复发缓解型多发性硬化患者深部灰质核团体积和灌注改变与临床评分的相关性
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摘要
目的采用基于体素的形态学(VBM)方法及3D伪连续动脉自旋标记(3DpCASL)技术探讨复发-缓解型多发性硬化(RRMS)患者深部灰质体积和灌注改变,及其与临床扩展残疾状态量表(EDSS)和神经心理学量表评分间的相关性。方法对30例RRMS患者(RRMS组)和24名健康志愿者(对照组)行EDSS量表和神经心理学量表测试,评估其记忆功能。行3DT1WI及3DpCASL扫描,并应用Matlab平台的SPM 8及VBM 8软件对图像进行预处理。采用SPM统计软件,分析RRMS患者深部灰质体积、灌注改变,进一步提取深部灰质体积、灌注显著改变脑区的参数值与EDSS和神经心理学量表评分进行相关性分析。结果与对照组比较,RRMS组双侧丘脑、左侧海马、左侧壳核、右侧苍白球体积显著下降(P均<0.05,FDR校正),双侧丘脑、双侧尾状核脑血流量(CBF)显著下降(P<0.05,FDR校正)。RRMS组左右侧丘脑体积、右侧苍白球体积、左侧丘脑CBF与符号数字转换测验评分呈正相关(rs=0.757、0.709、0.463、0.454,P均<0.05),左右侧丘脑体积、左侧丘脑CBF与Rey听觉词语学习测试-即刻记忆评分呈正相关(rs=0.565、0.503、0.492,P均<0.05),与EDSS评分均无明显相关性(P均>0.05)。结论 RRMS患者深部灰质体积和灌注均发生改变,深部灰质体积和灌注下降均与记忆功能受损有关。
Objective To investigate deep gray matter volume and perfusion changes in patients with relapsing-remitting multiple sclerosis(RRMS)with voxel-based morphometry(VBM)and 3Dpseudo-continuous arterial spin labeling(3D pCASL),and to explore the relationship between the changed parameters of deep gray matter and expanded disability status scale(EDSS)and neuropsychological scale scores.Methods Totally 30 RRMS patients(RRMS group)and 24 healthy volunteers(control group)were enrolled and tested with EDSS scale and neuropsychological scale to evaluate memory function.All subjects underwent 3D T1 WI and 3DpCASL,and the images were pretreated with SPM 8and VBM 8software on the Matlab platform.SPM statistical software was used to analyze the changes of deep gray matter volume and perfusion in RRMS patients,and further extraction of deep gray matter volume,perfusion parameter values in significantly changed brain regions,and correlation analysis was done for EDSS and neuropsychological scores.ResultsCompared with the control group,the volume of bilateral thalamus,left hippocampus,left putamen and right globus pallidus decreased significantly in RRMS group(all P<0.05,FDR correction),and the cerebral blood flow(CBF)of the bilateral thalamus and bilateral caudate nucleus decreased significantly in RRMS group(all P<0.05,FDR correction).In RRMS group,the volume of left and right thalamus,right globus pallidus,and the cerebral blood flow of left thalamus were positively correlated with symbol digit modalities test scores(rs=0.757,0.709,0.463,0.454,all P<0.05),while the volume of left and right thalamus and the cerebral blood flow of left thalamus were positively correlated with Rey auditory verbal learning test-immediate recall scores(rs =0.565,0.503,0.492,all P<0.05),and demonstrated no significant correlation with EDSS scores(all P>0.05).Conclusion Volume and perfusion of deep gray matter are changed in RRMS patients,and the decrease volume and perfusion associate with impairment of memory function.
Objective To investigate deep gray matter volume and perfusion changes in patients with relapsing-remitting multiple sclerosis(RRMS)with voxel-based morphometry(VBM)and 3Dpseudo-continuous arterial spin labeling(3D pCASL),and to explore the relationship between the changed parameters of deep gray matter and expanded disability status scale(EDSS)and neuropsychological scale scores.Methods Totally 30 RRMS patients(RRMS group)and 24 healthy volunteers(control group)were enrolled and tested with EDSS scale and neuropsychological scale to evaluate memory function.All subjects underwent 3D T1 WI and 3DpCASL,and the images were pretreated with SPM 8and VBM 8software on the Matlab platform.SPM statistical software was used to analyze the changes of deep gray matter volume and perfusion in RRMS patients,and further extraction of deep gray matter volume,perfusion parameter values in significantly changed brain regions,and correlation analysis was done for EDSS and neuropsychological scores.ResultsCompared with the control group,the volume of bilateral thalamus,left hippocampus,left putamen and right globus pallidus decreased significantly in RRMS group(all P<0.05,FDR correction),and the cerebral blood flow(CBF)of the bilateral thalamus and bilateral caudate nucleus decreased significantly in RRMS group(all P<0.05,FDR correction).In RRMS group,the volume of left and right thalamus,right globus pallidus,and the cerebral blood flow of left thalamus were positively correlated with symbol digit modalities test scores(rs=0.757,0.709,0.463,0.454,all P<0.05),while the volume of left and right thalamus and the cerebral blood flow of left thalamus were positively correlated with Rey auditory verbal learning test-immediate recall scores(rs =0.565,0.503,0.492,all P<0.05),and demonstrated no significant correlation with EDSS scores(all P>0.05).Conclusion Volume and perfusion of deep gray matter are changed in RRMS patients,and the decrease volume and perfusion associate with impairment of memory function.
