ESWAN序列在小血管病性血管性认知障碍非痴呆型中的应用研究

The Study of ESWAN in Vascular Cognitive Impairment-No Dementia with Small Vessel Disease

目的探讨多回波采集的重度T2*加权的三维梯度回波序列(enhanced T2star weighted angiography,ES-WAN)在小血管病性血管性认知障碍非痴呆型(vascular cognitive impairment-no dementia with small vessel disease,VCIND-SVD)中的应用价值。方法 VCIND-SVD患者27例(VCIND-SVD组);年龄、性别、受教育程度时间基本匹配的正常对照者11名(正常对照组),同时行ESWAN序列扫描和蒙特利尔认知评估量表(montreal cognitive assess-ment,MoCA)评估。在T2*mapping及R2*mapping上测量双侧前额叶内侧回、楔叶、背外侧前额叶白质、侧脑室后角旁白质、半卵圆中心、尾状核头、豆状核、丘脑等感兴趣区(ROI)的T2*值和R2*值,计算各ROI区T2*值和R2*值及MoCA各项得分之间的相关性,采用SPSS 13.0软件进行统计分析。结果与正常对照组相比,VCIND-SVD患者双侧前额叶内侧回、背外侧前额叶白质、侧脑室后角旁白质、半卵圆中心、丘脑的T2*值升高,R2*值降低,差异有统计学意义(P<0.05);而尾状核头及豆状核T2*值降低,R2*值升高,差异有统计学意义(P<0.05)。VCIND-SVD患者双侧背外侧前额叶白质、侧脑室后角旁白质、半卵圆中心的T2*值和R2*值分别与记忆力得分具有中度相关性(P<0.05);双侧背外侧前额叶白质的T2*值和R2*值与抽象思维得分具有中度相关性(P<0.05)。结论 T2*值和R2*值能反映VCIND-SVD患者部分微细结构及氧代谢变化,且有助于反映VCIND-SVD患者认知缺损可能的病理学基础。

Objective To explore the application value of Enhanced T2 Star Weighted Angiography（ESWAN） in Vascular cognitive impairment-no dementia with Small Vessel Disease（VCIND-SVD）.Methods ESWAN sequence were performed on 27 VCIND-SVD patients and 11 normal comparison subjects.Meanwhile,the Montreal Cognitive Assessment（MoCA） was carried out on them by two professional neurologists.And then,the T2＊ and R2＊ value on Region of interest,included bilateral anterior cingulated gyrus,cuneate lobe,dorsalateral prefrontal cortex,posterior horn of lateral ventricle,centrum semiovale,caudate,putamen and thalamus,were being measured and the correlation between the T2＊ and R2＊ value of each ROI and each part of MoCA scores was being analyzed.Results The T2＊ value on ROI of bilateral anterior cingulated gyrus,dorsalateral prefrontal cortex,posterior horn of lateral ventricle,centrum semiovale and thalamus in VCIND-SVD patients was higher than that in controls（P=0.021,0.000,0.000,0.000,0.017）.The R2＊ value was lower than that in controls（P=0.027,0.000,0.000,0.000,0.013）.However,the T2＊ value on ROI of bilateral caudate and putamen in VCIND-SVD patients was lower than that in controls（P=0.002,0.007）.The R2＊ value was higher than that in controls（P=0.033,0.029）.Moderate correlation was showed between the score of memory item in MoCA and the T2＊ and R2＊ value on ROI of bilateral dorsalateral prefrontal cortex,posterior horn of lateral ventricle and centrum semiovale in VCIND-SVD patients（r=-0.498,-0.430,-0.453;P=0.010,0.025,0.018 and r=0.481,0.402,0.500;P = 0.013,0.037,0.008）.So was that between the score of Abstraction item in MoCA and the T2＊ and R2＊ value on ROI of bilateral orsalateral prefrontal cortex（r=-0.466;P =0.017 and r=-0.447;P = 0.022）.Conclusion（1） The T2＊ value and R2＊ value are able to reflect some micro-structure changes and oxygen metabolism in gray matter,white matter and deep mucleus in VCIND-SVD patients.（2）The changes of T2＊ value and R2＊ value can reflect possible pathological changes in some cognition impairment.