肝气郁结证脑深部核团及扣带回的磁共振扩散张量成像

Magnetic Resonance Diffusion Tensor Imaging of Deep Brain Nucleus and the Cingulate Gyrus of the Liver Qi Stagnation Syndrome

目的:研究肝气郁结证患者脑深部神经核团及扣带回微结构损伤的特点。方法:选取2012年5月至2015年5月在北京中医药大学东方医院收治的肝气郁结证患者16例,同时选取正常对照者13例,进行磁共振DTI扫描,原始数据通过后处理计算出部分各向异性分数(FA)图和表观扩散系数(ADC)图。分别测量两侧海马、杏仁核、丘脑、豆状核、尾状核头和扣带回的FA值和ADC值。2组感兴趣区对应测量相同部位。并对2组结果进行统计学比较分析。结果:肝气郁结证组的右侧丘脑、双侧中扣带回FA值明显高于对照组(P=0. 043,0. 004,0. 001),左侧豆状核FA值明显低于对照组(P=0. 033)。肝气郁结证组的左侧前扣带回、双侧后扣带回ADC值明显低于对照组(P=0. 019,0. 039,0. 049)。右中扣带回FA值ROC分析显示,曲线下面积(AUC=0. 87,P=0. 001),最佳诊断界值FA值=0. 383750,灵敏度92. 3%,特异度68. 7%。结论:通过对肝气郁结证患者脑深部核团及扣带回的DTI研究,发现肝气郁结证患者脑深部神经核团及扣带回损伤存在于特定的脑区,其中右中扣带回FA值对鉴别诊断具有重要的意义。

Objective To study the microstructural damage characteristics of the nerve nuclei and cingulate cortex in the brain of the patients with liver qi stagnation using magnetic resonance diffusion tensor imaging（DTI）technique. Methods： A total of 16 patients with liver qi stagnation syndrome clinically confirmed by Dongfang Hospital,Beijing University of Chinese Medicine from May 2012 to May 2015 were selected.Meanwhile,13 normal controls were selected.These subjects were performed by magnetic resonance DTI scanning.After raw data processing,the map of fractional anisotropy（FA）and apparent diffusion coefficient（ADC）were calculated.The FA and ADC values were measured in the bilateral hippocampus,amygdala,thalamus,lentiform nucleus,caudate nucleus and cingulate cortex.Region of interest（ROI）was set at the same brain region.The FA and ADC value of 2 groups were analyzed statistically. Results： The FA values of the right thalamus and bilateral middle cingulate cortex in the disease were significantly higher than that of the control group（ P =0.043,0.004,0.043）.The FA value of the left lentiform nucleus was lower than that of the control group significantly（ P =0.033）.The ADC value of the left anterior cingulate cortex（ACC）and bilateral posterior cingulate cortex（PCC）were significantly lower than that of the control group（ P =0.019,0.039,0.049）.The FA value of the right middle cingulate cortex was taken as the biomarker,ROC analysis showed the area under the curve（AUC=0.87, P =0.001）,the best diagnostic value FA value was 0.383750,sensitivity 92.3%,and the specificity 68.7%. Conclusion： By the DTI analysis of the deep brain nuclei and cingulate cortex of the patients with liver qi stagnation syndrome,we found that the injury of the patient′s deep brain nerve nuclei and cingulate cortex exists in specific brain regions.The FA value of the right middle cingulate cortex played an important role for syndrome differentiation.