CAJ | 학술논문

目的运用磁共振成像（magnetic resonance imaging，MRI）基于白质地图的扩散张量成像（diffusion tensor imaging，DTI）技术研究皮质下缺血性血管病（subcortical ischemic vascular disease，SIVD）患者联络纤维的超微结构改变，并分析DTI参数与认知功能的关系。方法连续入选40例SIVD患者，分为血管性认知障碍组18例，无认知障碍组22例，另设立20例正常老年人为对照组。对三组进行MRI检查并对其白质改变进行评分，对联络纤维进行基于白质地图分析（atlase based analysis，ABA）DTI成像，比较组间部分各向异性指数（fractional anisotrophy，FA）、平均扩散率（mean diffusivity，MD）差异，并对SIVD患者DTI参数与蒙特利尔认知评估量表（Montreal Cognitive Assessment，MoCA）得分进行相关性分析。结果无认知障碍组较正常组在右侧矢状层（下纵束/下额枕束）、右侧扣带（海马部）及左侧上额枕束的FA值减低；认知障碍组较正常组存在广泛的联络纤维FA值降低，差异均具有显著性。无认知障碍组与正常组比较，仅左侧扣带海马部及左侧上纵束MD值无显著差异，余联络纤维的MD值均显著增高；认知障碍组较正常组存在广泛的联络纤维MD值增高，差异均具有显著性。与无认知功能障碍组比较，认知功能障碍组在双侧矢状层（下纵束/下额枕束）、双侧扣带扣带回部、海马部、双侧上纵束、双侧上额枕束及双侧钩束的FA值减低，MD值增高，差异具有显著性。SIVD患者双侧矢状层（下纵束/下额枕束）、扣带扣带回部、上纵束、上额枕束及钩束和左侧扣带海马部的FA值与MoCA评分呈正相关，MD值与MoCA评分呈负相关。结论 SIVD患者联络纤维的FA值减低，MD值增高，且DTI参数与其认知功能密切相关。
목적운용자공진성상（magnetic resonance imaging，MRI）기우백질지도적확산장량성상（diffusion tensor imaging，DTI）기술연구피질하결혈성혈관병（subcortical ischemic vascular disease，SIVD）환자련락섬유적초미결구개변，병분석DTI삼수여인지공능적관계。방법련속입선40례SIVD환자，분위혈관성인지장애조18례，무인지장애조22례，령설립20례정상노년인위대조조。대삼조진행MRI검사병대기백질개변진행평분，대련락섬유진행기우백질지도분석（atlase based analysis，ABA）DTI성상，비교조간부분각향이성지수（fractional anisotrophy，FA）、평균확산솔（mean diffusivity，MD）차이，병대SIVD환자DTI삼수여몽특리이인지평고량표（Montreal Cognitive Assessment，MoCA）득분진행상관성분석。결과무인지장애조교정상조재우측시상층（하종속/하액침속）、우측구대（해마부）급좌측상액침속적FA치감저；인지장애조교정상조존재엄범적련락섬유FA치강저，차이균구유현저성。무인지장애조여정상조비교，부좌측구대해마부급좌측상종속MD치무현저차이，여련락섬유적MD치균현저증고；인지장애조교정상조존재엄범적련락섬유MD치증고，차이균구유현저성。여무인지공능장애조비교，인지공능장애조재쌍측시상층（하종속/하액침속）、쌍측구대구대회부、해마부、쌍측상종속、쌍측상액침속급쌍측구속적FA치감저，MD치증고，차이구유현저성。SIVD환자쌍측시상층（하종속/하액침속）、구대구대회부、상종속、상액침속급구속화좌측구대해마부적FA치여MoCA평분정정상관，MD치여MoCA평분정부상관。결론 SIVD환자련락섬유적FA치감저，MD치증고，차DTI삼수여기인지공능밀절상관。
Objective To investigate microstructure changes of association fibers in subcortical ischemic vascular disease (SIVD) patients using atlas-based analyses (ABA) of diffusion tensor imaging (DTI) and clinical correlations of ischemic changes. <br> Methods Forty SIVD patients (18 vascular cognitive impairment [VCI] patients and 22 non-cognitive impairment [NCI] patients) and 20 normal controls were performed with neuropsychological tests and 3-Tesla magnetic resonance imaging (MRI) including DTI scans. The rating score of white matter change, ABA of the fractional anisotropy (FA) and mean diffusivity (MD) were computed. The correlation between DTI parameters and Montreal Cognitive Assessment (MoCA) scores were evaluated. <br> Results Compared with NCI group, VCI group patients had lower FA value and higher MD value in bilateral sagittal stratum (inferior longitudinal fasciculus/inferior fronto-occipital fasciculus), cingulate gyrus (cingulum), hippocampus (cingulum), superior longitudinal fasciculus, superior fronto-occipital fasciculus, uncinate fasciculus. However, the rating score of white matter change showed no signiifcant difference. In addition, MoCA scores of SIVD patients positively correlated with FA values and negatively correlated with MD values of association ifbers, including bilateral sagittal stratum (inferior longitudinal fasciculus/inferior fronto-occipital fasciculus), cingulate gyrus (cingulum), superior longitudinal fasciculus, superior fronto-occipital fasciculus, uncinate fasciculus and left hippocampus (cingulum). <br> Conclusion FA values increase and MD values decrease in association ifbers of SIVD patients. Moreover, it is signiifcantly related with cognitive function.