【摘要】 目的结合磁共振波谱成像(MRSI)以及扩散张力成像(DTI)技术及磁共振影像(MRI)对肌萎缩性侧索硬化(ALS)进行对照研究,评价MRSI、DTI、MRI在ALS诊断中的作用。方法采用MRSI、DTI及MRI技术对ALS患者及对照组进行扫描,观察沿皮质脊髓束(CST)走行区域包括中央前回皮层下(SWM)、半卵圆中心(CS)、侧脑室旁白质(PV)、内囊后肢(PIC)、大脑脚(CP)的各向异性比(FA)以及平均扩散率(MD),以及SWM、PV、PIC平面氮乙酰门冬胺酸(NAA)与肌酸(Cr)比值在对照组及ALS患者的改变,并比较不同扫描序列在ALS诊断的作用。结果ALS的总FA较对照组明显降低(P<0.001),在CST走行区的SWM、CS、PV和PIC平面,ALS组的FA较对照组明显降低(P<0.05),MD在ALS组有升高的趋势,但无统计学差异。ALS组的NAA/Cr较对照组明显降低(P<0.05),在SWM和PV平面ALS组的NAA/Cr较对照组降低明显(P<0.05)。对T1WI、T2WI与FLAIR序列判断结果显示,对照组与ALS组间MRI的表现无明显差异。结论MRSI与DTI结合能够早期定量探测ALS患者CST的轴索损伤,SWM、CS、PV和PIC平面的FA,在SWM和PV的NAA/Cr为有效的指标。ALS与对照组MRI的表现则无明显差异。更多还原

【Abstract】 Objective To detect the patholgical changes of amyotrophic lateral sclerosis (ALS) with magnetic resonance spectrum imaging (MRSI), diffusion tensor imaging (DTI) and magnetic resonance imaging (MRI), to compare their differences and values in the diagnosis of ALS. Methods Twelve ALS patients were compared to 12 normal controls. Fractional anisotropy (FA) and mean diffusivity (MD) were measured at various locations in the corticospinal tract (CST), including the subcortical white matter (SWM), centrum semiovale (CS), periventricular white matter (PV), posterior limb of the internal capsule (PIC) and cerebral peduncle (CP), and the ratio of N-acetyl-asparte (NAA) to creatine (Cr) were measured at SWM, PV and PIC. Results ALS showed significantly lower FA than controls in the CST, including the SWM, CS, PV and PIC (P<0.001). Although there was a trend towards elevated MD in ALS, this did not reach statistical significance. NAA/Cr ratios were also decreased in ALS compared to normal controls (P<0.05), with significant differences at the SWM and PV but not in PIC. The T1WI, T2WI, FLAIR of ALS and normal control groups showed that there was no significant difference on MRI between the 2 groups. Conclusion The combination of whole-brain DTI and MRSI can in vivo detect axonal degeneration along CST in ALS patients. Measurements of FA in the SWM, CS, PV and PIC, and NAA/Cr ratios in the SWM and PV can offer the most powerful clues. The MRI changes can not tell ALS from normal control.更多还原