动脉自旋标记技术定量分析阿尔茨海默病不同阶段脑血流量

Arterial spin labeling quantitative analysis of cerebral blood flow in different stages of Alzheimer disease

目的基于三维动脉自旋标记(3D-ASL)技术定量分析阿尔兹海默病(AD)不同进展阶段脑血流量(CBF)改变,评价其鉴别效能。方法针对22例AD(AD组)、22例轻度认知功能障碍(MCI组)、25例主观认知功能下降(SCD组)患者和25名正常志愿者(NC组)采集头部3D T1WI和3D-ASL图像,经后处理获得双侧苍白球(GP)、壳核(PU)、尾状核(CA)、海马(HP)、丘脑(TH)、额叶皮层(FC)、顶叶皮层(PC)和枕叶皮质(OC)的CBF值。比较各组间CBF值差异,观察其与年龄、简易精神状态量表(MMSE)和蒙特利尔认知评估量表(MoCA)评分的相关性;以ROC曲线评价各脑区CBF值鉴别AD不同阶段的效能。结果AD组及MCI组除OC外各脑区CBF值均较NC组减低(P均<0.01);SCD组CA、PU及TH的CBF值均较NC组增高(P均<0.05)。AD组及MCI组HP的CBF值与MoCA评分均呈正相关(r=0.584、0.595,P均<0.01)。HP、TH、FC、PC、OC的CBF值鉴别AD不同进展阶段的AUC均较高。结论AD及MCI存在广泛脑灌注减少;SCD部分脑区存在灌注代偿;HP、TH、FC、PC、OC的CBF值对诊断及鉴别不同阶段AD有一定价值。

Objective To quantitatively analyze the cerebral blood flow(CBF)changes in the course of Alzheimer disease(AD)based on 3D arterial spin labeling(3D-ASL),and to observe its efficacy in differentiating different stages of AD.Methods 3D T1WI and 3D-ASL head images were collected from 22 AD patients(AD group),22 patients with mild cognitive impairment(MCI group),25 patients with subjective cognitive decline(SCD group)and 25 normal volunteers(NC group).CBF values of bilateral globus pallidus(GP),putamen(PU),caudate nucleus(CA),hippocampus(HP),thalamus(TH),frontal cortex(FC),parietal cortex(PC)and occipital cortex(OC)were obtained after post-processing.CBF values were compared among 4 groups,and the correlations of CBF value and age,mini-mental state examination(MMSE)and Montreal cognitive assessment scale(MOCA)scores were observed.Then ROC curves were drawn to evaluate the efficacy of CBF values in different brain regions in identifying different stages of AD.Results Except for OC,CBF values of brain regions in AD and MCI group were lower than those in NC group(all P<0.01).CBF of CA,PU and TH in SCD group were higher than those in NC group(all P<0.05).CBF value of HP in AD group and MCI group were both positively correlated with MOCA score(r=0.584,0.595,both P<0.01).AUC of CBF values of HP,TH,FC,PC and OC in differentiating different progression stages of AD were all high.Conclusion There were wide ranges of decreased cerebral perfusion in AD and MCI,while perfusion compensation was showed in some brain regions of SCD.CBF values of HP,TH,FC,PC and OC had certain value in diagnosis and differentiating AD in different stages.