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皮质下血管性轻度认知障碍患者的多模式磁共振研究
引用本文:徐群,;曹雯炜,;周滟,;李焰生.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(7):557-563.
作者姓名:徐群  ;曹雯炜  ;周滟  ;李焰生
作者单位:1200127.上海; 上海交通大学医学院附; 属仁济医院神经内科;2.上海交通大学医学院附; 属仁济医院影像科
基金项目:本研究由上海市卫生局科研课题(20I24251)和上海交通大学医工(理)交叉基金资助(YG2012MS08)
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。

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  
收稿时间:2013-12-04

Multi-model MRI Study of Patients with Subcortical Vascular Mild Cognitive Impairment
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(7):557-563.
Authors:XU Qun  CAO Wen-Wei  ZHOU Yan  LI Yan-Sheng
Affiliation:XU Qun, CAO Wen-Wei, ZHOU Yan, LI Yan-Sheng( Department of Neurology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China)
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·m^2·s^-1 and (0.89±0.05) ×10-9·m^2·s^-1, while the MD values within normal appearing white matter (NAWM) were (0.87±0.04)×10-9·m^2·s^-1 and (0.92±0.05)×10-9·m^2·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 coefifcient 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 identiifcation of early cognitive impairment among SIVD patients. The MD value within NAWM decreased signiifcantly during early phase of cognitive impairment, and it correlated independently with manifestations of different cognitive domains, which suggested it may be
Keywords:Vascular cognitive impairment  Diffusion tensor imaging  Magnetic resonance imaging  Subcortical ischemic vascular disease  Mild cognitive impairment
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