内颞叶结构MR体积测量在Alzheimer病和皮层下血管性痴呆鉴别诊断中的价值

MR volumetric measurement of medial temporal lobe in differentiating Alzheimer disease and subcortical ischemic vascular dementia

目的 评价内颞叶结构MR体积测量在阿尔茨海默病 (Alzheimerdisease,AD)和皮层下血管性痴呆 (subcorticalischemicvasculardementia ,SIVD)鉴别诊断中的价值。方法 对 33名可能为AD患者、17例可能为SIVD患者和 33例正常对照者行头颅MR扫描 ,在重建的斜冠状面图像上对杏仁核、海马结构、内嗅皮层、海马旁回及颞角行体积测量 ,对测量数据行标准化处理 ,然后进行统计学分析。结果 SIVD者与正常对照者比较 ,海马萎缩及颞角扩张 ,差异有显著意义 (P值均 <0 0 5 )。AD者与SIVD者比较 ,杏仁核、海马、内嗅皮层及海马旁回均萎缩 ,差异有非常显著意义 (P值均 <0 0 0 1) ;在AD组与SIVD组的判别分析中以上结构均有非常显著意义 (P值均 <0 0 0 1) ,以左侧内嗅皮层为著 (特异度、敏感度、准确度分别为 82 4 %、87 9%和 86 0 % ) ,两侧内嗅皮层区分 2组的平均准确度达 85 0 %。结论 内颞叶结构MR体积测量有助于区分AD与SIVD 。

Objective To evaluate the value of measurement of medial temporal structure by MR imaging volumetry in the differential diagnosis for patients with Alzheimer′s disease (AD) and subcotical ischemic vascular dementia (SIVD) Methods Thirty three probable patients of AD, 33 normal controls, and 17 patients suspected with SIVD had been scanned by MRI, and volumetric measurements of amygdala (AMY), hippocampal formations (HF), entorhinal cortices (EC), parahippocampal gyri (PHG), and temporal horn of lateral ventricle (TH) were done on a serial reconstructed MR images Results Both atrophy of HF and dilatation of TH were significant ( P < 0 05) in SIVD group compared with that in control group All the measurements with the exception of TH were atrophied significantly ( P <0 001) in AD group compared with that in SIVD group and could significantly discriminate the two groups Among these indexes, the left EC provided the best discrimination with the specificity of 82 4%, sensitivity of 87 9%, and accuracy of 86 0%, respectively, and the average accuracy of bilateral EC in discrimination was 85% Conclusion The MR imaging volumetric measurements of medial temporal structure could offer useful information in discriminating individuals with AD from that with SIVD Meanwhile, it should be understood that the AD type pathological changes could also be induced by cerebrovascular disease