弥漫性轴索损伤后早期磁共振弥散张量成像与恢复期认知功能的相关性研究

Study on the correlation of early magnetic resonance diffusion tensor imaging after diffuse axonal injury with cognitive function at recovery stage

目的:采用磁共振弥散张量成像(DTI)研究弥漫性轴索损伤(DAI)病人伤后早期白质纤维束损伤与恢复期时认知障碍之间的关系。方法:对18例DAI病人(DAI组)在伤后早期进行磁共振DTI检查,并与16名健康志愿者(对照组)进行比较。使用Track和MRIcron软件对DTI图像进行处理,得到不同感兴趣区域(ROI区)的部分各向异性(FA)值和表观弥散系数(ADC)值。比较DAI组和对照组ROI区的FA值和ADC值。对DAI病人恢复期中(17.26±4.31)个月行认知量表评估,并与受教育程度类似的健康志愿者进行比较,所使用的认知量表包括韦氏成人智力量表中的数字倒背测试(湖南版)、加利福尼亚言语学习测试量表、连线测验和Stroop色-词测试。比较2组认知功能的差异。对DAI组的DTI参数值与认知量表评分的相关性进行Pearson直线相关分析。结果:在伤后早期,DAI组病人所有ROI区的FA值均明显低于对照组(P<0.01);而钩束和下纵束的ADC值高于对照组(P<0.05),其他ROI区的ADC值差异无统计学意义(P>0.05)。与对照组相比,DAI组病人在恢复期中的数字倒背测试、加利福尼亚言语学习测试、短时自由回忆和短时线索回忆量表评分均降低(P<0.01);而连线测验、Stroop色-词测试卡片1、Stroop色-词测试卡片2和Stroop色-词测试卡片3评分均增高(P<0.05～P<0.01)。易损区钩束、下纵束、上纵束和前冠状束的FA值与工作记忆量表和执行功能量表总分呈明显正相关关系(P<0.01和P<0.05)。易损区钩束、下纵束、上纵束和前冠状束的ADC值与工作记忆量表和执行功能量表总分无明显检查相关关系(P>0.05)。结论:DAI病人早期磁共振DTI检查有助于预测伤后恢复期不同类型的认知功能障碍,为病人的早期诊断和治疗提供理论依据。

Objective： To investigate the correlation of magnetic resonance diffusion tensor imaging（ DTI） after diffuse axonal injury（ DAI） with cognitive function at recovery stage. Methods： Eighteen patients with DAI（ DAI group） were early examined using DTI,and the result of which was compared with that of 16 heathy volunteers（ control group）. DTI was processed using Track and MRIcron software,the fractional anisotropy（ FA） and apparent diffusion coefficient（ ADC） value were quantified from different regions of interest（ ROI） area,and the FA and ADC value between DAI group and control group were compared. The DAI patients at recovery stage[postinjury（ 17. 26 ± 4. 31） months] were assessed using the cognition scale,the result of which was compared with that of control group with similar education. The contents of cognition scale included the digital back test of Wechsler adult intelligence scale（ Hunan version）,California speech learning scale,wired test and Stroop color-word test. The difference of the cognition function between two groups was compared. The correlation between DTI parameter and cognition scale score was analyzed using the Pearson linear correlation in DAI group. Results： At early stage of DAI,the FA value in all ROI areas in DAI group were significantly lower than that in control group（ P〈0. 01）,the ADC values of fasciculus uncinatus and fasciculi longitudinalis inferior in DAI group were higher than those in control group（ P〈0. 05）,and the difference of the ADC in other ROI area was not statistically significant（ P〈0. 05）. At recovery stage,the scores of the digital back test,California speech learning scale,short-term free and clue recall scales in DAI group decreased compared with control group（ P〈0. 01）,and the scores of the wired test,and Stroop color-word test 1,2 and 3 in DAI group increased compared with control group（ P〈0. 05 to P〈0. 01）. The FA value in uncinate fasciculus,anterior corona radiata,superior longitudinal fasciculus and inferior longitudinal fasciculus was significantly correlated with the total scores of working memory and executive function scale in DAI group（ P〈0. 01 and P〈0. 05）,but the ADC value in ROIs was not significantly correlated with the total scores of working memory and executive function scale in DAI group（ P〉0. 05）. Conclusions： Early magnetic resonance DTI detection in DAI patients is helpful to predict different types of cognitive dysfunction during the recovery,which can provide a theoretical basis for the early diagnosis and treatment of patients.