复发缓解型多发性硬化患者扣带束白质完整性与扣带皮质灌注研究

Cingulum Integrity and Cingulate Cortical Perfusion in Patients with Relapsing Remitting Multiple Sclerosis

目的采用扩散张量成像(DTI)及三维伪连续动脉自旋标记(3D-pCASL)技术探讨复发缓解型多发性硬化(RRMS患者扣带束微结构与扣带皮层灌注改变及其与临床评分的相关性。资料与方法对24名RRMS患者(MS组)及26名体检者(对照组)行临床扩展残疾状态量表(EDSS)及神经心理学量表评分。所有研究对象行DTI及3D-pCASL扫描,测量左、右扣带束的各向异性分数(FA)值与平均扩散率(MD)值,以及扣带皮层8个亚区脑血流量(CBF)值,并评估其与EDSS及神经心理学评分之间的相关性。结果与对照组相比,MS组患者左侧前扣带皮层尾部、右侧后扣带皮层和峡部CBF值以及右侧扣带皮层平均CBF值均显著减低(P<0.05)。MS组双侧扣带束扣带部(CGC)FA值降低,MD值升高;右侧扣带束海马部(CGH)FA值降低,双侧CGH部MD值升高(P均<0.05)。符号数字转换测验(SDMT)评分与左侧前扣带皮层尾部、右侧后扣带皮层及扣带皮层峡部CBF值、双侧CGC部FA值以及与右侧CGH部MD值存在相关性(r=0.391、0.346、0.307、0.389、0.374、-0.371,P均<0.05)。汉密顿抑郁量表评分与双侧CGC部FA值及MD值存在相关性(r=-0.296、-0.338、0.324、0.343,P均<0.05)。控制年龄、性别及受教育程度后,SDMT评分与双侧CGC部FA值仍显著相关。结论 RRMS患者扣带束及扣带皮层出现改变,与患者认知功能障碍和抑郁相关,可能体现出扣带回的功能异质性。

Purpose To investigate the correlation between cingulum microstructure and changes of cingulate cortical perfusion and clinical scores in patients with relapsing remitting multiple sclerosis(RRMS) by diffusion tensor imaging(DTI) and three-dimensional pseudo continuous arterial spin labeling(3D-pCASL). Materials and Methods Expanded disability status scale(EDSS) and neuropsychological scale score were performed to 24 RRMS patients(MS group) and 26 examinees(control group). All subjects received DTI and 3D-pCASL to measure fractional anisotropy(FA) value and mean diffusion(MD) value of bilateral cingulum as well as cerebral blood flow(CBF) value in 8 sub-regions of cingulate cortex of left and right cingulum and assess correlation with EDSS and neuropsychological scale score. Results Compared with control group, CBF value of left anterior caudal CC, right posterior and isthmus of CC as well as mean CBF value of right cingulate cortex were significantly reduced(P<0.05). FA value of bilateral cingulum-cingulate gyrus(CGC) in MS group was decreased while MD value was elevated. FA value of right cingulum-hippocampus(CGH) was lowered and MD value of bilateral CGH was elevated(all P<0.05). There was correlations between symbol digit modalities test(SDMT) scores and CBF value of left anterior caudal CC, right posterior and isthmus of CC, FA value of bilateral CGC and MD value of right CGH(r=0.391, 0.346, 0.307, 0.389, 0.374 and-0.371, all P<0.05). There was also correlations between HAMD scoring and FA value as well as MD value of bilateral CGC(r=-0.296,-0.338, 0.324 and 0.343, all P<0.05). After controlling age, gender and degree of education, there was still significant correlation between SDMT scoring and FA value of bilateral CGC. Conclusion There were changes seen in cingulum and cingulate cortex of patients in RRMS group, which was related to cognitive disorder and depression of the patients. This might represent functional heterogeneity of cingulate gyrus.