皮层下缺血性脑血管病性痴呆的MRI研究

MRI findings in subcortical ischemic vascular dementia

目的分析皮层下缺血性脑血管病性痴呆的颅脑MR表现,探讨其与认知功能障碍的关系。方法对比分析25例皮层下缺血性脑血管病性痴呆者和25例皮层下缺血性脑血管病无痴呆者颅脑MR表现。结果①痴呆组中尾状核、豆状核、内囊膝、丘脑、额叶皮层下、颞叶皮层下、侧脑室体旁前部白质、半卵圆中心前部以及中部白质梗死的发生率均明显高于对照组(P<0.05),多发性脑梗死、双侧脑梗死、左侧脑梗死在痴呆组的发生率高于对照组(P<0.05);②痴呆组脑梗死总数目明显高于对照组(P<0.001),且尾状核、豆状核、内囊前肢、外囊、丘脑、额叶皮层下、颞叶皮层下、侧脑室体旁前部以及中部白质梗死的数目均明显高于对照组(P<0.05);③痴呆组患者梗死总体积明显大于对照组(P<0.001),且豆状核、内囊前肢、丘脑、额叶皮层下、颞叶皮层下、侧脑室体旁前部白质、半卵圆中心前部以及中部白质梗死体积均明显大于对照组(P<0.05);④痴呆组白质疏松的发生率与对照组比较无明显差异(P>0.05),2级、3级白质疏松的构成比高于对照组(P<0.001);⑤脑萎缩指数明显高于对照组(P<0.05),双侧海马体积均较对照组小,但差异均无统计学意义(P>0.05)。结论脑梗死灶的部位、数目、体积和脑白质疏松及脑萎缩的程度与皮层下缺血性脑血管病性痴呆发病有着密切联系。

Objective To analyze the brain MRI findings in subcortical ischemic vascular dementia and to investigate their correlations with cognitive disorder. Methods The brain MRI findings were compared between 25 dementia and 25 nondementia patients, all with subcortical ischemic vascular diseases. Results ①Incidences of infarction in caudate nucleus, lentiform nucleus, genu of internal capsule, thalamus, frontal and temporal subcortical white matter, anterior white matter around the body of lateral ventricle, and anterior and middle white matter of centrum semiovale were higher in dementia group than those in nondementia group （P〈0.05）; incidences of multiple cerebral infarction, bilateral and left cerebral infarction were higher in dementia group than those in nondementia group （P〈0.05）; ② The total number of infarcts was higher in dementia group than that in nondementia group （P〈0.001）, and the former showed a larger number of infarct than the latter in caudate nucleus, lenticular nucleus, anterior internal capsule, external capsule, thalamus, frontal and temporal subcortical white matter, anterior and middle white matter around the body of lateral ventricle （P〈0.05）; ③Dementia group showed larger total volume of infarct than nondementia group, especially in lentiform nucleus, anterior internal capsule, thalamus, frontal and temporal subcortical white matter, anterior white matter around the body of lateral ventricle and anterior and middle white matter of centrum semiovale （P〈0.05）; ④ Incidence of leukoaraiosis did not have difference between the 2 groups （P〉0.05）; the ratio of leukoaraiosis of 2 to 3 degree in dementia group was higher than that in nondementia group （P〈0.001）; ⑤ The index of cerebral atrophy in dementia group was significantly higher than that in nondementia group （P〈0.05）; the bilateral hippocampal volumes were a little smaller than those in nondementia group, but without statistical significance （P〉0.05）. Conclusion The number, location and size of infarct, the degree of leukoaraiosis and brain atrophy have a close relation with the pathogenesis of subcortical ischemic vascular dementia.