阿尔茨海默病重要影像学改变:顶叶变化

Changes in Parietal Lobe as A Typical Imaging Finding in Patients with Alzheimer's Disease

目的观察不同脑区代谢及结构改变与阿尔茨海默病(Alzheimer's disease,AD)的关系,探讨内侧颞叶萎缩外其他脑区结构变化对AD的诊断价值。方法选择2007年1月至2010年12月北京协和医院神经科门诊拟诊变性病性痴呆患者123例,进行梯度递进神经心理评价,对可能AD及有可能AD患者采用脱氧葡萄糖正电子发射体层摄影术(fluorodeoxy glucose-positron emission tomography,FDG-PET)评价脑代谢功能,视图直接观察、SUV值测定及NeuroQ分析3种方法评价不同脑区的变化;3DMRI进行脑结构检测,常规图像观察,基于体素的形态(voxel-based morphometric,VBM)及扩散张量成像(diffusio ntensor imaging,DTI)具体分析。结果 123例拟诊变性病性痴呆患者经梯度递进神经心理评价及临床鉴别诊断后符合可能AD患者41例,有可能AD患者43例。FDG-PET显示84例可能和有可能AD患者低代谢区100%出现在顶叶,79.8%(67例)在后扣带回,71.4%(60例)出现在后部颞顶区,61.9%(52例)在内侧颞叶。MRI显示顶叶萎缩67.9%(57例双侧)～84.5%(71例单侧),24例可用VBM分析的MRI显示顶叶萎缩明显重于对照组。12例临床可能的额颞叶痴呆患者未发现顶叶低代谢和萎缩。结论功能影像显示顶叶低代谢和结构影像显示顶叶萎缩对AD诊断及鉴别诊断有重要价值。

Objective To observe the metabolic and structural changes in different cerebral areas in pa- tients with Alzheimer＇s disease （AD） and to explore the value of the changes in parietal lobe in the diagnosis of AD. Methods Totally 123 patients with suspected AD who were assessed in our hospital from January 2007 to December 2010 were entrolled in this study. The brain functions were evaluaed using fluorodeoxy glucose-posi- tron emission tomography （FDG-PET）. Changes in different cerebral areas were evaluated by direct observa- tion, SUV measurement, and NeuroQ analysis. The brain structure was obseved under three-dimensional megnatic resonance imaging （MRI）, which were further anlysed via voxel-based morphometric （VBM） and diffusion tensor imaging （DTI）. Results Totally 41 patients were diagnosed as probable AD and 43 as possi- ble AD. FDG-PET revealed that, among these 84 patients, hypomatebolism was detected in the parietal lobe of all patients （100%）, and also in posterior cingutate （79.8%）, posterior temporoparietal lobe （71.4%）, and medial temple lobe （61.9%）. MRI showed atrophy on parietal lobe in 67.9% （57 cases of both sides ） to 84.5 % （71 cases of single side） of the patients. Among 24 patients who can be assessed using VBM, MRI showed the atrophy of parietal lobe was much more obvious. No hypomatebolism or atrophy of the parietal lobe was found in 12 clinically probable frontotemporal dementia patients. Conclusion Hypometabolism （as shown by functional imaging） and atrophy （ as shown by structural imaging） of the parietal lobe can be suggestive for the diagnosis of AD.