目的：探究轻度阿尔茨海默病（Alzheimer’s disease，AD）患者的脑血流（Cerebral blood flow，CBF）灌注和脑灰质体积的变化特点。方法：临床招募轻度AD患者和健康对照老年人进行包含3D-T1WI和3D伪连续动脉自旋标记（Three-dimensional pseudo-continuous arterial spin labeling，3D-pcASL）序列的磁共振扫描，运用统计参数图（Statistical parametric mapping，SPM）8软件对两组受试者全脑CBF图进行基于体素的全脑灌注差异的分析；采用基于体素的形态学测量方法（Voxel-based morphometry，VBM）比较两组受试者全脑灰质体积的差异；对灌注有差异的脑区的CBF与简易智力状态检查量表（Mini-mental state examination，MMSE）评分进行相关性分析。结果：共纳入轻度AD患者26例（年龄（73.0±6.8）岁，男16例），年龄、性别相匹配的健康对照者53例（年龄（73.7±8.2）岁，男23例）。与对照组相比，轻度AD组患者CBF灌注减低区主要位于双侧顶叶（以楔前叶、角回为主）、枕叶以及左侧颞叶和额叶；CBF灌注增高区主要位于右海马和海马旁回、右扣带回、基底节核团以及双侧额叶（以眶面和内侧面为主）（P<0.01，FDR校正，团块阈值>100像素）。轻度AD患者的脑灰质萎缩主要位于双侧颞叶内侧结构（海马、海马旁回、杏仁核），也累及双侧岛叶和基底节核团（P<0.01，FDR校正，团块阈值>100像素）。轻度AD组患者左颞顶叶脑回、双侧额上回的CBF值与MMSE评分呈现正相关；双侧内侧和旁扣带回、右前扣带回的CBF值与MMSE评分呈现负相关（P<0.05）。结论：轻度AD患者存在以顶叶为主的低灌注和以海马、基底节区、额叶为主的高灌注改变，而其灰质萎缩主要集中在双侧颞叶内侧结构。
Abstract
Objective: To investigate the changes of cerebral blood perfusion and gray matter volume in patients with mild Alzheimer’s disease(AD). Methods: Magnetic resonance imaging(MRI) scanning including 3D-T1WI and 3D pseudo-continuous arterial spin labeling(3D-pcASL) sequences was performed in patients with mild Alzheimer’s disease and cognitively normal elderly. Statistical analysis of the differences of whole brain perfusion based on voxel in cerebral blood flow(CBF) map of the whole brain of the two groups of subjects was performed using Statistical Parametric Mapping(SPM) 8 software. Voxel-based morphometry(VBM) was used to compare the difference of whole brain gray matter volume between the two groups. Correlation analysis was performed between the CBF of the brain region with different perfusion and the Mini-mental State Examination(MMSE) score. Results: A total of 26 patients with mild AD(age (73.0±6.8) years, 16 males) and 53 age-sex matched healthy controls(age (73.7±8.2) years, 23 males) were included. Compared with the normal control group, the decreased CBF perfusion areas in the mild AD group were mainly located in the bilateral parietal lobe(precuneus, angular gyrus), occipital lobe and left temporal lobe and frontal lobe, the increased CBF perfusion areas were mainly located in the right hippocampus and parahippocampal gyrus, right cingulate gyrus and basal ganglia and bilateral frontal lobes(orbitalis and medial side)(P<0.01, FDR correction, Bulk threshold>100 pixels). The gray matter atrophy in patients with mild AD was mainly located in the bilateral medial temporal lobe structure(hippocampus, parahippocampal gyrus, amygdala), and also involved the bilateral insular lobes and basal ganglia nuclei(P<0.01, FDR correction, Bulk threshold>100 pixels). The CBF values of the left temporal parietal gyrus and bilateral superior frontal gyrus were positively correlated with the MMSE scores in the mild AD group. The CBF values of the bilateral medial and lateral cingulate gyrus and the right anterior cingulate gyrus were negatively correlated with the MMSE scores(P<0.05). Conclusion: In mild AD patients, there are mainly low perfusion in the parietal lobe and high perfusion in the hippocampus, basal ganglia and frontal lobe, while gray matter atrophy is mainly concentrated in the medial structures of bilateral temporal lobes.
关键词
阿尔茨海默病 /
磁共振成像
Key words
Alzheimer disease /
Magnetic resonance imaging
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基金
辽宁省重点研发计划指导计划（2018225091）。
