皮质下血管性轻度认知障碍患者的多模式磁共振研究

摘要/Abstract

摘要：

目的明确对皮质下缺血性血管病（subcortical ischemic vascular disease，SIVD）患者早期认知损害较为敏感的磁共振成像（magnetic resonance imaging，MRI）指标。方法 32例SIVD患者经过认知测试，被分为无认知障碍（no cognitive impairment，NCI）组18例，血管性轻度认知障碍（vascular mild cognitive impairment，VaMCI）组14例，分析其认知测试指标与MRI参数之间的关系。结果 NCI组、VaMCI组全脑白质（whole brain white matter，WBWM）平均弥散度（mean diffusivity，MD）分别为（0.84±0.03）×10-9·m2·s-1和（0.89±0.05）×10-9·m2·s-1，表观正常白质（normal appearing white matter，NAWM）的MD分别为（0.87±0.04）×10-9·m2·s-1和（0.92±0.05）×10-9·m2·s-1，差异均有显著性（P均为0.003）；NCI组、VaMCI组WBWM各向异性分数（fractional anisotropy，FA）分别为（0.37±0.02）和（0.35±0.02），两组有显著差异（P =0.002），两组NAWM的FA分别为（0.35±0.02）和（0.33±0.02），差异亦有显著性（P =0.001）。SIVD患者WBWM的MD值、NAWM的MD值和FA值与注意- 执行均相关，相关系数分别为－0.401（P =0.031）、－0.422（P =0.023）和0.409（P =0.027），NAWM的 MD值与记忆相关，相关系数为－0.377（P =0.044），多元逐步回归显示仅NAWM的MD值与注意-执行（β=－0.453，P =0.009）、记忆（β=－0.414，P =0.019）和总体认知（β=－0.410，P =0.02）独立负相关。而常规MRI参数未显示组间差异，与认知功能亦未见相关性。结论 MRI弥散张量成像（diffusion tensor imaging，DTI）可以作为早期识别SIVD患者认知障碍的有效手段。NAWM的MD值在认知障碍早期即下降，并与多项认知域独立相关，是较为敏感的DTI指标。

文章导读： 本研究结果表明，表观正常白质的平均弥散度值在血管性认知障碍早期即显示差异，并与多项认
知水平独立相关，提示MRI弥散张量成像可以作为早期识别皮质下缺血性血管病患者认知障碍的
重要手段之一

关键词: 血管性认知障碍; 弥散加权成像; 磁共振; 皮质下缺血性血管病; 轻度认知功能障碍

Abstract:

Objective To investigate the sensitive magnetic resonance imaging (MRI) indices for early cognitive impairment in patients with subcortical ischemic vascular disease (SIVD). Methods Thirty two SIVD patients were thoughtfully interviewed and evaluated by a set of neuropsychological tests. The patients were divided into no cognitive impairment (NCI), vascular mild cognition impairment (VaMCI) groups. The correlations between MRI indices and cognitive characteristics of these patients were assessed. Results The mean diffusivity (MD) values within whole brain white matter (WBWM) were (0.84±0.03)×10-9·m2·s-1 and (0.89±0.05) ×10-9·m2·s-1, while the MD values within normal appearing white matter (NAWM) were (0.87±0.04)×10-9·m2·s-1 and (0.92±0.05)×10-9·m2·s-1 respectively. There were significant differences between two groups (all P =0.003). The fractional anisotropy (FA) values within the WBWM were (0.37±0.02) and (0.35±0.02), while the FA within the NAWM were (0.35±0.02) and (0.33±0.02) respectively. There were also significant differences between two groups (P =0.002, P =0.001). The correlation coefficients of WBWM MD, NAWM MD and NAWM FA with attention-executive function were -0.401 (P =0.031), -0.422 (P =0.023) and 0.409 (P =0.027) respectively, while the correlation coefficient of NAWM MD with memory function was -0.377 (P =0.044). Multi-factor stepwise regression analysis showed that the NAWM MD correlated negatively with attention-executive (β =-0.453, P =0.009), memory (β =-0.414, P =0.019) and general cognition (β =-0.410, P =0.02) independently. Conclusion Diffusion tensor imaging (DTI) can be regarded as an effective method for identification of early cognitive impairment among SIVD patients. The MD value within NAWM decreased significantly during early phase of cognitive impairment, and it correlated independently with manifestations of different cognitive domains, which suggested it may be regarded as a sensitive measurement of DTI.

