磁共振波谱检测肌萎缩侧索硬化的上运动神经元损害
|
摘要
目的探讨质子磁共振波谱(proton magnetic resonance spectroscopy,1 H-MRS)检测肌萎缩侧索硬化(amyotrophic lateral sclerosis,ALS)的上运动神经元损害(upper motor neuron,UMN)的特点和诊断准确性。方法收集ALS患者31例和健康对照32名,采用1 H-MRS检测脑中央前回皮质下、内囊后肢和大脑脚感兴趣区代谢产物N-乙酰天冬氨酸(NAA)、胆碱(Cho)、肌酸(Cr)的水平,计算NAA/Cr、NAA/(Cho+Cr)、Cho/Cr比值,采用受试者工作特征(receiver operating characteristic,ROC)曲线分析1 H-MRS对ALS患者UMN损害的诊断价值。结果 ALS患者各锥体束走行部位和部位组合的NAA/Cr和NAA/(Cho+Cr)较对照组显著降低(P<0.05)。NAA比值预测ALS的UMN损害的ROC曲线下面积(area under the curve,AUC)为0.67~0.91,其中内囊后肢、大脑脚两部位的平均NAA/(Cho+Cr)和三部位的平均NAA/(Cho+Cr)的AUC、灵敏度、特异度分别为0.91、0.828、0.906和0.90、0.769、0.875。结论 1 H-MRS可检出ALS患者锥体束走行的生化代谢异常,是评估ALS的UMN损害的客观影像学指标,其诊断准确性中等,多水平检测和综合指标的选择有助于提高其诊断效力。
Objective To evaluate the feature and diagnostic accuracy of proton magnetic resonance spectroscopy(1 H-MRS)in detecting upper motor neuron(UMN)involvement in amyotrophic lateral sclerosis(ALS).Methods The study included 31 ALS patients and 32 healthy controls and measured the concentration of N-acetylaspartate(NAA),choline(Cho)and creatine(Cr)by 1 H-MRS in subcortical white matter of precentral gyrus,posterior limb of internal capsule(PLIC)and cerebral peduncle(CP).Ratios of NAA/Cr,NAA/(Cho+Cr)and Cho/Cr were calculated from these measurements.The diagnostic value of NAA ratios for ALS lesions was analyzed by receiver operating characteristic(ROC)curves.Results Compared with the controls,ALS group had significantly decreased NAA/Cr and NAA/(Cho+Cr)ratios at the three levels along the corticospinal tract(CST)(P<0.05).In ROC analysis,areas under the curves(AUC)ranged from 0.67to0.91.The average NAA/(Cho+Cr)ratio of PLIC and CP showed the best performance with an AUC of 0.91,a sensitivity of 0.828 and a specificity of 0.906,followed by the average NAA/(Cho+Cr)ratio of all the three levels,with the corresponding data as 0.90,0.769 and 0.875.Conclusions 1 H-MRS can reveal metabolite abnormalities in the intracranial CTS of ALS patients and serve as a neuroimaging biomarker for UMN involvement.Regarding its moderate diagnostic accuracy, multilevel measurements and synthetically using parameters will help to improve its efficacy.
Objective To evaluate the feature and diagnostic accuracy of proton magnetic resonance spectroscopy(1 H-MRS)in detecting upper motor neuron(UMN)involvement in amyotrophic lateral sclerosis(ALS).Methods The study included 31 ALS patients and 32 healthy controls and measured the concentration of N-acetylaspartate(NAA),choline(Cho)and creatine(Cr)by 1 H-MRS in subcortical white matter of precentral gyrus,posterior limb of internal capsule(PLIC)and cerebral peduncle(CP).Ratios of NAA/Cr,NAA/(Cho+Cr)and Cho/Cr were calculated from these measurements.The diagnostic value of NAA ratios for ALS lesions was analyzed by receiver operating characteristic(ROC)curves.Results Compared with the controls,ALS group had significantly decreased NAA/Cr and NAA/(Cho+Cr)ratios at the three levels along the corticospinal tract(CST)(P<0.05).In ROC analysis,areas under the curves(AUC)ranged from 0.67to0.91.The average NAA/(Cho+Cr)ratio of PLIC and CP showed the best performance with an AUC of 0.91,a sensitivity of 0.828 and a specificity of 0.906,followed by the average NAA/(Cho+Cr)ratio of all the three levels,with the corresponding data as 0.90,0.769 and 0.875.Conclusions 1 H-MRS can reveal metabolite abnormalities in the intracranial CTS of ALS patients and serve as a neuroimaging biomarker for UMN involvement.Regarding its moderate diagnostic accuracy, multilevel measurements and synthetically using parameters will help to improve its efficacy.
引文
[1]Brooks BR,Miller RG,Swash M,et al.El Escorial revisited:revised criteria for the diagnosis of amyotrophic lateral sclerosis[J].Amyotroph Lateral Scler Other Motor Neuron Disord,2000,1(5):293-299.
[2]Ellis CM,Simmons A,Jones DK,et al.Diffusion tensor MRI assesses corticospinal tract damage in ALS[J].Neurology,1999,53(5):1051-1058.
[3]The ALS CNTF treatment study(ACTS)phaseⅠ-Ⅱstudy group.The amyotrophic lateral sclerosis functional rating scale.Assessment of activities of daily living in patients with amyotrophic lateral sclerosis[J].Arch Neurol,1996,53(2):141-147.
[4]翦凡,崔丽英,管宇宙,等.肌萎缩侧索硬化38例弥散张量成像及磁共振波谱表现[J].中华神经科杂志,2008,41(5):294-298.
