颞叶内侧亚结构体积变化对阿尔茨海默病的诊断价值

The diagnostic value of medial temporal volume change in Alzheimer＇s disease

目的研究颞叶内侧亚结构体积变化对阿尔茨海默病（Alzheimer＇s disease，AD）的诊断价值。方法依据DSM—IV标准，人组23例AD，其中男9例，女14例；入组23例正常对照老人，其中男11例，女12例。应用3D—MRI测量海马、杏仁核、内嗅皮质、旁嗅皮质等指标。在GE后处理工作站上对3D—MRI资料进行后处理及标准化，使用SPSS11．0软件进行统计分析。结果旁嗅皮质总体积与认知评估量表得分有显著相关性。各结构体积诊断AD的灵敏度和特异度分别为：海马总体积（73．9％，97％）；杏仁核总体积（39．1％，95．7％）；内嗅皮质总体积（73．9％，95．7％）；旁嗅皮质总体积（95．7％，87．0％）；颞角总体积（34．8％，39．1％）。总体判别函数为颞角总体积×3．887＋旁嗅皮质总体积×5．960-内嗅皮质总体积×0．074＋杏仁体总体积×3．489＋海马总体积×6．656—22．449，总体判别正确率为91．3％，旁嗅皮质总体积的标准化系数及与函数的相关系数均最大。结论旁嗅皮质总体积在早中期阿尔茨海默病的诊断中起重要作用，可利用内侧颞叶亚结构体积变化对早中期AD进行诊断。

Objective To study the metastructure volumes of medial temporal lobe in diagnosis the patients with Alzheimerg disease （AD） using 3 dimensional MRI. Methods 23 AD patients according to DSM-IV criteria and 23 normal controls （NC） were examined with 3D-MRI. Hippocampus formation, amygdala, entorhinal cortex （ EC）, perirhinal cortex （ PC）, and cornu temporale were measured with 3D-MRI. Results Sensitivity and specificity of diagnosis AD were 73.9% ,97% （ Hippocampus formation） ;39.1% ,95.7% （amygdala） ;73.9% , 95.7% （EC） ;95.7%, 87.0% （PC） and 34.8 % , 39.1% （ cornu temporale）. Overall discriminate function = cornu temporal × 3. 887 ＋ PC × 5. 960 - EC x 0. 074 ＋ amygdale× 3. 489 ＋ hippocampus formation ×6. 656 - 22. 449. Over-all-accuracy was 91.3%. Conclusion The total volume of PC can better diagnosis the mild to moderate AD than other structure of medial temporal lobe. The changes of the medial temporal lobe volume could be used in diagnosis the patients with Alzheimer＇s disease.