引文
[1]尹平,刘义,周津如,等.动态对比增强磁共振成像观察复发缓解型多发性硬化微循环改变.中国医学影像技术,2016,32(7):1010-1014.
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[6] Trapp BD,Stys PK.Virtual hypoxia and chronic necrosis of demyelinated axons in multiple sclerosis.Lancet Neurol,2009,8(3):280-291.
[7] Popescu V,Klaver R,Voorn P,et al. What drives MRImeasured cortical atrophy in multiple sclerosis?Mult Scler,2015,21(10):1280-1290.
[8] Minagar A,Barnett MH,Benedict RH,et al.The thalamus and multiple sclerosis:Modern view on pathologic,imaging and clinical aspects.Neurology,2013,80(2):210-219.
[9] Batista S,Zivadinov R,Hoogs M,et al.Basal ganglia,thalamus and neocortical atrophy predicting slowed cognitive processing in multiple sclerosis.J Neurol,2012,259(1):139-146.
[10] Debernard L,Melzer TR,Alla S,et al.Deep grey matter MRI abnormalities and cognitive function in relapsing-remitting multiple sclerosis.Psychiatry Res,2015,234(3):352-361.
[11] Francis PL,Jakubovic R,O'Connor P,et al.Robust perfusion deficits in cognitively impaired patients with secondaryprogressive multiple sclerosis.AJNR Am J Neuroradiol,2013,34(1):62-67.
[12]郭会映,孙芳,倪玲,等.非痴呆型血管性认知功能障碍的结构及静息态功能磁共振研究.临床放射学杂志,2014,33(5):657-661.
[13] Quarantelli M,Ciarmiello A,Morra VB,et al.Brain tissue volume changes in relapsing-remitting multiple sclerosis:Correlation with lesion load. Neuroimage,2003,18(2):360-366.
[14] Debernard L,Melzer TR,Stockum SV,et al.Reduced grey matter perfusion without volume loss in early relapsing-remitting multiple sclerosis.J Neurol Neurosurg Psychiatry,2014,85(5):544-551.
[2]顾瑶,李咏梅,付佳亮,等.多发性硬化伴发记忆障碍MRI研究进展.中国医学影像技术,2018,34(3):444-447.
[3] Benedict RH,Ramasamy D, Munschauer F,et al. Memory impairment in multiple sclerosis:Correlation with deep grey matter and mesial temporal atrophy. J Neurol Neurosurg Psychiatry,2009,80(2):201-206.
[4] Selchen D,Bhan V,Blevins G,et al.MS,MRI,and the 2010McDonald criteria:A Canadian expert commentary.Neurology,2012,79(23Suppl 2):S1-S15.
[5] Damjanovic D,Valsasina P,Rocca MA,et al.Hippocampal and deep gray matter nuclei atrophy is relevant for explaining cognitive impairment in MS:A multicenter study.AJNR Am J Neuroradiol,2017,38(1):18-24.
[6] Trapp BD,Stys PK.Virtual hypoxia and chronic necrosis of demyelinated axons in multiple sclerosis.Lancet Neurol,2009,8(3):280-291.
[7] Popescu V,Klaver R,Voorn P,et al. What drives MRImeasured cortical atrophy in multiple sclerosis?Mult Scler,2015,21(10):1280-1290.
[8] Minagar A,Barnett MH,Benedict RH,et al.The thalamus and multiple sclerosis:Modern view on pathologic,imaging and clinical aspects.Neurology,2013,80(2):210-219.
[9] Batista S,Zivadinov R,Hoogs M,et al.Basal ganglia,thalamus and neocortical atrophy predicting slowed cognitive processing in multiple sclerosis.J Neurol,2012,259(1):139-146.
[10] Debernard L,Melzer TR,Alla S,et al.Deep grey matter MRI abnormalities and cognitive function in relapsing-remitting multiple sclerosis.Psychiatry Res,2015,234(3):352-361.
[11] Francis PL,Jakubovic R,O'Connor P,et al.Robust perfusion deficits in cognitively impaired patients with secondaryprogressive multiple sclerosis.AJNR Am J Neuroradiol,2013,34(1):62-67.
[12]郭会映,孙芳,倪玲,等.非痴呆型血管性认知功能障碍的结构及静息态功能磁共振研究.临床放射学杂志,2014,33(5):657-661.
[13] Quarantelli M,Ciarmiello A,Morra VB,et al.Brain tissue volume changes in relapsing-remitting multiple sclerosis:Correlation with lesion load. Neuroimage,2003,18(2):360-366.
[14] Debernard L,Melzer TR,Stockum SV,et al.Reduced grey matter perfusion without volume loss in early relapsing-remitting multiple sclerosis.J Neurol Neurosurg Psychiatry,2014,85(5):544-551.