弥散张量成像在SLE合并认知功能障碍中的应用研究

Assessment of white matter injury in systemic lupus erythematosus with cognitive dysfunction by diffusion tensor imaging

目的应用弥散张量成像（DTI）分析合并认知功能障碍的系统性红斑狼疮（SLE）患者脑白质纤维束受损特点。方法通过蒙特利尔认知功能评估表评估认知功能，对11例合并认知功能障碍的SLE患者、11例无认知功能障碍的SLE患者及10例正常对照者采集常规磁共振成像（MRI）和弥散张量成像（DTI）数据，利用SPM5软件联合基于体素的全脑配准分析方法，比较各组间脑局部灰度的差异。结果11例合并认知功能障碍的SLE患者中，3例常规MRI有异常病灶，11例无认知功能障碍的SLE患者常规MRI无异常影像。在DTI中，与非认知功能障碍组相比，认知功能障碍组的右侧布罗德曼6、21区及右侧楔前叶表观弥散系数（ADC）值明显增高（P〈0．01），各向异性分数（FA）值差异无统计学意义；与正常对照组相比，认知功能障碍组的右侧海马旁回、小脑扁桃体、脑桥脑白质FA值显著降低（P〈0．01），右侧额上回、楔叶、颞中回、脑岛、布罗德曼13、20、21、27、30、47区及左侧额中回、布罗德曼10区、胼胝体压部、扣带回的脑白质ADC值明显增高（P〈0．01）。与正常对照组相比，非认知功能障碍组的右侧海马旁回、额上回、布罗德曼10、25区、左侧颞中回、齿中回、布罗德曼3、13、19、25区及双侧脑岛、胼胝体膝部的ADC值明显增高（P〈0．01），FA值差异无统计学意义。结论SLE合并认知功能障碍时，DTI较常规MRI对脑白质病变的敏感性更高。

Objective To investigate the white matter injury in patients with systemic lupus erythematosus （SLE） combined with cognitive dysfunction by diffusion tensor imaging （DTI）. Methods The Montreal cognitive assessment, conventional magnetic resonance imaging （MRI） and DTI were performed in 11 SLE patients with cognitive dysfunction （ CDF）, 11 SLE patients without cognitive dysfunction （ non- CDF） and 10 heahh controls. Local gray differences among three groups were compared by SPM5 software and voxel-based analysis. Results In conventional MRI, abnormal lesions were detected in 3 CDF patients. In DTI, compared to non-CDF group, CDF patients showed significantly increased apparent diffusion coefficient （ADC） values in right precuneus and brodmann area 6, 21 （P 〈0. 01 ）. No difference of fractional anisotropy （FA） was found between these two groups. Compared to health controls, CDF patients showed significantly decreased FA values in right parahippocampa gyms, cerebellar tonsil and pons （P 〈 0. 01 ）, and increased ADC values in right superior frontal gyrus, cuneus, middle temporal gyms, insula, brodmann area （13, 20, 21,27, 30, 47）, and left middle frontal gyrus, brodmann area 10, cingulate gyrus and corpus callosum （P 〈 0. 01 ）. Compared to health controls, non-CDF patients showed significantly increased ADC values in right parahippocampa gyms, superior frontal gyms, brodmann area （ 10, 25）, left middle temporal gyms, middle occipital gyrus, brodmann area （3, 13, 19, 25） , bilateral insula and corpus callosum （ P 〈 0. 01 ）, and no difference of FA. Conelusiorts DTI is more sensitive to detect white matter impairment of cognitive dysfunetion in SLE patients than conventional MRI.