应用基于体素的MR形态测量学分析抽动秽语综合征患儿脑灰质体积变化

Volume changes of whole brain gray matter in pediatric patients with Tourette syndrome： evidencefrom voxel-based morphometry

目的应用优化的基于体素的形态测量学（VBM）技术，分析抽动秽语综合征（TS）患儿全脑灰质异常情况。方法选取31例TS患儿（TS组）和与之年龄、性别匹配的50名正常儿童（正常对照组）进行3DT1WI0利用基于统计参数图（SPM）2软件的VBM2工具箱对扫描获得的图像进行预处理，对TS患儿和正常儿童的全脑灰质体积采用t检验进行比较。将灰质体积差异区域的改变值提取出来，与临床耶鲁综合抽动严重程度评分量表（YGTSS）评分、病程进行多元线性分析。结果应用VBM方法，发现Ts组的左顶上小叶、右小脑半球、左海马旁回灰质体积较对照组增大，增加体积分别为4059、2126、84mm^3，其差异有统计学意义（t值分别为3．93、3．71、3．58，P值均〈0．05）。延髓和左桥脑体积较对照组减小，减小体积分别为213、117mm。（t值分别为3．53、3．48，P值均〈0．05）。体积差异区域的体积改变值与临床YGTSS评分无相关性（P〉0．05），左海马旁回灰质体积与患儿病程呈负相关（Beta=-0．391，P=0．039）。结论VBM能够显示常规MRI表现正常的TS患儿的灰质异常。颞顶叶和小脑体积增加可能是TS患儿的适应性反应，左海马旁回灰质体积可能是评价TS患者预后的一项客观指标。

Objectives To identify the related abnormalities of gray matter in pediatric patients with Tourette syndrome （TS） by using the optimized voxel-based morphometry （VBM）. Methods Three dimensional T1WI was acquired in 31 TS children （28 boys, 3 girls, mean age 8 years, range 4-15 years） and 50 age- and sex-matched controls on a 1.5 Tesla Philips scanner. Images were pre-processed and analyzed using a version of VBM 2 in SPM 2. The whole brain gray matter volume was compared between the study and control group by using t-test. Multivariate linear regression analysis was used for analyzing the correlation between the change of grey matter volume within each brain region （ mm3 ） and YGTSS score and course of disease of TS patients. Statistical analyses were performed by using SPSS 13.0. Results Using VBM, significant increases in gray matter volumes in left superior parietal lobule, right cerebellar hemisphere and left parabippocampal gyrus were detected in TS patients, and the volume changes were 4059, 2126 and 84 mm3（t = 3.93, 3.71, 3.58 ,P 〈 0.05 ） respectively. Compared to the control group, decreased grey matter volumes were found in medulla and left pans, and the volume changes were 213 and 117 mm3 （ t = 3.53,3.48, P 〈 O. 05 ） respectively. Tic severity was not correlated with any volume changes of gray matter in brain （P 〉 0. 05, a small volume correction, KE≥10 voxel）. Tic course was negatively correlated with the gray matter volume of left parahippoeampal gyrus （ Beta = - O. 391, P = 0. 039 ） . Conelusions Using VBM technique, the gray matter abnormalities can be revealed in TS patients without obvious lesions on conventional MR imaging. The increasing volume of temporal and parietal lobes and cerebellar may be an adaptive anatomical change in response to experiential demand . The gray mattervolume of the parahippocampal gyrus may be used as one potential objective index for evaluating the prognosis of TS.