3D-pCASL对阿尔茨海默病临床诊断价值的探究

The Value of 3D-pCASL in Clinical Diagnosis of Alzheimer’s Disease

目的:三维准连续动脉自旋标记(3D-pCASL)成像技术定量探究阿尔茨海默症(AD)及轻度认知功能障碍(MCI)患者脑血流灌注的临床诊断价值。方法:经神经内科诊断为AD(AD组,21例)和MCI(MCI组,32例)及招募的健康志愿者(正常对照组,29名)纳入研究。采用3.0T磁共振扫描仪完成常规序列、3D-pCASL及3D T1W成像,并在工作站上完成双侧各14个对称位置脑区(人工勾画)的脑血流量(CBF)测量,并进行各组间比较。对有统计学差异的脑区CBF值与MMSE及MOCA量表评分的相关性进行分析。结果:除左侧额上回和右侧尾状核外,AD组及MCI组各脑区CBF值较NC组均减低(P<0.05)。AD组双侧海马头、海马体、海马尾、楔叶、楔前叶、前扣带回、中扣带回、后扣带回、额中回,左侧中央前回、中央后回CBF值均明显低于NC组(P<0.05);MCI组右侧海马头、海马尾、楔叶、楔前叶、前扣带回,左侧楔叶、楔前叶、额中回、中央前回、中央后回CBF值均明显低于NC组(P<0.05)。AD组及MCI组左侧额中回、MCI组右侧楔叶的CBF值与MoCA评分显著相关(r=0.530、0.513、0.375,P=0.020、0.004、0.041);MCI组左侧楔前叶及NC组左侧海马尾的CBF值与MMSE评分显著相关(r=0.467、-0.428,P=0.009、0.026)。结论:3D-pCASL可以显示AD及MCI患者多个脑区灌注减低,这个影像结果可能有助于AD及MCI的诊断。

Purpose:To quantitatively explore the clinical diagnostic value of cerebral blood flow perfusion in patients with Alzheimer’s disease(AD)and mild cognitive impairment(MCI)by three-dimensional pseudocontinuous arterial spin labeling(3D-pCASL)imaging.Methods:Twenty-one patients diagnosed as AD(AD group),thirty-two patients as MCI(MCI group)and twenty-nine healthy volunteers(NC group)were enrolled in this study.Conventional sequence,3D-pCASL and 3DT1W imaging were completed by 3.0 T magnetic resonance scanner,and cerebral blood flow(CBF)measurement of 14 bilaterally symmetrical brain regions(manually sketched)was completed on the workstation,and the comparison between all groups was carried out.The correlations between CBF values in brain regions with statistical differences and mini-mental state examination(MMSE)and Montreal cognitive assessment(Mo CA)scale scores were analyzed.Results:Except for the left superior frontal gyrus and the right caudate nucleus,CBF values in AD and MCI brain regions were lower than those in NC group(P<0.05).There were statistically significant differences in the CBF values of bilateral hippocampus head,hippocampus body,hippocampus tail,cuneus lobe,precuneus,anterior cingulate gyrus,middle cingulate gyrus,posterior cingulate gyrus,middle frontal gyrus,left precentral gyrus and postcentral gyrus between AD group and NC group(P<0.05).There were significant differences in CBF values of right hippocampus head,hippocampus tail,cuneus lobe,precuneus,anterior cingulate gyrus,left cuneus lobe,precuneus,postcentral gyrus,precentral gyrus and postcentral gyrus between MCI group and NC group(P<0.05).The CBF values of left middle frontal gyrus in AD group and MCI group and right cuneate lobe in MCI group were significantly correlated with Mo CA score(r=0.530,0.513,0.375;P=0.020,0.004,0.041);CBF values of left precuneus in MCI group and left hippocampal tail in NC group were significantly correlated with MMSE score(r=0.467,-0.428;P=0.009,0.026).Conclusion:The perfusion of multiple brain regions in AD and MCI is decreased.The CBF values of multiple brain regions have high clinical diagnostic value in the diagnosis of AD and MCI.