CAJ | 학술논문

目的：脊髓是多发性硬化（MS）的好发部位之一，严重影响患者生活质量。本文探讨基于体素的形态学（VBM）方法及静息态功能磁共振成像（RS-fMRI）在单纯脊髓受累的多发性硬化（MS-SSCI）患者中的应用价值。资料与方法20例MS-SSCI患者及对照组20例健康志愿者行3D T1WI及RS-fMRI扫描，通过VBM方法分析脑灰质及白质体积、全脑体积、局部核团体积变化情况，以后扣带回（PCC）作为种子点行全脑静息态功能连接分析并行组间比较，进一步分析MS-SSCI结构、功能变化参数与临床扩展残疾状态量表（EDSS）评分的相关性。结果①MS-SSCI组较对照组全脑灰、白质体积、全脑体积未见明显变化（P>0.05），双侧颞中回、左侧颞下回灰质体积萎缩（P<0.01）；左侧内侧前额叶、左侧颞下回、左侧尾状核、右侧补充运动区与PCC之间的功能连接（FC）明显升高（双样本t检验，经AlphaSim校正，P<0.05，体素大小>40）；②MS-SSCI结构变化参数与EDSS评分均无明显相关性（P>0.05）；左侧颞下回FC值与EDSS评分呈正相关（r=0.63，P<0.05）。结论 MS-SSCI脑内结构及PCC的FC均发生改变，但仅功能变化参数与临床残疾状况相关，提示功能活动异常较微结构损伤更加敏感。
목적：척수시다발성경화（MS）적호발부위지일，엄중영향환자생활질량。본문탐토기우체소적형태학（VBM）방법급정식태공능자공진성상（RS-fMRI）재단순척수수루적다발성경화（MS-SSCI）환자중적응용개치。자료여방법20례MS-SSCI환자급대조조20례건강지원자행3D T1WI급RS-fMRI소묘，통과VBM방법분석뇌회질급백질체적、전뇌체적、국부핵단체적변화정황，이후구대회（PCC）작위충자점행전뇌정식태공능련접분석병행조간비교，진일보분석MS-SSCI결구、공능변화삼수여림상확전잔질상태량표（EDSS）평분적상관성。결과①MS-SSCI조교대조조전뇌회、백질체적、전뇌체적미견명현변화（P>0.05），쌍측섭중회、좌측섭하회회질체적위축（P<0.01）；좌측내측전액협、좌측섭하회、좌측미상핵、우측보충운동구여PCC지간적공능련접（FC）명현승고（쌍양본t검험，경AlphaSim교정，P<0.05，체소대소>40）；②MS-SSCI결구변화삼수여EDSS평분균무명현상관성（P>0.05）；좌측섭하회FC치여EDSS평분정정상관（r=0.63，P<0.05）。결론 MS-SSCI뇌내결구급PCC적FC균발생개변，단부공능변화삼수여림상잔질상황상관，제시공능활동이상교미결구손상경가민감。
PurposeSpinal cord is one of the most frequently involved sites of multiple sclerosis (MS), which seriously affects the life quality of patients. In this paper, we investigate the application value of voxel-based morphology (VBM) and resting-state magnetic resonance imaging (RS-fMRI) in multiple sclerosis patients with single spinal cord involvement (MS-SSCI).Materials and Methods Three-dimensional T1WI data and RS-fMRI data were acquired from 20 patients with MS-SSCI and 20 normal controls, grey matter volume (GMV), changes of white matter volume (WMV), total intracranial volume (TIV) and local nuclei volume were compared between the two groups using VBM, posterior cingulate cortex (PCC) was regarded as the seed point and the functional connectivity about whole brain was compared between the two groups by using resting-state functional connectivity analysis, the relationships between MS-SSCI structure, function change parameters and expanded disability states scale (EDSS) scores were further explored.Results①Compared with the control group, GMV, WMV, TIV of MS-SSCI group were not significantly reduced, only the volume of some regions (bilateral middle temporal gyrus, left inferior temporal gyrus) showed significant atrophy (P<0.01); MS-SSCI exhibited increased functional connectivity (FC) in the left medial prefrontal cortex, left inferior temporal gyrus, left caudate nucleus and right supplementary motor area (two-sample t test, after AlphaSim correction,P<0.01, voxel size >40).②There was no significant correlation (P>0.05) between MS-SSCI structure change parameters and EDSS; while a significant correlation between EDSS scores and FC was noted in the left inferior temporal gyrus (r=0.633,P<0.05).Conclusion Both structural abnormalities and altered FC with PCC can be detected in MS-SSCI, but only functional parameters are associated with clinical abnormalities, which are more sensitive than microstructural changes.