VBM分析在颞叶癫痫患者脑结构MRI检测中的应用

【目的】基于像素的形态学测量（VBM ）法分析颞叶癫痫患者脑区灰质密度和体积的差异,探讨VBM对常规M RI未发现病灶的颞叶癫痫患者的检测准确性。【方法】选择本院收治的30例常规M RI未发现病灶的颞叶癫痫患者（颞叶癫痫组）,其中男13例,女17例;选择同期本院体检健康者30例（对照组）,其中男16例,女14例。采用磁化预备快速梯度回波序列进行高分辨率全脑结构像扫描两组研究对象脑部,通过VBM分析其全脑灰质体积及密度变化。【结果】①颞叶癫痫患者组的左侧枕叶、楔叶,右侧小脑山顶脑区的灰质密度较对照组降低,差异有显著性意义;双侧壳核、外侧苍白球、左侧颞下回、右侧额下回脑区的灰质密度较对照组升高,差异有显著性意义;②颞叶癫痫患者组双侧岛叶,右侧中央前回、颞上回、楔叶、楔前叶、枕中回、缘上回,左侧颞中回、角回、舌回、颞横回、中央后回、中央旁小叶、海马旁回、梭状回的脑灰质体积较正常对照组降低,差异有显著性;未发现灰质体积升高的脑区。【结论】颞叶癫痫患者不仅颞叶灰质存在异常,而且颞叶外脑区也存在广泛的灰质异常,对于常规M RI未发现病灶的颞叶癫痫患者,进行VBM 分析可发现广泛的脑结构异常。     

帕金森病基于体素的MRI形态学研究

目的：用基于体素的形态学分析（VBM）方法,研究帕金森病（PD）患者全脑灰质体积异常区域及分布特征。方法：采集3．0T高场强MR高分辨T1WI,运用VBM方法对25例PD患者及23例健康对照组的大脑灰质图像进行比较,并对两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：PD患者的脑灰质体积较对照组广泛减少,这些区域包括双侧岛叶、海马旁回、杏仁核,右侧颞叶、枕叶、顶叶、额叶,此外还有左额内侧回等区域。结论：VBM方法能较全面、准确、定量地表现PD患者广泛存在的脑灰质体积缺失区域,可以为PD患者的多系统受累的病理机制提供必要的神经影像学依据。     

MRI脑灰质形态学分析在双重病理所致颞叶癫痫的应用

目的应用基于体素形态学(VBM)及基于表面形态学(SBM)分析,探讨双重病理所致颞叶癫痫磁共振成像(MRI)脑灰质结构变化。方法收集病理确诊为海马硬化(HS)合并局灶性皮质发育不良(FCD)的双重病理颞叶癫痫患者36例(左侧癫痫组20例、右侧癫痫组16例)及健康对照组30例行MRI T_1WI 3D BRAVO序列扫描,使用SPM及Freesurfer软件分别进行灰质体积及皮层厚度、皮层表面积分析,并采用独立样本t检验获得有统计学差异脑区。结果左、右侧癫痫组与对照组比较,病侧大部分颞叶(含海马)灰质体积减小,左侧癫痫组同侧丘脑及杏仁核灰质体积减小,其差异均有显著统计学意义(FDR校正,P0.001,K≥20体素)。癫痫组均出现部分颞叶及颞叶以外脑区皮层增厚,但左、右侧癫痫组异常脑区存在不同;同时癫痫组病变侧颞叶脑区皮层表面积减小,上述差异均具有统计学意义(未校正,P0.01,顶点数≥100)。结论HS合并FCD致颞叶癫痫病变侧颞叶(含海马)灰质体积广泛缩小为主要形态学特征,皮层表面积减小对病变定侧也有一定作用,单纯通过皮层增厚观察双重病理中FCD存在一定局限性。     

应用基于体素的形态测量学分析慢性原发性三叉神经痛患者脑灰质形态改变

目的 应用基于体素的形态测量学（VBM）方法,分析慢性原发性三叉神经痛（CPTN）患者脑灰质形态改变。方法 利用VBM-DARTEL算法,对30例CPTN患者（CPTN组）及30名年龄、性别相匹配的健康志愿者（正常对照组）的3D-T1W序列脑结构数据行VBM处理及统计分析,探讨CPTN患者脑灰质体积改变及其与临床指标（病程及量表评分）的相关性。结果 与正常对照相比,CPTN患者双侧前扣带回（ACC）后部及中扣带回（MCC）、双侧颞叶、双侧丘脑、左侧海马及海马旁回、右侧中央前回灰质体积减小,右侧后扣带回（PCC）及右侧顶叶灰质体积增大（P均<0.05）,但所有差异脑区的灰质体积与临床指标之间无线性相关关系。结论 CPTN患者存在多个脑区灰质体积的异常,VBM方法能显示这些改变,为临床评价CPTN患者脑形态学异常提供客观的影像学依据。     