[5]中华医学会神经病学分会肌电图与临床神经电生理学组,中华医学会神经病学分会神经肌肉病学组.中国肌萎缩侧索硬化诊断和治疗指南[J].中华神经科杂志,2012,45(7):531-533.
[6]翦凡,崔丽英,刘明生,等.肌萎缩侧索硬化症的经颅磁刺激运动诱发电位研究[J].脑与神经疾病杂志,2006,14(5):345-349,393.
[7]Prokscha T,Guo J,Hirsch S,et al.Diffusion tensor imaging in amyotrophic lateral sclerosis-Increased sensitivity with optimized region-of-interest delineation[J].Clin Neuroradiol,2014,24(1):37-42.
[8]翦凡,崔丽英,潘华,等.弥散张量成像对肌萎缩侧索硬化的诊断价值[J].中华神经科杂志,2015,48(2):99-102.
[9]Liu C,Jiang R,Yi X,et al.Role of diffusion tensor imaging or magnetic resonance spectroscopy in the diagnosis and disability assessment of amyotrophic lateral sclerosis[J].J Neurol Sci,2015,348(1-2):206-210.
[10]Cervo A,Cocozza S,SaccàF,et al.The combined use of conventional MRI and MR spectroscopic imaging increases the diagnostic accuracy in amyotrophic lateral sclerosis[J].Eur J Radiol,2015,84(1):151-157.
[11]Abe K,Fujimura H,Kobayashi Y,et al.Degeneration of the pyramidal tracts in patients with amyotrophic lateral sclerosis.A premortem and postmortem magnetic resonance imaging study[J].J Neuroimaging,1997,7(4):208-211.
[12]Schuff N,Rooney WD,Miller R,et al.Reanalysis of multislice(1)H MRSI in amyotrophic lateral sclerosis[J].Magn Reson Med,2001,45(3):513-516.
[13]Govind V,Sharma KR,Maudsley AA,et al.Comprehensive evaluation of corticospinal tract metabolites in amyotrophic lateral sclerosis using whole-brain 1H MR spectroscopy[J].PLoS One,2012,7(4):e35607.
[14]Bede P,Hardiman O.Lessons of ALS imaging:Pitfalls and future directions-A critical review[J].Neuroimage Clin,2014,4:436-443.
[15]宇传华,徐勇勇.ROC分析的基本原理[J].中华流行病学杂志,1998,19(2):413-415.
[16]Stagg CJ,Knight S,Talbot K,et al.Whole-brain magnetic resonance spectroscopic imaging measures are related to disability in ALS[J].Neurology,2013,80(7):610-615.
[2]Ellis CM,Simmons A,Jones DK,et al.Diffusion tensor MRI assesses corticospinal tract damage in ALS[J].Neurology,1999,53(5):1051-1058.
[3]The ALS CNTF treatment study(ACTS)phaseⅠ-Ⅱstudy group.The amyotrophic lateral sclerosis functional rating scale.Assessment of activities of daily living in patients with amyotrophic lateral sclerosis[J].Arch Neurol,1996,53(2):141-147.
[4]翦凡,崔丽英,管宇宙,等.肌萎缩侧索硬化38例弥散张量成像及磁共振波谱表现[J].中华神经科杂志,2008,41(5):294-298.
[5]中华医学会神经病学分会肌电图与临床神经电生理学组,中华医学会神经病学分会神经肌肉病学组.中国肌萎缩侧索硬化诊断和治疗指南[J].中华神经科杂志,2012,45(7):531-533.
[6]翦凡,崔丽英,刘明生,等.肌萎缩侧索硬化症的经颅磁刺激运动诱发电位研究[J].脑与神经疾病杂志,2006,14(5):345-349,393.
[7]Prokscha T,Guo J,Hirsch S,et al.Diffusion tensor imaging in amyotrophic lateral sclerosis-Increased sensitivity with optimized region-of-interest delineation[J].Clin Neuroradiol,2014,24(1):37-42.
[8]翦凡,崔丽英,潘华,等.弥散张量成像对肌萎缩侧索硬化的诊断价值[J].中华神经科杂志,2015,48(2):99-102.
[9]Liu C,Jiang R,Yi X,et al.Role of diffusion tensor imaging or magnetic resonance spectroscopy in the diagnosis and disability assessment of amyotrophic lateral sclerosis[J].J Neurol Sci,2015,348(1-2):206-210.
[10]Cervo A,Cocozza S,SaccàF,et al.The combined use of conventional MRI and MR spectroscopic imaging increases the diagnostic accuracy in amyotrophic lateral sclerosis[J].Eur J Radiol,2015,84(1):151-157.
[11]Abe K,Fujimura H,Kobayashi Y,et al.Degeneration of the pyramidal tracts in patients with amyotrophic lateral sclerosis.A premortem and postmortem magnetic resonance imaging study[J].J Neuroimaging,1997,7(4):208-211.
[12]Schuff N,Rooney WD,Miller R,et al.Reanalysis of multislice(1)H MRSI in amyotrophic lateral sclerosis[J].Magn Reson Med,2001,45(3):513-516.
[13]Govind V,Sharma KR,Maudsley AA,et al.Comprehensive evaluation of corticospinal tract metabolites in amyotrophic lateral sclerosis using whole-brain 1H MR spectroscopy[J].PLoS One,2012,7(4):e35607.
[14]Bede P,Hardiman O.Lessons of ALS imaging:Pitfalls and future directions-A critical review[J].Neuroimage Clin,2014,4:436-443.
[15]宇传华,徐勇勇.ROC分析的基本原理[J].中华流行病学杂志,1998,19(2):413-415.
[16]Stagg CJ,Knight S,Talbot K,et al.Whole-brain magnetic resonance spectroscopic imaging measures are related to disability in ALS[J].Neurology,2013,80(7):610-615.