遗忘型轻度认知功能障碍患者弥散张量成像研究
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摘要
目的:利用磁共振弥散张量成像(DTI)技术和基于纤维示踪的空间统计(TBSS)的后处理方法,探讨aMCI患者脑白质微观结构的变化特点以及与认知障碍的关系。方法:对25例aMCI患者及22例健康老年志愿者进行神经心理学评估,采用3.0T磁共振对受试者进行DTI检查,应用TBSS方法分析脑白质区域的部分各向异性(fractional anisotropy, FA)和平均扩散率(mean diffusivity,MD),并分析FA值和MD值与认知评估的相关性。结果:aMCI组在情景记忆、视空间、工作记忆、处理速度、执行功能、推理、语言功能等认知领域得分均低于正常对照组(均P<0.05)。TBSS两组差异比较,与正常对照组相比,aMCI患者在小脑中脚、胼胝体、内囊、外囊及放射冠区域出现FA值的减低,在胼胝体、内囊、外囊、放射冠及上纵束出现MD值的升高。基于模板的白质纤维束分析结果显示,与正常对照组相比,aMCI组双侧丘脑前辐射、双侧皮质脊髓束、双侧扣带回皮质的扣带束、双侧海马的扣带束、胼胝体辐射线枕部、胼胝体辐射线额部、左侧额枕下束、双侧上纵束及双侧钩束出现显著的FA值减低,经过Bonferroni校正后左侧丘脑前辐射及左侧海马的扣带束结果仍为显著;双侧丘脑前辐射、双侧皮质脊髓束、双侧扣带回皮质的扣带束、双侧海马的扣带束、胼胝体辐射线额部、双侧上纵束及右侧钩束出现显著的MD值增加,经过Bonferroni校正后左侧海马的扣带束结果仍为显著。相关分析发现,aMCI患者左侧海马的扣带束的MD值升高与ROCF回忆评分减低呈现显著相关性(r=-0.422, P=0.049)。结论:DTI技术可用于精确检测在常规磁共振成像上表现正常的aMCI患者早期白质微结构的变化,这些变化可以成为诊断疾病的生物学标记物。
Objective The Diffusion tensor imaging(DTI) techniques andTract-based Spatial Statistic(TBSS) post-processing methods were used to investigate the change of white matter microstructural of patients with amnestic mild cognitive impairment(aMCI) and it's relationship with cognitive impairment.Methods We conducted a neuropsychological evaluation on 25 patients with aMCI and 22 healthy elderly volunteers. All subjects were examined by 3.0T magnetic resonance imaging, and the fractional anisotropy(FA) and mean diffusivity(MD) of the white matter region were analyzed using the tract-based spatial statistic method.We also analyzed the correlation between FA and MD values and cognitive assessment. Results The scores of aMCI in the cognitive areas such as episodic memory, visual-spatial ability, working memory, processing speed, executive function, reasoning, and language function were lower than the normal control(all P<0.05). The differences of TBSS in the two groups,compared with the normal control, aMCI patients showed a decrease in FA in the middle cerebellar peduncle, corpus callosum, internal capsule, external capsule and corona radiata, while in the corpus callosum, internal capsule, external capsule, corona radiata and the superior longitudinal fasciculus showed an increase in MD. The analysis of white matter fiber bundle based on template showed that compared with the normal control, aMCI patients showed significant decrease in FA in bilateral anterior thalamic radiation, bilateral corticospinal tract, bilateral cingulum of the cingulate cortex, bilateral cingulum of hippocampus, forceps major, forceps minor, left Inferior fronto-occipital fasciculus, bilateral superior longitudinal fasciculusand bilateral uncinate fasciculu. And the result of the left anterior thalamic radiation and left cingulum of hippocampus after Bonferroni correction remained significant.Compared with the normal control, aMCI patients showed significant increase in MD inbilateral anterior thalamic radiatio, bilateral corticospinal tract, bilateral cingulum of the cingulate cortex, bilateral cingulum of hippocampus, forceps minor,bilateral superior longitudinal fasciculusand rightuncinate fasciculu. And the result of the left anterior thalamic radiation and left cingulum of hippocampus after Bonferroni correction remained significant.The correlation analysis found that the increase of the MD value of the left cingulum of hippocampus in patients with aMCI was significantly correlated with the decrease of the Rey-Osterrich Complex Figure Recall Text(r=-0.422, P=0.049). Conclusion DTI can be used to detect changes of white matter microstructural in patients with aMCI who performed normal in conventional magnetic resonance imaging accurately. These changes can be used as biomarkers for diagnosing disease.