联合磁源性影像和磁共振波谱技术评估颞叶癫痫的价值

目的：探讨磁源性成像（MSI）和磁共振波谱（^1H—MRS）技术结合在颞叶癫痫诊断定位中的价值。方法：设健康对照者10例，特发颞叶癫痫患者8例，应用MEG定位痫性病灶，选取MEG异常区域、对侧相应区域和双颞叶内侧区域测量NAA／Cho值，并观察是否存在海马硬化。结果：8例患者MEG检查结果均异常，6例MEG异常相应区域MRS检查NAA／Cho值减少，符合率为62．5％；MRI显示海马硬化2例，MRI正常6例，颞叶内侧MRS扫描未见明显改变。结论：联合MSI和MRS技术可进一步提高颞叶癫痫致痫灶的定位准确性。     

慢性高原病患者脑灰质变化的VBM-MRI研究

目的采用MRI基于体素的形态学测量（VBM-MRI）技术,分析慢性高原病（CMS）患者全脑灰质体积的变化。材料与方法对14例临床确诊的CMS患者和年龄、性别、受教育年限、海拔高度相匹配的11例正常志愿者行全脑扫描,获取3D-T1结构图像。利用VBM方法对CMS组和正常组的全脑灰质图像进行基于体素的统计学比较。结果与对照组相比,CMS患者右侧舌回、后扣带回、双侧海马旁回及左侧颞下回灰质体积增加;左侧前扣带回灰质体积减少。结论利用VBM方法对MR结构图像分析能够客观显示CMS患者特定脑区体积的变化,从影像学角度揭示高原缺氧对脑结构的影响。     

MRI评价抗癫痫药物对原发全面性癫痫患者脑灰质结构的影响

目的 运用基于体素的形态学(VBM)分析方法,探讨抗癫痫药物(AEDs)对全面强直阵挛癫痫(GTCS)患者脑灰质结构的影响。方法 将19例服用AEDs治疗的GTCS患者(服药组)及19例未服药患者(未服药组)纳入本研究。采集3D T1数据,并采用VBM方法将患者脑灰质结构进行分割,并对分割后的灰质结构进行两样本t检验。针对服药患者,分2次分别纳入及不纳入病程作为协变量,将服药时间与全脑灰质体积进行相关分析。结果 与未服药组比较,服药组GTCS患者脑灰质体积增加的区域以双侧额叶、顶叶、颞叶、尾状核及小脑半球为主。无论是否将病程纳为协变量,双侧壳核、丘脑灰质体积与服药时间呈正相关。结论 VBM可显示AEDs对脑灰质结构造成的微细改变;AEDs对GTCS患者脑灰质结构可能具有一定的保护作用。     

基于自动分割技术联合基于体素的形态学观察帕金森病脑灰质结构

目的 探讨基于自动分割技术联合基于体素的形态学(VBM)观察帕金森病(PD)患者全脑灰质异常区域及分布特征的应用价值。方法 基于自动分割技术,应用FIRST工具对29例PD患者(PD组)及30名健康人(对照组)的T1图像皮层下灰质结构精确分割,对比两组各灰质结构体积。并应用VBM方法对两组脑灰质图像进行比较。结果 两组右侧壳核皮层下灰质体积差异有统计学意义(t=10.201,P<0.05)。与对照组比较,PD组脑灰质体积(右侧初级运动皮层,双侧额叶、边缘叶、部分左侧小脑后叶、右侧小脑前叶、右侧小脑后叶、右侧颞叶、顶叶、壳核及左侧枕叶)广泛减少,部分左侧小脑后叶体积增加,两侧半球脑体积缺失不对称(右侧大于左侧)。结论 通过FIRST工具可精确分割并直接计算皮层下灰质结构体积,应用VBM技术可定量分析脑结构形态学异常;二者结合可较全面地表现PD脑灰质体积广泛减少的形态学特点。     

不同部位脑梗死所致脑灰质结构改变

目的 采用基于体素的形态学分析方法（VBM）比较不同部位脑梗死患者脑灰质结构改变。方法 对慢性期运动功能恢复良好的25例基底节区梗死、13例脑桥梗死患者和22名性别、年龄相匹配的健康志愿者行高分辨率T1W扫描,采用VBM 8软件包进行图像后处理,分别比较基底节区梗死组、脑桥梗死组与正常对照灰质体积存在差异的脑区。结果 基底节区梗死组患侧初级运动皮层（M1区）、丘脑灰质体积减小。脑桥梗死组两侧小脑半球后叶灰质体积减小,以健侧为著;两侧辅助运动区（SMA）、健侧大脑半球M1区灰质体积增加。结论 不同部位脑梗死所致脑灰质结构改变存在差异,可能对临床实现个体化治疗及康复训练有一定指导意义。     

