多发性硬化患者皮质及白质受累的相关性

Correlation Between Cortical and White Matter in Patients with Multiple Sclerosis

目的探讨基于体素形态学分析(VBM)及扩散张量成像(DTI)在多发性硬化(MS)皮质及白质相关性中的应用价值。资料与方法收集MS患者及健康对照组各20例。通过VBM分析两组脑皮质体积变化,测量变化脑区皮层下白质DTI参数并行纤维素追踪。分析VBM及DTI各参数与临床扩展残疾状态量表(EDSS)的相关性。结果与对照组相比,MS组小脑蚓部、右侧颞上回、左侧岛叶、双侧直回、双侧中央旁小叶脑体积较小,差异有统计学意义(P<0.01,体素大小>40),无明显体积增大脑区。两组间存在差异脑皮层下白质区的DTI各参数比较,MS组中各向异性分数减低的脑区有小脑蚓部、右侧颞上回、左侧岛叶、右侧直回、左侧直回(P<0.05),纤维束减少的脑区分别为小脑蚓部、右侧颞上回及左侧中央旁小叶(P<0.05),各脑区表观扩散系数值均无明显变化(P>0.05),各大脑皮层缩小脑区及相应皮层下白质DTI参数与患者EDSS评分无明显相关性(r=0.182,P>0.05)。结论MS患者多个脑区皮层体积萎缩,并且萎缩皮层下白质纤维束数目减少,部分各向异性分数值减低,表观扩散系数值无明显变化,提示MS皮层受累可表现为体积减小,受累皮质与皮质下白质病灶空间上具有相关性。

Purpose To explore the value of voxel morphological analysis(VBM)and diffusion tensor imaging(DTI)in the correlation between cortex and white matter in multiple sclerosis(MS).Materials and Methods Twenty patients with MS and 20 healthy controls were enrolled in this study.The changes of cerebral gray matter volume between the two groups were analyzed by VBM,and the DTI parameters of subcortical white matter in the cerebral area were measured and paralleled with cellulose tracking.The correlation between the VBM and DTI parameters and the clinical extended disability status scale(EDSS)was analyzed.Results Compared with the control group,the volume of cerebellar vermis,right superior temporal gyrus,left insular lobe,bilateral straight gyrus,and bilateral paracentral lobules in the MS group was statistically smaller(P<0.01,Element size>40),no obvious increase in brain area.There was a difference between the two groups.The DTI parameters of the subcortical white matter area were compared.In MS group,the brain regions with reduced anisotropic scores included cerebellar vermis,right superior temporal gyrus,left insular lobe,right straight gyrus and left straight gyrus(P<0.05),the brain regions with reduced fiber bundles were the cerebellar vermis,the right superior temporal gyrus and the left central paralobule(P<0.05),and there was no significant change in the apparent diffusion coefficient values of each brain region(P>0.05).There was no significant correlation between the reduction of the cerebral cortex and the corresponding subcortical white matter DTI parameters of the patients with EDSS score(r=0.182,P>0.05).Conclusion The cortical volume of multiple brain areas of MS patients is atrophic,the number of white matter fiber bundles under the atrophic cortex is reduced,and the value of some anisotropy scores is reduced.The apparent diffusion coefficient value has no significant change,suggesting that the involvement of MS cortex can be manifested as volume reduction and involvement cortical and subcortical white matter lesions are spatially related.