静息态功能性磁共振成像评估颈动脉狭窄患者海马与认知功能的相关性

目的 基于静息态功能性磁共振成像，探讨颈动脉狭窄患者认知功能与海马体积及功能连接的相关性。方法 对2019年1至12月于南京大学医学院附属鼓楼医院收治的40例颈动脉狭窄患者与社区招募的31名正常对照者行认知量表评估认知功能，结构磁共振检查测量海马体积，静息态磁共振检查全脑功能连接，分析两组的认知功能、海马体积及功能连接差异，探讨认知功能和海马体积及功能连接的相关性。结果 颈动脉狭窄组简易精神状态量表(MMSE)(F=13.346,P=0.001)、蒙特利尔认知评估量表(MoCA)(F=52.005,P<0.001)评分显著低于正常对照组，差异有统计学意义。与正常对照组相比，颈动脉狭窄组全海马体积明显萎缩(右侧t=2.176,P=0.033;左侧t=2.881,P=0.005),以左侧为甚；海马尾(右侧t=2.394,P=0.019;左侧t=3.158,P=0.002)和海马体(右侧t=2.336,P=0.022;左侧t=3.165,P=0.002)体积较正常对照组缩小；颈动脉狭窄组不同海马亚区中下托(右侧t=2.211,P=0.030;左侧t=2.430,P=0.018)和分子层...

Correlations between Hippocampus and Cognitive Score in Patients with Carotid Artery Stenosis Based on Resting State Functional Magnetic Resonance Imaging

Objective To investigate the correlations among brain functional connectivity,hippocampal subregion volume and cognitive score in the patients with carotid artery stenosis(CAS)based on resting state functional magnetic resonance imaging. Methods Forty CAS patients treated in the Nanjing Drum Tower Hospital Affiliated to Medical School of Nanjing University from January to December in 2019 and 31 healthy volunteers were enrolled in this study.All the participants underwent cognitive assessment,structural MRI for the measurement of hippocampal volume,and resting state functional magnetic resonance imaging for the examination of brain functional connectivity(FC).We compared the cognitive function,hippocampal subregion volumes,and brain functional connectivity between the two groups and investigated the correlations between the three indicators. Results The CAS patients had lower mini-mental state examination(MMSE)(F=13.346,P=0.001)and Montreal cognitive assessment(MoCA)(F=52.005,P<0.001)scores than the healthy volunteers.Compared with healthy volunteers,CAS patients showed small whole hippocampus(right side:t=2.176,P=0.033;left side:t=2.881,P=0.005;especially on the left side),small hippocampal tail(right side:t=2.394,P=0.019;left side:t=3.158,P=0.002),small hippocampal body(right side:t=2.336,P=0.022;left side:t=3.165,P=0.002),small subiculum(right side:t=2.211,P=0.030;left side:t=2.430;P=0.018),and small molecular layer(right side:t=2.103,P=0.039;left side:t=2.702,P=0.009).The whole hippocampal volume was positively correlated with MoCA and MMSE scores(left MoCA:r=0.289,P=0.015;right MMSE:r=0.249,P=0.038;left MMSE:r=0.316,P=0.008).The volume changes in the subiculum,presubiculum,and left molecular layer were positively correlated with MoCA(right subiculum:r=0.290,P=0.015;left subiculum:r=0.382,P=0.001;right presubiculum:r=0.293,P=0.014;left presubiculum:r=0.440,P<0.001;left molecular layer:r=0.259,P=0.031)and MMSE scores(right subiculum:r=0.278,P=0.020;left subiculum:r=0.419,P<0.001;right presubiculum:r=0.296,P=0.013;left presubiculum:r=0.506,P<0.001;left molecular layer:r=0.298,P=0.012),while the volume changes in the remaining hippocampal subregions were not correlated with cognitive scores(all P>0.05).Compared with healthy volunteers,the CAS patients presented low FC values of the left hippocampus to the occipital lobe and frontal lobe and of right hippocampus to the occipital lobe,temporal lobe,prefrontal lobe,and middle frontal gyrus(Gaussian random field correction,voxel P<0.01,cluster P<0.05).The volume changes of the left whole hippocampus,hippocampal head,and cornu ammonis 1(CA1)were positively correlated with the FC value of right hippocampus to the temporal lobe(left whole hippocampus:r=0.358,P=0.025;right hippocampal head:r=0.325,P=0.044;left hippocampal head:r=0.360,P=0.024;right CA1:r=0.326,P=0.043;left CA1:r=0.341,P=0.034).MoCA and MMSE scores were positively correlated with the FC value of right hippocampus to the frontal lobe(MoCA middle frontal gyrus:r=0.389,P=0.014;MoCA prefrontal lobe:r=0.363,P=0.023;MMSE prefrontal lobe:r=0.321,P=0.046). Conclusions CAS patients have different levels of cognitive impairment.Hippocampal atrophy and a decline in the FC value of hippocampus to the occipital lobe may play a role in cognitive impairment in CAS patients.This discovery lays a foundation for the future research on the mechanism of cognitive dysfunction in CAS patients.