基于定量磁化率成像评估的脑小血管病患者灰质核团铁沉积情况及其与认知功能的相关性分析

Quantitative susceptibility mapping assessment of iron deposition in gray matter nuclei and the correlation with cognitive function in cerebral small vessel disease

目的基于定量磁化率成像(QSM)评估脑小血管病(CSVD)患者灰质核团铁沉积情况,分析其与认知功能的相关性。方法回顾性连续纳入2016年12月至2022年11月于首都医科大学宣武医院神经内科门诊就诊的CSVD患者和2022年9月至11月首都医科大学宣武医院放射与核医学科既往其他研究招募的健康对照者。收集和比较CSVD患者和健康对照者一般资料,包括年龄、性别、既往史(高血压病、糖尿病、高脂血症)、吸烟、饮酒和蒙特利尔认知评估(MoCA)量表评分。收集所有CSVD患者和健康对照者头部MRI,包括三维T1加权成像、QSM、T2加权成像及液体衰减反转恢复(FLAIR)序列成像。根据CSVD患者头部MRI评估相关影像学特征及CSVD总负荷评分,将患者分为CSVD轻微(CSVD-m)组和CSVD严重(CSVD-s)组;健康对照者为对照组。基于QSM获取所有CSVD患者及健康对照者灰质核团磁化率值。采用单因素协方差分析及Bonferroni校正比较3组灰质核团磁化率值,对差异有统计学意义的灰质核团的磁化率值与MoCA量表评分进行Spearman相关性分析。结果共纳入CSVD患者61例,其中CSVD-s组29例,CSVD-m组32例;对照组共纳入健康对照者32名。(1)CSVD-s组、CSVD-m组和对照组年龄、性别、高血压病、糖尿病、高脂血症、吸烟、饮酒差异均无统计学意义(均P>0.05)。CSVD-s组、CSVD-m组MoCA评分低于对照组[25.0(22.5,27.5)分、27.0(25.0,29.0)分比28.0(27.0,29.0)分,H=15.006,P<0.01]。CSVD-s组与CSVD-m组脑微出血、脑白质高信号、血管周围间隙影像学特征分布差异均有统计学意义(均P<0.05)。(2)3组间左侧壳核(F=4.790)、苍白球(F=12.896)、海马(F=3.904)及右侧壳核(F=36.278)、苍白球(F=39.449)、尾状核(F=6.797)、丘脑(F=6.525)磁化率值差异均有统计学意义(均P<0.05)。Bonferroni校正后,CSVD-s组左侧壳核、苍白球及右侧壳核、苍白球、尾状核、丘脑磁化率值均高于对照组(均P<0.05);CSVD-m组左侧苍白球及右侧苍白球、壳核、丘脑磁化率值均高于对照组(均P<0.01),左侧海马磁化率值低于对照组(P=0.045)。(3)左侧壳核及右侧壳核磁化率值与MoCA量表评分均呈负相关(左侧:r s=-0.316,P=0.015;右侧:r s=-0.316,P=0.014)。结论CSVD患者灰质核团中铁代谢异常,双侧壳核铁沉积均与认知功能存在相关性。

Objective To evaluate iron deposition in gray matter nuclei in patients with cerebral small vessel disease(CSVD)based on quantitative susceptibility mapping(QSM)and to analyze its correlation with cognitive function.Methods Patients with CSVD attending the outpatient clinic in the Department of Neurology at Xuanwu Hospital of Capital Medical University from December 2016 to November 2022,and healthy controls recruited from previous studies in the Department of Radiology and Nuclear Medicine at Xuanwu Hospital of Capital Medical University from September 2022 to November 2022 were retrospectively consecutively collected.Baseline data of CSVD patients and healthy controls was collected and compared,including age,sex,past history(hypertension,diabetes,hyperlipidemia),smoking history,alcohol consumption history and Montreal cognitive assessment(MoCA)scale score.MRI of all CSVD patients and healthy controls were collected,including three-dimensional T1 weighted imaging,QSM,T2 weighted imaging,and fluid attenuated inversion recovery(FLAIR)sequence imaging.According to the MRI-related imaging features and CSVD total burden score,the patients were divided into mild CSVD(CSVD-m)group and severe CSVD(CSVD-s)group,and healthy controls were the control group.QSM was used to obtain the susceptibility values of gray matter nuclei for all CSVD patients and controls.One-way covariance analysis and Bonferroni correction were used to compare the gray matter nuclei susceptibility values among the three groups.Spearman correlation analysis was performed between susceptibility values of gray matter nuclei with statistically significant differences in susceptibility values and cognitive function.Results A total of 61 cases of CSVD patients were included,including 29 cases in the CSVD-s group and 32 cases in the CSVD-m group;32 healthy controls were included in the control group.(1)There was no statistically significant difference in age,sex,hypertension,diabetes,hyperlipidemia,smoking,and alcohol consumption between the CSVD-s group,CSVD-m group and control group(all P>0.05).The MoCA scale scores of the CSVD-s group and CSVD-m group were lower than those of the control group(25.0[22.5,27.5]points,27.0[25.0,29.0]points than 28.0[27.0,29.0]points,H=15.006,P<0.01).The difference in the imaging features distribution of cerebral microbleeds,white matter hyperintensity,and perivascular space among the CSVD-s group and the CSVD-m group was statistically significant(all P<0.05).(2)The differences in susceptibility values of the left putamen(F=4.790),pallidus(F=12.896),hippocampus(F=3.904)and the right putamen(F=36.278),pallidus(F=39.449),caudate nucleus(F=6.797),and thalamus(F=6.525)were statistically significant among the three groups(all P<0.05).After Bonferroni correction,the susceptibility values of the left putamen and pallidus and the right putamen,pallidus,caudate nucleus,and thalamus in the CSVD-s group were higher than those of the control group(all P<0.05);the susceptibility values of the left pallidus and the right pallidus,putamen,and thalamus in the CSVD-m group were higher than those of the control group(all P<0.01),and the left hippocampus was lower than that of the control group(P=0.045).(3)The susceptibility values of the bilateral putamen were significantly negatively correlated with MoCA scale score(left putamen:r s=-0.316,P=0.015;right putamen:r s=-0.316,P=0.014).Conclusion Abnormal iron metabolism occurs in gray matter nuclei of CSVD patients,and iron deposition in the putamen correlate with cognitive dysfunction.