基于多模态MRI探讨高血压相关脑体积及脑白质信号改变的临床研究

Clinical study of hypertension-related brain volume and white matter hyperintensity changes based on multimodal MRI

目的采用基于体素的形态学分析(voxel-based morphometry,VBM)及脑白质高信号(white matter hyperintensity,WMH)半定量评估研究高血压患者脑灰白质体积及WMH的变化。材料与方法本试验为前瞻性研究,纳入2019年1月至2022年11月南京大学医学院附属苏州医院高血压确诊病例及健康对照者。入组病例均进行薄层sT1WI序列检查,图像数据导入EKM-KELM+分类算法模型,进行自动解剖标记(anatomical automatic labeling,AAL)脑区分割,计算每个脑区的灰质体积(gray matter volume,GMV)、白质体积(white matter volume,WMV)及全脑体积(total intracranial volume,TIV),每个脑区灰白质体积分别采用灰或白质体积/TIV的比值表示。同时对液体衰减反转恢复(fluid attenuated inversion recovery,FLAIR)序列图像中的WMH进行Scheltens视觉定量评估。结果(1)本研究共纳入509例,其中,青年组(20~40岁)136例,中年组(41~60岁)218例,老年组(61~80岁)155例,组内性别、血压级别均无统计学差异(P>0.05);(2)青年组GMV/TIV比较显示,不同高血压级别在左嗅皮质(P=0.031)、左额直回(P=0.036)、右额直回(P=0.022)、右枕下回(P=0.011)差异具有统计学意义;青年组WMV/TIV比较显示,在左侧中央前回(P=0.041)、左侧颞中回(P=0.033)、左侧后扣带回(P=0.001)、右侧后扣带回(P=0.041)、右侧枕下回(P=0.019)差异具有统计学意义;(3)中年组GMV/TIV比较显示,不同高血压级别在左辅助运动区体积差异具有统计学意义(P=0.036),WMV/TIV比较差异均无统计学意义;(4)老年组GMV/TIV比较显示,不同高血压等级在右侧嗅皮质体积差异具有统计学意义(P=0.047),WMV/TIV比较差异均无统计学意义;(5)WMH Scheltens视觉评分显示:青年组差异均无统计学意义(P>0.05);中年组脑室旁WMH(额角、枕角、侧脑室旁)差异具有统计学意义(P=0.028、0.032、0.020),深部白质(额叶)差异具有统计学意义(P=0.024);老年组脑室旁WMH(额角)、深部白质(额叶)及基底节白质区(苍白球)差异具有统计学意义(P=0.022、0.024、0.015)。结论MRI多模态半定量分析可以有效评估高血压患者脑体积及WMH变化,青年组随着高血压级别升高脑GMV变化的脑亚区较中老年组变化的脑亚区多;中老年组WMH较青年组更易出现。

Objective:The volume and white matter hyperintensities(WMH)in the brain were studied,based on voxel-based morphometry(VBM)and semi-quantitative assessment of WMH in hypertensive patients.Materials and Methods:This retrospective study included confirmed hypertensive cases and healthy control cases from Suzhou Science and Technology City Hospital Affiliated to Nanjing University from January 2018 to November 2022.All enrolled cases underwent thin layers T1WI sequence examination.Firstly,images were imported into the brain structure EKM-KELM+classification algorithm model to calculate gray matter volume(GMV),white matter volume(WMV)and total intracranial volume(TIV).The gray and white matter volume of each brain region was expressed as the ratio of GMV/TIV and WMV/TIV,respectively,to analyze the variation characteristics of brain gray matter volume in hypertensive patients of different ages.At the same time,Scheltens Visual Quantitative Assessment of WMH was performed on fluid attenuated inversion recovery(FLAIR)images.Results:(1)A total of 509 cases were included in this study,including 91 cases in the normal blood pressure group and 418 cases in the hypertension group.Among them,136 cases were young(20-40 years old),218 cases were middle-aged(41-60 years old)and 155 cases were elderly(61-80 years old).There were no significant differences in gender and age within groups(all P>0.05).(2)There were significant differences among hypertension grades in GMV/TIV of the left olfactory cortex(P=0.031),left straight gyrus(P=0.036),right straight gyrus(P=0.022),and right inferior occipital gyrus(P=0.011)in young patients.(3)The comparison of GMV/TIV in the middle-aged group showed that there was significant difference in the volume of the left supplementary motor area among different hypertension levels(P=0.036),while there was no significant difference in WMV/TIV.(4)GMV/TIV comparison showed that there was significant difference in right olfactoid cortex volume among different hypertension grades(P=0.047),while there was no significant difference in WMV/TIV.(5)Scheltens visual score showed that there was no significant difference in the young group(P>0.05).In the middle age group,there were statistically significant differences in the high signal of voidural quality(frontal angle,occipital angle and lateral ventricle)(P=0.028,0.032,0.020),and statistically significant differences in deep white matter(frontal lobe)(P=0.024).There was significant difference in the frontal Angle,frontal lobe and pallidum WMH in the old group(P=0.022,0.024,0.015).Conclusions:Multi modal semi-quantitative analysis of MRI can effectively evaluate changes in BVM and WMH in hypertensive patients.With the increase of blood pressure level,the gray matter volume of the young group changed more than that of the middle and old group.WMH was more likely to appear in the middle-aged group than in the young group.