Key words: Vascular cognitive impairment; Diffusion tensor imaging; Magnetic resonance imaging; Subcortical ischemic vascular disease; Mild cognitive impairment

徐群1，曹雯炜1，周滟2，李焰生1. 皮质下血管性轻度认知障碍患者的多模式磁共振研究[J]. 中国卒中杂志, 2014, 9(07): 557-563.

XU Qun*, CAO Wen-Wei, ZHOU Yan, LI Yan-Sheng. Multi-model MRI Study of Patients with Subcortical Vascular Mild Cognitive
Impairment[J]. Chinese Journal of Stroke, 2014, 9(07): 557-563.

参考文献

1 Román GC, Erkinjuntti T, Wallin A, et al. Subcortical

ischemic vascular dementia[J]. Lancet Neurol, 2002,

1:426-436.

2 Gorelick PB, Scuteri A, Black SE, et al. American

He a r t As so c i a t ion St roke Cou nc i l , Cou nc i l

on Epidemiology and Prevent ion, Council on

Cardiovascular Nursing, Council on Cardiovascular

Radiolog y and I nt e r vent ion, and Cou nci l on

Cardiovascular Surgery and Anesthesia. Vascular

contributions to cognitive impairment and dementia:a

statement for healthcare professionals from the

Amer ican Hear t Association/Amer ican St roke

Association[J]. Stroke, 2011, 42:2672-2713.

3 Ba s se r PJ, Pie r paol i C. Mic rost r uc t u r a l and

physiological features of tissue elucidated by

quantitative-diffusion-tensor MRI[J]. J Magn Reson

Ser B, 1996, 111:209-219.

4 Galluzzi S, Sheu CF, Zanetti O, et al. Distinctive

clinical features of mild cognitive impairment with

subcortical cerebrovascular disease[J]. Dement

Geriatr Cogn Disord, 2005, 19:196-203.

5 Roman GC, Tatemichi TK, Erkinjuntti T, et al.

Vascular dementia:diagnostic criteria for research

studies, reporter of the NINDS-AIREN international

workshop[J]. Neurology, 1993, 43:250-260.

6 郭起浩, 孙一, 袁晶, 等. 8种执行功能测验在上海

社区老年人中的应用[J]. 中国行为医学科学, 2007,

16:628-631.

7 郭起浩, 孙一, 虞培敏, 等. 听觉词语学习测验的社

区老人常模[J]. 中国临床心理学杂志, 2007, 15:132-

134, 141.

8 Frisoni GB, Galluzzi S, Bresciani L, et a1. Mild

cognitive impairment with subcortical vascular

features:Clinical characteristics and outcome[J]. J

Neurol, 2002, 249:1423-1432.

9 O'Sullivan M, Jones DK, Summers PE, et al. Evidence

for cortical "disconnection" as a mechanism of age 2012, 32:193-197.

17 O'Sullivan M, Morris RG, Huckstep B, et al. Diffusion

tensor MRI correlates with executive dysfunction

in patients with ischaemic leukoaraiosis[J]. J Neurol

Neurosurg Psychiatry, 2004, 75:441-447.

18 Ro c kwo o d K, Mo o r h o u s e PK, S o n g X, e t

al. Disease progression in vascular cognitive

impairment:cognitive, functional and behavioural

outcomes in the Consortium to Investigate Vascular

Impairment of Cognition (CIVIC) cohort study[J]. J

Neurol Sci, 2007, 252:106-112.

19 Correia S, Lee SY, Voorn T, et al. Quantitative

tractography metrics of WM integrity in diffusiontensor

MRI[J]. Neuroimage, 2008, 42:568-581.

20 Fu JL, Zhang T, Chang C, et al. The value of

diffusion tensor imaging in the differential diagnosis

of subcor tical ischemic vascular dementia and

Alzheimer's disease in patients with only mild white

matter alterations on T2-weighted images[J]. Acta

Radiol, 2012, 53:312-317.

21 Román G, Pascual B. Contribution of neuroimaging

to the diagnosis of Alzheimer's disease and vascular

dementia[J]. Arch Med Res, 2012, 43:671-676.

22 Jokinen H, Kalska H, Mantyla R, et al. White matter

hyperintensities as a predictor of neuropsychological

deficits post-stroke[J]. J Neurol Neurosurg Psychiatry,

2005, 76:1229-1233.

related cognitive decline[J]. Neurology, 2001, 57:632-

638.

10 Kim SH, Kang HS, Kim HJ, et al. The effect of

ischemic cholinergic damage on cognition in patients

with subcortical vascular cognitive impairment[J]. J

Geriatr Psychiatry Neurol, 2012, 25:122-127.

11 Sachdev PS, Brodaty H, Valenzuela MJ, et al.

Progression of cognitive impairment in stroke

patients[J]. Neurology, 2004, 63:1618-1623.

