肌萎缩侧索硬化症的~1H-MR波谱研究

目的 探讨肌萎缩侧索硬化症(ALS)患者的1H-MRS表现及其与临床评分的关系.方法 对15例临床确诊及拟诊为ALS的患者(ALS组)和15名年龄相匹配的健康志愿者(对照组)进行1H-MRS扫描,采用单体素平均TE选择性单点分辨波谱序列(TE-Averaged PRESS).扫描图像经后处理,分别获得以中央前回为中心的运动皮层和内囊后肢处的以下成分波峰:N-乙酰天门冬氨酸(NAA)、谷氨酸(Glu)、谷氨酸复合物(Glx)以及肌酸(Cr),并测量NAA/Cr、Glu/Cr和Glx/Cr峰高相对值.采用t检验比较两组间各比值的差异,并分析上述各值与ALS患者临床评分的直线相关关系.结果 ALS组运动皮层和内囊后肢的NAA/Cr值为1.91±0.34、1.53±0.17,对照分别为2.23±0.33,1.66±0.07.两组间差异有统计学意义(t值分别为4.25、2.90,P值分别为0.00、0.01).AIS组运动皮层和内囊后肢Glu/Cr为0.34±0.05、0.29±0.06,Glx/Cr为0.40±0.04、0.33±0.06,均高于对照组(Glu/Cr分别为0.30±0.03、0.25±0.04,Glx/Cr分别为0.32±0.05,0.26±0.03),两组间差异有统计学意义(t值分别为2.56、2.40、7.34、5.30,P值分别为0.02,0.03、0.00、0.00).ALS患者Norris评分值为(57±8)分,ALS功能分级评分(ALSFRS)值为(29±4)分.直线相关分析发现ALS患者运动皮层Glx/Cr值与Norris评分呈负相关(r=-0.75,P=0.00),而与ALSFRS值无相关性.结论 ALS患者谷氨酸类代谢物含量升高.(1)H-MRS可反映ALS患者脑内代谢物的变化特征.

1H-MR spectroscopy study in amyotrophic lateral sclerosis

Objective To characterize the features of proton magnetic resonance spectroscopy (1H-MRS)on amyotrophic lateral sclerosis(ALS)and its correlations with clinical scale.Methods Fifteen patienta with definite or probable ALS and 15 age and gender matched normal controls were enrolled.1H-MRS was performed on a 3.0 T GE imaging system(GE Medical System,Milwaukee,Wisconsin,USA).TE-averaged point resolved selective spectroscopy was used.N-acetylaspartate(NAA),creatine (Cr).Gh and Glx(glutamate+glutamine)values of subcortical motor area and posterior limb of the intemal capsule were acquired,t teat was used to compare differencea between groups,the correlations between the above valuea and clinical scale were analyzed.Results The motor area and posterior limb of the internal capsule in ALS patients had significantly lower NAA/Cr(1.91±0.34,1.53±0.17)compared with normal subjects(2.23±0.33,1.66±0.07)(t=4.25,2.90,P=0.00,0.01).ALS patients had significantly higher Glu/Cr(0.34±0.05,0.29±0.06)and Glx/Cr(0.40±0.04,0.33±0.06),compared with normal subjects(0.30±0.03,0.25±0.04)and(0.32±0.05,0.26±0.03)(t=2.56,2.40.7.34.5.30,P=0.02,0.03,0.00,0.00).The Norris scale of ALS patients were 57±8,ALSFRS were 29±4.The Norris scale was negatively correlated with Glx/Cr of primary motor cortex by lineal correlation analysis(r=-0.75,P=0.00),while ALSFRS had no correlation with GK/Cr.Conclusions Neuronal loss and Glu+Gln increase can be detected by using proton MRS in ALS patients.(1)H-MRS is an useful tool in reflecting the characteristic changes of metabolite in ALS.