CAJ | 학술논문

目的研究肌萎缩侧索硬化(ALS)的弥散张量成像(DTI)和磁共振波谱(MRS)特点,并对ALs的病理生理机制进行初步探讨.方法 ALS患者38例,单纯下运动神经元受累疾病患者8例,混合型颈椎病5例和健康对照34名,行常规头颅MRI、DTI和1H-MRS测定.结果 21%(8/38)的ALS患者可见T2 FLAIR序列双侧锥体束走行异常高信号,强度高于皮质灰质.ALS组和健康对照组相比,中央前回(ALS组0.492±0.059,健康对照组0.552 4-0.045,F=17.150,P<0.01)、内囊后肢(分别为0.679 ±0.048、0.727±0.031,F=19.481,P<0.01)、大脑脚(左侧0.740±0.038、0.761±0.024,F=4.290;右侧0.720±0.044、0.746±0.034,F=3.264,均P<0.01)的部分各向异性(FA值)显著降低;ALS组上述部位的N-乙酰大冬氨酸/肌酸(NAA/Cr)值和健康对照组相比亦存在显著降低.AKS组各部位FA值降低百分率分别为10.9%、6.6%、2.8%～3.5%,以中央前回处最为显著;内囊前肢、枕叶处的FA值亦有不同程度降低.结论 DTI和MRS枪测不仪有助于ALS患者:运动神经元高位受累的确认和ALS的诊断和鉴别诊断,而且还可促进对ALS病理机制和病损分布的了解.
목적 연구기위축측색경화(ALS)적미산장량성상(DTI)화자공진파보(MRS)특점,병대ALs적병리생리궤제진행초보탐토.방법 ALS환자38례,단순하운동신경원수루질병환자8례,혼합형경추병5례화건강대조34명,행상규두로MRI、DTI화1H-MRS측정.결과 21%(8/38)적ALS환자가견T2 FLAIR서렬쌍측추체속주행이상고신호,강도고우피질회질.ALS조화건강대조조상비,중앙전회(ALS조0.492±0.059,건강대조조0.552 4-0.045,F=17.150,P<0.01)、내낭후지(분별위0.679 ±0.048、0.727±0.031,F=19.481,P<0.01)、대뇌각(좌측0.740±0.038、0.761±0.024,F=4.290;우측0.720±0.044、0.746±0.034,F=3.264,균P<0.01)적부분각향이성(FA치)현저강저;ALS조상술부위적N-을선대동안산/기산(NAA/Cr)치화건강대조조상비역존재현저강저.AKS조각부위FA치강저백분솔분별위10.9%、6.6%、2.8%～3.5%,이중앙전회처최위현저;내낭전지、침협처적FA치역유불동정도강저.결론 DTI화MRS창측불의유조우ALS환자:운동신경원고위수루적학인화ALS적진단화감별진단,이차환가촉진대ALS병리궤제화병손분포적료해.
Objective To investigate the diffusion tensor imaging(DTI)and magnetic resonance spectroscopy(MRS)changes in amyotrophic lateral sclerosis(ALS)and to study on the physiopathology of ALS.Methods Thirty-eight AIS patients,8 patients with pure lower motor neuron involvement and 5 patients with mixed-type cervical spondylosis and 34 healthy controls were enrolled and examined with the conventional brain MRI,DTI and 1H-MRS.Results T2-weighted and T2 FLAIR images revealed abnormal high signals in bilateral pyramidal tract positions in 21%(8/38)of ALS patients,which was higher than that in the coaex When compared with the control group,the values of FA in the precentral gyms(0.492±0.059 vs 0.552±0.045,F=17.150,P<0.01),the posterior limb of the internal capsule(0.679±0.048 vs 0.727 4-0.031.F=19.481.P<0.01)and the cerebral peduncle(1eft:0.740 4-0.038 vs 0.761 4±0.024.F=4.290;right:0.720 ±0.044 vs 0.746 ±0.034,F=3.264,both P<0.01)of the ALS group were decreased significantly.so were the values of NAA/Cr.And the FA reduction rate was 10.9%,6.6% and 2.8%-3.5% respectively.There was also a significant decrease in FA in the anterior limb of the internal capsule and the occipital lobe in the ALS group.Conclusion Not only does the application of DTI and MRS help to demonstrate upper motor neuron involvement in the brain and facilitate the diagnosis and differential diagnosis of ALS,but also increases the understanding of the lesion distribution and physiopathology in ALS.