基于DTI的急性CO中毒患者的灰质核团结构损伤研究

Study of Gray Matter Nuclei in Patients with Acute CO Poisoning Based on Diffusion Tensor Imaging

目的应用扩散张量成像(DTI)观察急性CO中毒患者脑灰质核团的结构损伤改变,使用影像技术量化大脑深部灰质损害程度,研究其损伤特点以及与记忆认知能力受损的相关性。方法对25例急性CO中毒患者和25名性别、年龄相匹配的健康志愿者进行头部常规MRI及DTI检查,以双侧海马、尾状核、丘脑、杏仁核、苍白球、壳核作为感兴趣区,测量急性CO中毒患者大脑深部灰质核团的平均扩散系数(MD)、各向异性分数(FA)、表观扩散系数(ADC)变化并进行两独立样本t检验统计。选取异常海马区DTI参数与CO中毒所致的认知功能障碍临床量表评分进行Pearson相关性分析。结果与健康对照组对比,急性CO中毒患者组双侧苍白球(t=-2.876,P<0.05)、海马(t=-2.267,P<0.05)、尾状核(t=-2.410,P<0.05)、壳核(t=-2.375,P<0.05)FA值降低,杏仁核、丘脑FA值变化无统计学意义(P>0.05);海马、苍白球、壳核MD值和ADC值升高(P<0.05),尾状核、丘脑及杏仁核MD、ADC值变化无统计学意义(P>0.05)。海马区FA值与MMSE、MoCA评分呈一定正相关,MD、ADC值与MMSE、MoCA评分呈一定负相关(P<0.05)。结论DTI可以敏感反映急性CO中毒导致脑内灰质核团隐匿微细结构损害,可以一定程度早期量化脑损伤程度,可能与认知功能损伤有关。

Objective Diffusion tensor imaging(DTI)was used to observe the structural changes of gray matter nuclei in patients with acute CO poisoning,and image technology was used to quantify the degree of deep gray matter damage in the brain,to study the characteristics of impairment and its correlation with impaired memory and cognitive function.Methods Routine head MRI and diffusion tensor imaging(DTI)were performed in 25 patients with acute CO poisoning and 25 healthy volunteers matched in sex and age.Bilateral hippocampus,caudate nucleus,thalamus,amygdala,globus pallidus and putamen were taken as regions of interest.The average diffusion coefficient(MD),anisotropy score(FA),and apparent diffusion coefficient(ADC)of the deep gray matter nucleus in the brain of patients with acute CO poisoning were measured and two independent sample t tests were performed.Pearson correlation analysis was performed by selecting the DTI parameters of abnormal hippocampus and the scores of clinical dysfunction caused by CO poisoning.Results Compared with the healthy control group,the patients with acute CO poisoning had bilateral globus pallidus(t=-2.876,P<0.05),hippocampus(t=-2.267,P<0.05),and caudate nucleus(t=-2.410,P<0.05),the FA value of the putamen decreased(t=-2.375,P<0.05).The FA values of the amygdala and thalamus were not statistically significant(P>0.05);the MD and ADC values of the hippocampus,globus pallidus,and putamen increased(P<0.05).The changes of MD and ADC values of caudate nucleus,thalamus and amygdala were not statistically significant(P>0.05).In the hippocampus,FA values were positively correlated with MMSE and MoCA scores,and MD and ADC values were negatively correlated with MMSE and MoCA scores(P<0.05).Conclusion DTI can sensitively reflect the acute micro-structural damage caused by acute CO poisoning in the gray matter nucleus in the brain.It can quantify the degree of hypoxic brain damage in the early stage and may be related to cognitive impairment.