儿童孤独症368例临床脑影像学资料分析

Analysis of clinical brain imaging data of 368 cases with autism children

目的探讨孤独症脑影像学的特征,为孤独症的神经影像学进一步病因研究提供依据。方法对368例孤独症患儿的结构性和功能性脑影像学资料进行回顾性分析。结果孤独症患儿脑结构MRI异常率35.5%(55/155)>CT异常率12.7%(26/205),其存在的主要异常部位为大脑皮层、脑白质、小脑、基底节和脑室系统。功能性脑影像学检查SPECT、fMRI、MRS、DTI中以SPECT应用最多,31例患儿SPECT结果显示所有患儿脑血流灌注均有局部改变,其中局部脑血流灌注减少的有26例,发生率为83.9%,主要为额颞顶叶和海马区,局部脑血流灌注增加的部位均为基底节区。结论孤独症的发生与大脑多个部位的结构或功能改变密切相关,功能性脑影像学比结构影像学检查对探讨孤独症的病理机制更为敏感,值得推广和进一步研究。

Objective To explore the characteristics of brain imaging in autism. Method Structural and functional brain imaging of 368 children with autism were analyzed retrospectively. Results The abnormality rate of MRI（35.5%, 55/155） was higher than that of CT（12.7% ,26/205） ,the main abnormal positions were the cerebral cortex,white matter, cerebellum,basal ganglia and the ventricular system in autistic brain. There were SPECT, fMRI, MRS, DT1 for functional brain imaging,SPECT was the more commonly used. 31 cases of SPECT showed that the cerebral blood flow perfusion was changed locally in all children,the regional cerebral blood flow was reduced in 26 cases,the incidence rate was 83.9% ,mainly in the frontal lobe,temporal lobe, parietal lobe and hippocampus. The parts of regional cerebral blood flow perfusion increased were all in the basal ganglia region. Conclusions The occurrence of autism is closely related to the changes of structure or function of multiple part of brain. Functional brain imaging is more sensitive than structural imaging on autism pathogenesis studies,which is considered worthy of application and further study.