磁共振波谱分析对颞叶内侧癫痫患者脑功能定位的监测和评估作用

目的:通过对颞叶癫痫患者的磁共振波谱分析(magneticresonancespec-troscopy,MRS)结果进行分析,探讨其在诊断颞叶内侧癫痫中的作用与意义。方法:经手术治疗的颞叶癫痫患者19例,外侧型5例,内侧型14例,经术中皮质脑电图及手术后病理结果证实;手术前行脑电图、MRI及MRS检查。结果:5例颞叶外侧型癫痫患者海马区MRS检查均无异常,14例颞叶内侧型癫痫患者中6例海马区MRI显示异常,14例MRS检查均显示异常,其中1例显示双侧异常,经硬膜下埋藏电极检查左侧明显。结论:MRS可在MRI出现改变之前发现海马硬化,MRS诊断灵敏且特异性高,是颞叶内侧癫痫诊断治疗、病变功能区域监测及评估的一个可靠方法。     

Whole-brain voxel-based statistical analysis of gray matter and white matter in temporal lobe epilepsy

Volumetric MRI studies based on manual labeling of selected anatomical structures have provided in vivo evidence that brain abnormalities associated with temporal lobe epilepsy (TLE) extend beyond the hippocampus. Voxel-based morphometry (VBM) is a fully automated image analysis technique allowing identification of regional differences in gray matter (GM) and white matter (WM) between groups of subjects without a prior region of interest. The purpose of this study was to determine whole-brain GM and WM changes in TLE and to investigate the relationship between these abnormalities and clinical parameters. We studied 85 patients with pharmacologically intractable TLE and unilateral hippocampal atrophy and 47 age- and sex-matched healthy control subjects. The seizure focus was right sided in 40 patients and left sided in 45. Student's t test statistical maps of differences between patients' and controls' GM and WM concentrations were obtained using a general linear model. A further regression against duration of epilepsy, age of onset, presence of febrile convulsions, and secondary generalized seizures was performed with the TLE population. Voxel-based morphometry revealed that GM pathology in TLE extends beyond the hippocampus involving other limbic areas such as the cingulum and the thalamus, as well as extralimbic areas, particularly the frontal lobe. White matter reduction was found only ipsilateral to the seizure focus, including the temporopolar, entorhinal, and perirhinal areas. This pattern of structural changes is suggestive of disconnection involving preferentially frontolimbic pathways in patients with pharmacologically intractable TLE.     

颞叶癫痫儿童灰质异常脑区与神经心理学测验的关系及意义

[目的]评估儿童颞叶癫痫（ TLE）临床表现和神经心理学测验成绩与局部脑萎缩的相关性.[方法]症状性TLE患儿14例（海马萎缩所致中颞叶癫痫 9例,颞叶新皮质损伤所致TLE 5例）,健康对照儿童14名;中颞叶癫痫（ MTLE）成人及其对照各9例.所有入组对象进行脑MRI获取T1结构像,用像素为基础的形态测定法分析图像.所有儿童进行综合神经心理学测验.[结果]TLE患儿同侧海马和海马外周区灰质体积显著减小,灰质体积减小与神经心理学测验成绩显著相关（P〈0.05）.单侧海马萎缩的MTLE患儿中,癫痫发作区域同侧的海马灰质体积显著减小,同侧扣带和对侧额中回皮质萎缩,皮质萎缩程度及范围较同类成人患者小.[结论]与成人MTLE患者相似,儿童MTLE与海马和海马外周的细胞减少有关;儿童TLE灰质萎缩的程度和范围较成人患者小,仅限于额叶区;中颞叶和额叶区灰质体积的减小与神经心理学测验成绩显著相关;TLE患儿的认知或行为障碍是神经网络损伤的结果.     

帕金森病轻度认知功能障碍:基于体素的全脑灰质形态学研究

目的采用基于体素的形态学测量方法,分析帕金森病(PD)伴轻度认知功能损害(MCI)患者全脑灰质结构的变化。方法利用3.0T MR仪对22例伴MCI的PD患者(PD伴MCI组)、21例认知功能正常的PD患者(单纯PD组)及20名健康对照(NC组)进行T1W扫描。采用SPM8为基础的VBM8工具箱进行数据处理。结果与NC组比较,PD伴MCI组脑灰质萎缩见于双侧额叶、左侧颞叶、双侧枕叶、双侧小脑、左侧后扣带回及左侧海马区域;单纯PD组脑灰质萎缩集中出现于左侧额叶、颞叶。与单纯PD组相比,PD伴MCI组左侧颞中回和海马旁回出现灰质萎缩。结论伴有MCI的PD患者的脑灰质结构改变范围比不伴MCI者更广,提示PD患者认知功能改变存在脑形态结构水平的异常。     

