特发性快速眼动睡眠行为障碍脑白质结构的弥散张量成像研究

Diffusion Tensor Imaging Study of White Matter Microstructural Integrity in Idiopathic Rapid Eye Movement Sleep Behavior Disorder

目的利用磁共振弥散张量成像(MR DTI)观察特发性快速眼动睡眠行为障碍(iRBD)患者全脑白质微观结构的改变。方法收集临床确诊的25例iRBD患者为iRBD组及性别、年龄匹配的25例健康对照者为对照组。采集DTI序列数据,使用基于脑图谱的分析方法获取DTI参数,包括各向异性分数(FA)、平均弥散率(MD)、轴向弥散率(AD)以及径向弥散率(RD),评估组间差异。结果与对照组比较,iRBD患者中穹窿体及穹窿柱、双侧小脑上脚、双侧小脑下脚、左侧内侧丘系、左侧穹窿/终纹、右侧上放射冠及右侧后放射冠白质微观结构出现改变,以MD值改变范围最广泛。DTI观察值与患者的病程、睡眠REM期占比、REM期周期性腿动指数具有相关性。结论iRBD患者具有以脑桥与穹窿为核心的多发脑白质纤维结构改变,MD值可作为iRBD患者脑白质微观结构改变的较为敏感观察指标。

Aim To reveal the microstructural changes of the whole brain white matter fibers in patients with idiopathic rapid eye movement sleep behavior disorder(iRBD)by applying diffusion tensor imaging(DTI).Methods A total of 25 patients diagnosed with iRBD and 25 healthy control subjects with matching gender and age were included.All subjects underwent DTI examination and DTI parameters were obtained using atlas-based analysis,including fractional anisotropy(FA),mean diffusivity(MD),axial diffusivity(AD),and radial diffusivity(RD).Statistical differences between the groups were assessed.Results Compared with the healthy control subjects,significant microstructural changes were found in the white matter of the column and body of fornix,bilateral superior cerebellar peduncle,bilateral inferior cerebellar peduncle,left medial lemniscus,left fornix/stria terminalis,right superior corona radiata and right posterior corona radiata in patients with iRBD,with the most extensive changes in MD values.DTI values were correlated with the disease duration,the proportion of sleep duration in REM stage,and periodic limb movement index in REM sleep.Conclusion DTI revealed multiple abnormalities of white matter fibers in the brain of iRBD patients,which mainly concentrated in the pons and fornix.MD value may be a sensitive parameter for detecting white matter microstructural integrity in patients with iRBD.