Objective The Diffusion tensor imaging(DTI) techniques andTract-based Spatial Statistic(TBSS) post-processing methods were used to investigate the change of white matter microstructural of patients with amnestic mild cognitive impairment(aMCI) and it's relationship with cognitive impairment.Methods We conducted a neuropsychological evaluation on 25 patients with aMCI and 22 healthy elderly volunteers. All subjects were examined by 3.0T magnetic resonance imaging, and the fractional anisotropy(FA) and mean diffusivity(MD) of the white matter region were analyzed using the tract-based spatial statistic method.We also analyzed the correlation between FA and MD values and cognitive assessment. Results The scores of aMCI in the cognitive areas such as episodic memory, visual-spatial ability, working memory, processing speed, executive function, reasoning, and language function were lower than the normal control(all P<0.05). The differences of TBSS in the two groups,compared with the normal control, aMCI patients showed a decrease in FA in the middle cerebellar peduncle, corpus callosum, internal capsule, external capsule and corona radiata, while in the corpus callosum, internal capsule, external capsule, corona radiata and the superior longitudinal fasciculus showed an increase in MD. The analysis of white matter fiber bundle based on template showed that compared with the normal control, aMCI patients showed significant decrease in FA in bilateral anterior thalamic radiation, bilateral corticospinal tract, bilateral cingulum of the cingulate cortex, bilateral cingulum of hippocampus, forceps major, forceps minor, left Inferior fronto-occipital fasciculus, bilateral superior longitudinal fasciculusand bilateral uncinate fasciculu. And the result of the left anterior thalamic radiation and left cingulum of hippocampus after Bonferroni correction remained significant.Compared with the normal control, aMCI patients showed significant increase in MD inbilateral anterior thalamic radiatio, bilateral corticospinal tract, bilateral cingulum of the cingulate cortex, bilateral cingulum of hippocampus, forceps minor,bilateral superior longitudinal fasciculusand rightuncinate fasciculu. And the result of the left anterior thalamic radiation and left cingulum of hippocampus after Bonferroni correction remained significant.The correlation analysis found that the increase of the MD value of the left cingulum of hippocampus in patients with aMCI was significantly correlated with the decrease of the Rey-Osterrich Complex Figure Recall Text(r=-0.422, P=0.049). Conclusion DTI can be used to detect changes of white matter microstructural in patients with aMCI who performed normal in conventional magnetic resonance imaging accurately. These changes can be used as biomarkers for diagnosing disease.
引文
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[14]Zhuang L,Sachdev P S,Trollor J N,et al.Microstructural white matter changes in cognitively normal individuals at risk of amnestic MCI[J].Neurology,2012,79(8):748-754.DOI:10.1212/WNL.0b013e31826-61f4d
[15]Fu J L,Liu Y,Li Y M,et al.Use of diffusion tensor imaging for evaluating changes in the microstructural integrity of white matter over 3 years in patients with amnesic-type mild cognitive impairment converting to Alzheimer’s disease[J].J Neuroimaging,2014,24(4):343-348.DOI:10.1111/jon.12061
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[20]Liu J,Liang P,Yin L,et al.White Matter Abnormalities in Two Different Subtypes of Amnestic Mild Cognitive Impairment[J].PLoS One,2017,12(1):e170185.DOI:10.1371/journal.pone.0170185
[21]Von Der Heide R J,Skipper L M,Klobusicky E,et al.Dissecting the uncinate fasciculus:disorders,controversies and a hypothesis[J].Brain,2013,136(Pt6):1692-1707.DOI:10.1093/brain/awt094
[22]Schmahmann J D,Smith E E,Eichler F S,et al.Cerebral white matter:neuroanatomy,clinical neurology and neurobehavioral correlates[J].Ann N Y Acad Sci,2008,1142:266-309.DOI:10.1196/annals.1444.017
[23]Catani M,Mesulam M.The arcuate fasciculus and the disconnection theme in language and aphasia:history and current state[J].Cortex,2008,44(8):953-961.DOI:10.1016/j.cortex.2008.04.002
[24]Fouquet M,Desgranges B,Landeau B,et al.Longitudinal brain metabolic changes from amnestic mild cognitive impairment to Alzheimer’s disease[J].Brain,2009,132(Pt 8):2058-2067.DOI:10.1093/brain/awp132
[2]Bosch B,Arenaza-Urquijo E M,Rami L,et al.Multiple DTI index analysis in normal aging,amnestic MCI and AD.Relationship with neuropsychological performance[J].Neurobiol Aging,2012,33(1):61-74.DOI:10.1016/j.neurobiolaging.2010.02.004
[3]Xie Y,Cui Z,Zhang Z,et al.Identification of Amnestic Mild Cognitive Impairment Using Multi-Modal Brain Features:A Combined Structural MRI and Diffusion Tensor Imaging Study[J].J Alzheimers Dis,2015,47(2):509-522.DOI:10.3233/JAD-150184
[4]Wai Y Y,Hsu W C,Fung H C,et al.Tract-based spatial statistics:application to mild cognitive impairment[J].Biomed Res Int,2014,2014:713079.DOI:10.1 155/2014/713079
[5]Teipel S J,Meindl T,Grinberg L,et al.The cholinergic system in mild cognitive impairment and Alzheimer’s disease:an in vivo MRI and DTI study[J].Hum Brain Mapp,2011,32(9):1349-1362.DOI:10.1002/hbm21111
[6]Gyebnar G,Szabo A,Siraly E,et al.What can DTI tell about early cognitive impairment?-Differentiation between MCI subtypes and healthy controls by diffusion tensor imaging[J].Psychiatry Res,2018,272:46-57DOI:10.1016/j.pscychresns.2017.10.007
[7]Liu D,Wang Z,Shu H,et al.Disrupted white matter integrity is associated with cognitive deficits in patients with amnestic mild cognitive impairment:An atlas-based study[J].SAGE Open Med,2016,4:2103720812.DOI:10.1177/2050312116648812
[8]Lin S H,Hsu W C,Ng S H,et al.Increased Water Diffusion in the Parcellated Cortical Regions from the Patients with Amnestic Mild Cognitive Impairment and Alzheimer’s Disease[J].Front Aging Neurosci,2016,8:325.DOI:10.3389/fnagi.2016.00325
[9]Van der Werf Y D,Jolles J,Witter M P,et al.Contributions of thalamic nuclei to declarative memory functioning[J].Cortex,2003,39(4-5):1047-1062.
