【摘要】 目的 评估多模态影像学技术在不同阶段阿尔茨海默病患者中的应用价值。方法 募集2016年12月1日至2018年11月30日就诊于包头市中心医院神经内科受试者共56例，根据入组标准及排除标准，纳入轻度认知功能障碍期者(MCI组)18例、痴呆阶段阿尔茨海默病者(AD组)18例以及与上述病例相匹配健康志愿者(正常组)20例。所有受试者均进行简易智能量表(MMSE)、蒙特利尔认知评估量表(MoCA)、及神经心理量表评估，之后行头部磁共振成像及弥散张量成像，其中有5例患者进一步行PET/CT检查，进而分析不同阶段阿尔茨海默病在多模态影像学中的差异，从而为诊断及分期提供客观依据。结果 (1)AD组、MCI组和正常组三组间各项分数异性矩阵相比较：AD组连接明显稀疏于MCI组和正常组；MCI组和正常组的连接无显著性差异，总体上相似；(2)AD组、MCI组及正常组三组间回归年龄与性别等协变量后，进行图论指标计算，其中三组间全局属性指标结果无统计学意义(P>0.05);(3)MCI组与AD组相比较，介数中心性、度中心性和节点效率三个指标存在显著差异(P<0.05);(4)正常组与AD组相比较，介数中心性、集聚系数、度中心性、节点效率和最短路径长度五个指标存在显著差异(P<0.05);(5)正常组与MCI组相比较，介数中心性、集聚系数和度中心性三个指标存在显著差异(P<0.05);(6)在PET/CT中AD患者与MCI患者相比，随着认知障碍程度的增加，脑内出现弥漫性、对称性葡萄糖代谢减低，主要集中在默认模式网络、额叶、颞叶及顶叶等与认知相关脑区。(7)在阿尔茨海默病的不同阶段，PET/CT及DTI中均可能在与认知相关的默认模式网络、额叶、颞叶及顶叶中出现节点属性及葡萄糖代谢变化。结论 (1)在不同阶段阿尔茨海默病患者中，弥散张量成像节点属性存在差异；PET/CT中随着不同认知域受到波及，直观反映出脑内葡萄糖代谢变化，以期协助疾病早期诊断及分期；(2)多模态影像学在阿尔茨海默病的进程中可提供结构及功能变化的影像学依据。更多还原

【Abstract】 Objective To evaluate the application value of multimodal imaging technology in patients with Alzheimer’s disease at different stages. Methods A total of 56 subjects from December 1,2016 to November 30,2018 in the Department of Neurology of Baotou central hospital were recruited. According to the inclusion criteria and exclusion criteria, 18 patients with mild cognitive impairment(MCI group),18 patients with Alzheimer’s disease(AD group) and 20 healthy volunteers(normal group) were enrolled. All subjects were assessed by MMSE,MOCA and neuropsychological scale, and then brain magnetic resonance imaging(MRI) and diffusion tensor imaging(DTI) were performed. Five patients were further examined by PET/CT,and the differences in multimodal imaging in different stages of Alzheimer’s disease were analyzed, so as to provide an objective basis for diagnosis and staging. Results(1) The results showed that the connectivity of AD group was significantly less than that of MCI group and normal group; there was no significant difference between MCI group and normal group, and there was no significant difference in the connection between MCI group and normal group;(2) MCI group and normal group, after regression of covariates such as age and gender among ad group the graph theory index was calculated, and the results of global attribute index among the three groups were not statistically significant;(3) There were significant differences between MCI group and ad group(P<0.05);(4) There were significant differences between normal group and ad group(P<0.05);(5) between normal group and MCI group, there were significant differences in five indexes(P<0.05)(6) Compared with MCI patients, AD patients showed diffuse and symmetrical glucose metabolism decrease with the increase of cognitive impairment, mainly concentrated in the cognitive related brain areas such as the silent pattern network, frontal lobe, temporal lobe and parietal lobe.(7) In different stages of Alzheimer’s disease, PET/CT and DTI may have node attributes and glucose metabolism changes in the default mode network, frontal lobe, temporal lobe and parietal lobe. Conclusion(1)In different stages of Alzheimer’s disease patients, diffusion tensor imaging node attributes are different; PET/CT with different cognitive domain affected, directly reflect the brain glucose metabolism changes, in order to assist the early diagnosis and staging of the disease;(2) Multimodal imaging in the process of Alzheimer’s disease can provide imaging basis for structural and functional changes.更多还原