employed to assess whether structural connectivity in various thalamo‐cortical circuits could differentiate between VS, MCS?, and MCS+ patients. First, the thalamus was individually segmented into seven clusters based on patterns of cortical connectivity and tested for univariate differences across groups. Second, reconstructed whole‐brain thalamic tracks were used as features in a multivariate searchlight analysis to identify regions along the tracks that were most informative in distinguishing among groups. At the univariate level, it was found that VS patients displayed reduced connectivity in most thalamo‐cortical circuits of interest, including frontal, temporal, and sensorimotor connections, as compared with MCS+, but showed more pulvinar‐occipital connections when compared with MCS?. Moreover, MCS? exhibited significantly less thalamo‐premotor and thalamo‐temporal connectivity than MCS+. At the multivariate level, it was found that thalamic tracks reaching frontal, parietal, and sensorimotor regions, could discriminate, up to 100% accuracy, across each pairwise group comparison. Together, these findings highlight the role of thalamo‐cortical connections in patients' behavioral profile and level of consciousness. Diffusion tensor imaging combined with machine learning algorithms could thus potentially facilitate diagnostic distinctions in DOC and shed light on the neural correlates of consciousness. Hum Brain Mapp 38:431–443, 2017 . © 2016 Wiley Periodicals, Inc.