[10]Floresco S B,Grace A A.Gating of hippocampal-evoked activity in prefrontal cortical neurons by inputs from the mediodorsal thalamus and ventral tegmental area[J].JNeurosci,2003,23(9):3930-3943.
[11]Grambaite R,Selnes P,Reinvang I,et al.Executive dysfunction in mild cognitive impairment is associated with changes in frontal and cingulate white matter tracts[J].J Alzheimers Dis,2011,27(2):453-462.DOI:10.3233/JAD-2011-110290
[12]Pettersson A F,Olsson E,Wahlund L O.Motor function in subjects with mild cognitive impairment and early Alzheimer's disease[J].Dement Geriatr Cogn Disord,2005,19(5-6):299-304.DOI:10.1159/000084555
[13]Huang H,Fan X,Weiner M,et al.Distinctive disruption patterns of white matter tracts in Alzheimer’s disease with full diffusion tensor characterization[J].Neurobiol Aging,2012,33(9):2029-2045.DOI:10.1016/j.neurobiolaging.2011.06.027
[14]Zhuang L,Sachdev P S,Trollor J N,et al.Microstructural white matter changes in cognitively normal individuals at risk of amnestic MCI[J].Neurology,2012,79(8):748-754.DOI:10.1212/WNL.0b013e31826-61f4d
[15]Fu J L,Liu Y,Li Y M,et al.Use of diffusion tensor imaging for evaluating changes in the microstructural integrity of white matter over 3 years in patients with amnesic-type mild cognitive impairment converting to Alzheimer’s disease[J].J Neuroimaging,2014,24(4):343-348.DOI:10.1111/jon.12061
[16]Catani M,Jones D K,Donato R,et al.Occipitotemporal connections in the human brain[J].Brain,2003126(Pt 9):2093-2107.DOI:10.1093/brain/awg203
[17]Huang H,Zhang J,Jiang H,et al.DTI tractography based parcellation of white matter:application to the mid-sagittal morphology of corpus callosum[J].Neuroimage,2005,26(1):195-205.DOI:10.1016/j.neuroimage.2005.01.019
[18]Fellgiebel A,Schermuly I,Gerhard A,et al.Functional relevant loss of long association fibre tracts integrity in early Alzheimer’s disease[J].Neuropsychologia,2008,46(6):1698-1706.DOI:10.1016/j.neuropsychologia.2007.12.010
[19]Geldmacher D S,Quigg M,Elias W J.MR tractography depicting damage to the arcuate fasciculus in a patient with conduction aphasia[J].Neurology,2007,69(3):321,321-322.DOI:10.1212/01.wnl.0000275278.38229.7b
[20]Liu J,Liang P,Yin L,et al.White Matter Abnormalities in Two Different Subtypes of Amnestic Mild Cognitive Impairment[J].PLoS One,2017,12(1):e170185.DOI:10.1371/journal.pone.0170185
[21]Von Der Heide R J,Skipper L M,Klobusicky E,et al.Dissecting the uncinate fasciculus:disorders,controversies and a hypothesis[J].Brain,2013,136(Pt6):1692-1707.DOI:10.1093/brain/awt094
[22]Schmahmann J D,Smith E E,Eichler F S,et al.Cerebral white matter:neuroanatomy,clinical neurology and neurobehavioral correlates[J].Ann N Y Acad Sci,2008,1142:266-309.DOI:10.1196/annals.1444.017
[23]Catani M,Mesulam M.The arcuate fasciculus and the disconnection theme in language and aphasia:history and current state[J].Cortex,2008,44(8):953-961.DOI:10.1016/j.cortex.2008.04.002
[24]Fouquet M,Desgranges B,Landeau B,et al.Longitudinal brain metabolic changes from amnestic mild cognitive impairment to Alzheimer’s disease[J].Brain,2009,132(Pt 8):2058-2067.DOI:10.1093/brain/awp132