血管性痴呆的MRI定量研究

The measurement study of MR imaging in vascular dementia

目的 寻找可预测血管性痴呆 (vasculardementia ,VaD)的神经影像学指标。方法 对 30名VaD和 30名中风后非痴呆 (strokewithoutdementia,SWD)患者进行MRI测量研究 ,测量指标包括 :大脑白质病变面积、脑梗死面积、脑室 脑比率和正中矢状面胼胝体面积与幕上颅腔面积比率 ,并分析脑梗死所在部位。用判别分析方法寻找区分VaD与SWD的测量指标。结果 小血管病和多发脑梗死是VaD的主要基础病变。VaD组大脑白质病变面积 (Z =- 3 5 44 ,P =0 0 0 0 )、左侧皮层梗死面积(Z =- 2 5 38,P =0 0 11)、脑室 脑比率 (t=4 475 ,P =0 0 0 0 )等指标均大于SWD组 ,两者间差异具有显著性意义 ;胼胝体面积比率 (t=- 4 6 16 ,P =0 0 0 0 )则小于SWD组 ,两者间差异具有显著性意义。有效判别指标依次为 :胼胝体面积比率、脑室 脑比率、大脑白质病变面积、左侧皮层梗死面积、左顶叶梗死面积和皮层梗死总面积。结论 小血管病患者有胼胝体萎缩 ,侧脑室扩张和广泛大脑白质病变提示VaD ;而左侧大脑皮层梗死 。

Objective To identify the neuroimaging determinants which could predict the occurrence of the vascular dementia (VaD). Methods The findings of cranial MRI were compared in 30 VaD patients and 30 stroke without dementia (SWD) patients by means of quantitative measurement of some indexes. The indexes of measurement included the cerebral white matter lesion (WML) area, the cerebral infarct area, the ratio of ventricle to brain(VBR) and the ratio between the areas of the corpus callosum and supratentorial brain at the midsaggittal plane. Discriminant analysis was used to search for the indexes which could contribute significantly to distinguishing the two groups. Results Small cerebral vessel disease and multi infarct were two major basal diseases of VaD in this series. The WML areas( t =-3.544, P =0.000), the left cortical infarct( Z =-2.538, P =0.011) and VBR ( t =4.475, P =0.000) were significantly higher and the corpus collsum areas( t = -4 616, P =0.000) was significantly lower in the VaD group than that in the SWD group. The indexes that could significantly discriminate the two groups was: callosal atrophy, ventricle to brain ratio, WML area, left cortical infarct area, left parietal infarct area, total cortical infarct area. Conclusions Callosal atrophy, lateral ventricle enlargement and extensive WML are important predictors of incidence of dementia in the small vessel disease; however, left cortical infarct, especially left parietal infarct, is important predictor of incidence of dementia in the multi infarct.