Gray matter atrophy associated with duration of temporal lobe epilepsy

Hippocampal sclerosis is the most common abnormality associated with medial temporal lobe epilepsy (MTLE). Converging evidence supports that hippocampal sclerosis progresses with time. However, it is unclear whether extrahippocampal atrophy in patients with MTLE, similarly to hippocampal sclerosis, is an unremitting progressive process. In this article, we investigate the relationship between duration of epilepsy and gray matter concentration reduction in patients with MTLE within and outside the hippocampus. We employed a voxel-based morphometry study of MRI of the entire brain of 36 patients with drug refractory MTLE and 49 neurologically healthy age-matched controls. We performed a voxel-based parametric and nonparametric investigation of the association between gray matter concentration, age and duration of epilepsy. We complemented the investigation by extracting the gray matter concentration of regions of interest (ROIs) within the limbic system, and we investigated the association between the gray matter concentration on the ROIs and duration of epilepsy. Patients with MTLE exhibited gray matter concentration reduction that is negatively correlated with the duration of epilepsy within the ipsilateral hippocampus, temporal lobes as well as extratemporal limbic structures that are closely connected with the hippocampus. In conclusion, longer duration of refractory epilepsy was associated with a more intense hippocampal and extrahippocampal atrophy in patients with MTLE. The mechanism of progressive neuronal damage in MTLE may be related to active seizure activity within a limbic network, and early seizure control may prevent further brain atrophy in patients with refractory MTLE.     

优化VBM算法和DARTEL算法分析阿尔茨海默病MRI

目的 探讨优化VBM算法和DARTEL算法在分析阿尔茨海默病（AD）患者MRI的差别。方法 利用两种算法对14例AD患者（AD组）和23名健康对照（NC组）的MRI进行分析,并对其全脑灰质进行基于体素的统计学比较。结果 两种算法均报告颞叶右侧、海马、海马沟、海马旁回、杏仁核、枕叶深部存在灰质萎缩,但DARTEL算法报告的簇明显多于优化VBM算法;另外,部分区域在设置P<0.005时优化VBM算法仍未见报告。结论 分析AD患者的MRI时,采用DARTEL算法比优化VBM算法更合理。     

Voxel-based morphometry of unilateral temporal lobe epilepsy reveals abnormalities in cerebral white matter

Voxel-based morphometric (VBM) investigations of temporal lobe epilepsy have focused on the presence and distribution of gray matter abnormalities. VBM studies to date have identified the expected abnormalities in hippocampus and extrahippocampal temporal lobe, as well as more diffuse abnormalities in the thalamus, cerebellum, and extratemporal neocortical areas. To date, there has not been a comprehensive VBM investigation of cerebral white matter in nonlesional temporal lobe epilepsy. This study examined 25 lateralized temporal lobe epilepsy patients (13 left, 12 right) and 62 healthy controls in regard to both temporal and extratemporal lobe gray and white matter. Consistent with prior reports, gray matter abnormalities were evident in ipsilateral hippocampus and ipsilateral thalamus. Temporal and extratemporal white matter was affected ipsilateral to the side of seizure onset, in both left and right temporal lobe epilepsy groups. These findings indicate that chronic temporal lobe epilepsy is associated not only with abnormalities in gray matter, but also with concomitant abnormalities in cerebral white matter regions that may affect connectivity both within and between the cerebral hemispheres.     

中国人群帕金森病患者灰质萎缩:采用中国人脑图谱Chinese2020的基于体素的形态学研究

目的 采用基于体素的形态学测量（VBM）方法探讨中国人脑图谱Chinese2020检测中国人群帕金森病（PD）患者灰质体积改变的价值。方法 收集15例PD患者（PD组）和15名性别和年龄匹配的健康志愿者为对照组。分别采用基于中国人群的脑图谱Chinese2020和基于高加索人群的脑图谱MNI152进行空间标准化,比较配准到这2种标准空间所引起的脑结构形变差异,并采用VBM方法比较2种图谱检出PD患者灰质体积萎缩的脑区以及萎缩脑区灰质占比的差异。结果 采用MNI152脑图谱发现PD患者灰质萎缩脑区包括双侧颞叶并扩展至同侧脑岛/海马/海马旁回、左侧枕上回/楔叶/楔前叶及右侧壳核;采用Chinese2020图谱后,除上述脑区外,右侧额中回亦可见灰质体积萎缩。PD组和对照组受试者脑结构配准到Chinese2020空间发生形变小于配准到MNI152空间,且基于Chinese2020检测灰质萎缩脑区灰质占比高于采用MNI152图谱（t=2.502,P=0.037）。结论 基于中国人群的神经影像学研究应该采用中国人脑图谱进行空间标准化,其脑结构形变更小、所识别出的脑区灰质占比更高,从而提高检测的准确性。