半自动MRI定量方法测定脑白质高信号体积与病变定性评分的相关性

Volumetric quantitation and qualitation of white matter lesions in evaluation of cognitive impairment

背景:在磁共振T2加权像和液体衰减反转恢复像中脑白质病变表现为白质高信号,目前对脑白质高信号体积、部位与认知功能损害的关系仍存在争议。目的:以头颅磁共振对皮质下缺血性脑血管病患者白质高信号进行定量和定性测定,分析高信号体积和部位与认知损害的关系。设计、时间及地点:于2007-12/2008-09在河北省人民医院神经内科完成。对象:依据影像学诊断标准确定皮质下缺血性脑血管病53例,记录症状和体征,并进行神经心理学评估。方法:采用美国GE公司生产的半自动1.5TMRI机对患者行头MRI扫描,定量测定脑白质高信号体积,并结合脑白质病变定性评分。主要观察指标:分析皮质下缺血性脑血管病患者脑白质高信号体积与评分的相关性,以及白质病变与认知损害的关系。结果:脑白质高信号体积和评分高度相关(rs=0.989,P<0.001),两者呈曲线关系。分层多元线性回归分析显示,白质高信号体积、白质高信号总评分的变化可以分别解释简明精神状态检查评分改变的10.5%和6.8%,前者较后者能更敏感地预测简明精神状态检查评分变化。不同区域脑白质病变中,仅基底核区白质高信号评分与简明精神状态检查评分有关(t=-2.126,P=0.039),其他各区域白质高信号评分均非简明精神状态检查评分独立预测指标。结论:脑白质高信号体积与评分均可应用于脑白质病变的测定,前者测定较脑白质高信号评分更敏感;皮质下缺血性脑血管病患者认知功能损害随着脑白质病变的增多,尤其是基底核区白质病变的增多而加重。

BACKGROUND： Leukodystrophy presents white matter hyperintensity （WMH） on magnetic resonance T2 weighing image and fluid attented inversion recovery （FLAIR）. To date, it remains controversial about relationship of the volume and site of WMH with cognitive impairment. OBJECTIVE： To quantitatively and qualitatively measure WMH in patients with subcortical ischemic vascular disease, and to explore the relationship between the volume and site of WMH and cognitive impairment. DESIGN, TIME AND SE＇FrlNG： The experiment was performed at Department of Neurology, Hebei Provincial People＇s Hospital between December 2007 and September 2008. PARTICIPANTS： Fifty patients with subcortical ischemic vascular disease according to the criteria of Erkinjuntti were selected, and their symptoms and signs were recorded. In addition, the neuropsychology was evaluated. METHODS： A semi-automated 1.5T MRI quantitative method （GE, USA） was used to measure the volume of WMH, and qualitatively scored in combination with leukodystrophy. MAIN OUTCOME MEASURES： The correlation of volumetric quantitation and qualitation of WMH to the scores, and the relationship between white matter lesions and cognitive impairment. RESULTS： Significant correlation was found and curvilinear relationship was fitted between the volume and rating scales of WMH （rs=0.989, P〈 0.001）. WMH volume and rating scales contribute to the variance of mini-mental state examination （MMSE） about 10.5% and 6.8%, respectively; the former was more sensitive to predict the MMSE variance. Basal ganglia area WMH related with the MMSE scores （t= 2.126, P=0.039）, and WMH in other regions cannot predict the deterioration of cognition independently. CONCLUSIONS： Both the quantitive and qualitative measurement on the volume of white matter hyperintensity is suitable for the evaluation of white matter lesions, but the former is more sensitive. The extent of white matter lesions, especially in the basal ganglia area, might predict poor performance on general cognitive function.