【摘要】 背景:磁共振扩散张量成像和纤维素成像技术是惟一能在活体上进行白质纤维结构分析的方法。目的:通过扩散张量纤维束成像技术观察Broca失语症时语言功能区及其纤维结构的变化。设计、时间和地点:对比观察临床实验,于2003-11/2005-02在昆明医学院第一附属医院和首都医科大学北京天坛医院完成。对象:选择不同程度Broca失语症患者30例,女9例,男21例,年龄17~63岁。经北京医科大学附属一院神经心理研究室汉语失语成套测验确诊失语症,以不同亚项测试作出失语症分类诊断。方法:应用3T超高场强磁共振扫描仪及工作站对患者完成全脑的数据采集和处理。选定Brodmann 45、44区和22区、39区及右侧半球相应脑区为语言功能区,脑内与语言功能区密切相关的主要联合、连合纤维束为纤维追踪的兴趣区,分别进行神经纤维束的追踪显示。主要观察指标:观察从语言功能区发出的神经纤维束的走行、分布及其与其它脑区间的联系和病理情况下的改变,并与文献资料中的正常人进行对比。结果:30例Broca失语症患者全部进入结果分析。①Broca失语症患者的左侧45区和44区纤维束及其平均各向异性阈值少于正常人,差异有显著性意义(t=-2.683 65,-5.300 55,P < 0.05)。②Broca区向下穿行的纤维束中断或移位,与弓状纤维束前部的联系松散或分离,到中央前回及额叶内侧面的纤维减少。③Broca失语症的弓状纤维束的改变主要是前端的纤维束完整性破坏和纤维束移位所致Broca区与弓状纤维束的分离,左侧弓状束的纤维束数量和平均各向异性阈值也均少于正常人,差异有显著性意义(P < 0.05)。结论:脑Broca区皮质及其纤维环路结构的损伤均可导致Broca失语症的发生。更多还原

【Abstract】 BACKGROUND: Diffusion tensor imaging and fiber tractography (DT-FT) is the only method to identify cerebral white matter fiber organization in vivo. OBJECTIVE: To observe the changes in brain areas with language function and the fiber structure in patients with Broca aphasia. DESIGN, TIME AND SETTING: Comparative observation was performed at First Hospital of Kunming Medical College and Tiantan Hospital of Capital Medical University between November 2003 and February 2005. PARTICIPANTS: Thirty patients (9 females, 21 males, aged 17-63 years) with Broca aphasia of different degree were selected. They were diagnosed by a set of Chinese aphasia examinations of Research Laboratory of Neuropsychology, First Hospital of Beijing Medical University, following by further classification according to the subitems. METHODS: 3T super-high field magnetic resonance scanner was used for the data collection and processing of the entire brain. Brodmann areas 45, 44, areas 22 and 39 (Wernicke area), and the corresponding brain areas in the right hemisphere are selected as areas with language function. The primary commissure, commissural fibers (arcuate fasciculus, internal cap- sule, external capsule) that are closely correlated with language function were regarded as region of interest of fiber tracking. The neural fiber tracking was conducted. MAIN OUTCOME MEASURES: The tracking and distribution of neural fiber tracts, and its correlation with other brain areas, and changes under pathological conditions. All data were compared with normal brain. RESULTS: Thirty patients with Broca aphasia were included in final analysis. The mean fractional anisotropy of fiber tracts in left Brodmann areas 45 and 44 was significantly lower than that in normal Brodmann areas (t=-2.683 65, -5.300 55, P < 0.05). The inferior fiber tracts in Broca area showed interruption or displacement, loosely connected even separate from the frontal arcuate fasciculus. The fibers of precentral gyrus and medial frontal lobe were decreased. The separation of arcuate fasciculus from Broca area caused by the integrity disruption and displacement of fiber tracts of arcuate fasciculus was the main alteration of arcuate fasciculus in Broca aphasia. The number of fiber tracts of left arcuate fasciculus and the mean fractional anisotropy in Broca aphasia were significantly less than normal people (P < 0.05). CONCLUSION: The lesions of cerebral cortex and its fiber pathway in Broca area can result in Broca aphasia.更多还原