12 de Leeuw FE, de Groot JC, Achten E, et al. Prevalence

of cerebral white matter lesions in elderly people:a

population based magnetic resonance imaging study.

The Rotterdam scan study[J]. J Neurol Neurosurg

Psychiatry, 2001, 70:9-14.

13 Fa zeka s F, Kleine r t R, Of fenba che r H, et al.

Pathologic correlates of incidental MRI WM signal

hyperintensities[J]. Neurology, 1993, 43:1683-1689.

14 Awad IA, Johnson PC, Spetzler RF, et al. Incidental

subcortical lesions identified on magnetic resonance

imaging in the elderly II. Postmortem pathological

correlations[J]. Stroke, 1986, 17:1090-1097.

15 Englund E, Sjobeck M, Brockstedt S, et al. Diffusion

tensor MRI post mortem demonstrated cerebral WM

pathology[J]. J Neurol, 2004, 251:350-352.

16 张秋娟, 郭佑民, 白芝兰, 等. 皮层下缺血性脑血管病

患者弥散张量成像中脑微结构变化与整体认知功能

及执行功能的独立相关性研究[J]. 南方医科大学学报,

[1]	鲁燕, 杨保荣, 黄向萍, 杨冠桂, 陈圣文, 李建荣, 曾小明. 县级医院急性缺血性卒中超时间窗经MRI筛选溶栓的病例对照研究 [J]. 中国卒中杂志, 2022, 17(12): 1321-1326.
[2]	王恺闻, 卢宝全, 吴秀玲, 马佳丽. 基于MRA评估基底动脉闭塞预后评分预测非重症基底动脉闭塞患者预后效能的研究 [J]. 中国卒中杂志, 2022, 17(12): 1335-1342.
[3]	索阅, 张喆, 谢雪微, 孔庆乐, 王拥军, 荆京. 7.0T MRI在脑血管病中的应用进展[J]. 中国卒中杂志, 2022, 17(11): 1257-1263.
[4]	陈扬, 张婧, 陈芬, 丁杏, 陈昆涛. 卒中缺血性半暗带功能磁共振成像评估的研究进展[J]. 中国卒中杂志, 2022, 17(11): 1264-1270.
[5]	向薇, 徐璐瑶, 张曼曼, 魏红春, 梁志刚. 缺血性卒中急性期磁敏感加权成像不对称突出静脉征的发生率及影响因素分析[J]. 中国卒中杂志, 2022, 17(10): 1097-1102.
[6]	刘伊桐, 黄燕琪, 李明利, 冯逢, 高山, 徐蔚海. 颈动脉几何形态——60岁及以下无高危因素人群颅内动脉粥样硬化的潜在预测指标[J]. 中国卒中杂志, 2022, 17(09): 925-931.
[7]	简晓莉, 邓肖, 白雪. 延髓最后区综合征合并急性脑干综合征发病的视神经脊髓炎谱系疾病1例报道[J]. 中国卒中杂志, 2022, 17(09): 1007-1010.
[8]	徐璐瑶, 陈晓迪, 梁志刚. 卒中后失语的影像学评估研究进展[J]. 中国卒中杂志, 2022, 17(09): 1017-1021.
[9]	李琳琳, 吴娱倩, 张英魁. 大脑中动脉原位血栓磁共振成像多序列评估与信号解读[J]. 中国卒中杂志, 2022, 17(05): 544-547.
[10]	叶益超, 玉石, 佘亚军, 方正, 王毅. 血管性帕金森综合征的研究进展[J]. 中国卒中杂志, 2022, 17(04): 346-350.
[11]	毕京凤, 李琳琳, 刘欣瑶, 张英魁. 颈部动脉夹层磁共振成像多序列评估与信号解读[J]. 中国卒中杂志, 2022, 17(04): 402-406.
[12]	李昕, 张英魁, 曹康熙, 袁庆海. 1例青年卒中患者的多模态影像检查[J]. 中国卒中杂志, 2022, 17(03): 314-317.
[13]	李琳琳, 张英魁. 颅内脑外出血与磁共振多序列影像评估[J]. 中国卒中杂志, 2022, 17(01): 51-55.
[14]	刘欣瑶, 毕京凤, 张英魁. 脑出血信号改变机制与磁共振影像表现[J]. 中国卒中杂志, 2021, 16(12): 1217-1221.
[15]	凌一童, 张晓宇, 辛华, 张文婧, 董丽华. 以头晕为首发症状的双侧延髓内侧梗死2例[J]. 中国卒中杂志, 2021, 16(12): 1268-1272.