原发性进行性失语的影像学研究(附1例病例分析)

Imageological Study of Primary Progressive Aphasia with One Case Report

目的分析1例原发性进行性失语患者的脑影像学特点。方法对1例确诊感觉性失语的原发性进行性失语患者进行常规MRI及fMRI检查,即进行磁共振灌注成像(PWI)、磁共振波谱(MRS)分析、磁共振扩散张量成像(DTI)分析,明确患者脑内血流量、代谢及联系纤维的特点。结果常规MRI显示左侧额叶及颞叶萎缩;MRS显示左侧颞叶和额叶前部代谢较对侧明显减低;PWI显示左侧颞极及额前部的血流量较对侧减低;DTI显示左Broca区与其他脑区间纤维联系减少,三角区与Wernicke区无纤维联络;左侧Wernicke区通过弓状纤维到达额叶岛盖部的纤维减少;Broca及Wernicke区平均各向异性(FA)值及纤维束较正常人减少。结论原发性进行性失语病变部位主要在左侧颞叶、额叶,与对侧相应区域对比呈现低灌注、低代谢状态,Broca区与Wer-nicke区联系纤维减少。

Objective To analyze the imaging characteristics of one patient with primary progressive aphasia （PPA）. Methods The patient was examined with MRI and functional MRI （fMRI） to perform the analyses of perfusion weighted imaging （PWI）, magnetic resonance spectroscopy （MRS） and diffusion tensor imaging （DTI）, and studied the changes of cerebral blood flow （CBF）, metabolism, and association fibers of PPA. Results There was frontal lobe and temporal lobe atrophy on general MRI, lower metabolism compared with contralateral on MRS; there were decreased association fibers between Broca domain and other domain, no association fibers between triangular area and Wernicke domain on DTI, mean fraction anisotropism （FA） and fibers of Broca and Wernicke domain decreased compared with healthy adult. Conclusion Left temporal lobe and frontal lobe are the mainly diseased regions of PPA, and perfusion and metabolism are lower than the contral lobe, and the association fibers between Broca and Wernike domain are less than the control lobe.