CAJ | 학술논문

目的：应用1H-磁共振波谱(1H Magnetic resonance spectroscopy，1H-MRS)及扩散张量成像（diffusion tensor imaging, DTI）技术联合评价皮质下缺血性脑血管病（subcortical ischemic vascular disease, SIVD）认知障碍患者左丘脑损害，探讨其与执行功能的关系。方法对SIVD中14例血管性痴呆（vascular dementia, VaD）患者、14例血管性无痴呆型认知损害(vascular cognitive impairment no dementia, VCIND)患者及14例健康老年人行连线测验(trail making test,TMT)等神经心理评估，应用1H-MRS采集左丘脑感兴趣区（regions of interest, ROI）N-乙酰天门冬氨酸（NAA）、胆碱（Cho）、肌醇（MI）及肌酸（Cr）浓度，计算NAA/Cr、Cho/Cr及MI/Cr比值。同时进行DTI扫描，测定与1H-MRS所选ROI相同的左丘脑的部分各向异性分数（fractional anisotropy, FA）及平均扩散度（mean diffusivity, MD），进一步分析其与TMT时间的关系。结果与正常对照组比较，VaD组、VCIND组左丘脑NAA/Cr降低（F=3.656, P=0.038），SIVD组两组比较无明显差别（P﹤0.05）；VaD、VCIND组患者左丘脑MD值较正常对照组升高（F=3.882, P=0.030），病例组两组间无明显统计学差异（P﹤0.05）；左丘脑NAA/Cr、MI/Cr、Cho/Cr与同区域的FA及MD值均无明显相关（P﹤0.05）；左丘脑Cho/Cr与TMTb明显正相关（r=0.520, P=0.001），MD值与TMT b呈正相关（r=0.305, P=0.044）。结论1H-MRS与DTI结合能更好地检测出丘脑可能存在的隐匿性损伤；左丘脑Cho/Cr与MD值与执行功能相关。
목적：응용1H-자공진파보(1H Magnetic resonance spectroscopy，1H-MRS)급확산장량성상（diffusion tensor imaging, DTI）기술연합평개피질하결혈성뇌혈관병（subcortical ischemic vascular disease, SIVD）인지장애환자좌구뇌손해，탐토기여집행공능적관계。방법대SIVD중14례혈관성치태（vascular dementia, VaD）환자、14례혈관성무치태형인지손해(vascular cognitive impairment no dementia, VCIND)환자급14례건강노년인행련선측험(trail making test,TMT)등신경심리평고，응용1H-MRS채집좌구뇌감흥취구（regions of interest, ROI）N-을선천문동안산（NAA）、담감（Cho）、기순（MI）급기산（Cr）농도，계산NAA/Cr、Cho/Cr급MI/Cr비치。동시진행DTI소묘，측정여1H-MRS소선ROI상동적좌구뇌적부분각향이성분수（fractional anisotropy, FA）급평균확산도（mean diffusivity, MD），진일보분석기여TMT시간적관계。결과여정상대조조비교，VaD조、VCIND조좌구뇌NAA/Cr강저（F=3.656, P=0.038），SIVD조량조비교무명현차별（P﹤0.05）；VaD、VCIND조환자좌구뇌MD치교정상대조조승고（F=3.882, P=0.030），병례조량조간무명현통계학차이（P﹤0.05）；좌구뇌NAA/Cr、MI/Cr、Cho/Cr여동구역적FA급MD치균무명현상관（P﹤0.05）；좌구뇌Cho/Cr여TMTb명현정상관（r=0.520, P=0.001），MD치여TMT b정정상관（r=0.305, P=0.044）。결론1H-MRS여DTI결합능경호지검측출구뇌가능존재적은닉성손상；좌구뇌Cho/Cr여MD치여집행공능상관。
Objective To investigate the lesionsin theleft thalamus and to explore their correlation with executive functionin patients with subcortical ischemic vascular disease(SIVD)by using 1H magnetic resonance spectroscopy (1H-MRS) and diffusion tensor imaging (DTI). Methods Fourteen patients with vascular dementia (VaD), 14 patients with vas-cular cognitive impairment without dementia(VCIND)and 14 normal controls (NC) were recruited. The quantitative analy-sis of N-acetylaspartate (NAA), Choline (Cho), myoinositol (MI) and Creatine (Cr) resonance signals in region of interests (ROI) in the left thalamus were measured. Fractional anisotropy (FA) and mean diffusivity (MD) values in the same region were examined by using DTI. The relationship were analyzedamong the MRS, DTI ratios and cognitive impairment reflect-ed in MMSE and trail making test(TMT). Results The NAA/Cr ratio showed a gradual decrease in the left thalamus of VaD andVCIND patients compared with controls(F=3.656, P=0.038). There was no significant difference in NAA/Cr ra- tiobetween VaD and VCIND patients.Compared with controls, patients with VaD and VCIND demonstrated increased MD value in the left thalamus(F=3.882, P=0.030).There was no significant difference in MD value between VaD and VCIND patients (P>0.05). There were no correlations between NAA/Cr, MI/Cr, Cho/Cr value and DTI parameters in the ROI (P>0.05). TMTb time was positively associated with Cho/Cr(r=0.520,P=0.001 ) and with MD value in the left thalamus (r=0.305, P=0.044). Conclusions Combination of 1H-MRS with DTI can provide the valuable informationon the potential lesions in the thalamus in patients with SIVD. The Cho/Cr and MD values in the leftthalamus may be correlated with ex-ecutive function.