轻微肝性脑病大脑结构与功能异常MRI表现

发布时间：2018-10-29 08:56

【摘要】：目的观察肝硬化(HC)继发轻微肝性脑病(MHE)患者大脑灰质结构和功能改变特征。方法对单纯HC患者30例(单纯HC组)、HC伴发MHE患者32例(MHE组)、健康对照34名(对照组)行神经心理学测试及结构与功能MR扫描,基于体素的形态学及局部一致性(ReHo)方法,分析大脑灰质结构和ReHo改变。结果 MHE组完成NCT-A时间较单纯HC组及对照组明显增高,而MHE组DST评分明显降低(P均0.001)。与对照组比较,MHE组灰质体积改变的区域和强度明显增加。尾状核与眶部额内侧回(MFG)体积缩小和丘脑增大仅见于MHE组。双侧丘脑ReHo降低仅见于单纯HC组,双侧辅助运动区(SMA)、内侧额上回(SFG)及前扣带回(ACC)ReHo显著降低主要见于MHE组。单纯HC和MHE组丘脑体积与平均ReHo值呈正相关(r=0.342,P=0.007)。MHE组丘脑体积与眶部MFG体积改变呈正相关(r=0.448,P=0.01);SMA、ACC及内侧SFG平均ReHo值与NCT-A完成时间呈负相关(r=-0.529、-0.414、-0.450,P均0.05),与DST评分呈正相关(r=0.562、0.483、0.459,P均0.05)。结论联合结构与功能MRI研究可能为MHE诊断和发病机制提供更可靠的客观依据,丘脑、尾状核、额叶及扣带回体积与ReHo改变可能是MHE大脑结构与功能损伤的MRI影像特征。
[Abstract]:Objective to observe the changes of gray matter structure and function in patients with mild hepatic encephalopathy (MHE) secondary to liver cirrhosis (HC). Methods 30 patients with HC (32 patients with), HC accompanied with MHE in HC group (MHE group) and 34 healthy controls (control group) underwent neuropsychological tests and structural and functional MR scans. The changes of brain gray matter structure and ReHo were analyzed based on morphologic and local consistent (ReHo) method of voxel. Results the time to complete NCT-A in MHE group was significantly higher than that in HC group and control group, while the DST score in MHE group was significantly lower (P 0.001). Compared with the control group, the area and intensity of gray matter volume change in MHE group were significantly increased. The (MFG) volume of caudate nucleus and orbital medial frontal gyrus decreased and thalamus enlarged only in MHE group. The decrease of ReHo in bilateral thalamus was found only in simple HC group. The decrease of (SFG) in medial superior frontal gyrus of (SMA), and (ACC) ReHo in anterior cingulate gyrus in bilateral auxiliary motor area was mainly found in MHE group. There was a positive correlation between the volume of thalamus and the mean ReHo in HC and MHE groups (r = 0.342P ~ (0.007). There was a positive correlation between the volume of thalamus and the volume of MFG in orbit (r = 0.448). The mean ReHo value of SMA,ACC and medial SFG was negatively correlated with the completion time of NCT-A (r = 0. 529 ~ 0. 414 ~ 0. 450) and positively correlated with the DST score (r = 0. 562P = 0. 483n, P = 0. 05). Conclusion the study of combined structure and function MRI may provide a more reliable objective basis for the diagnosis and pathogenesis of MHE. The changes of thalamus, caudate nucleus, frontal lobe and cingulate gyrus volume and ReHo may be the MRI imaging features of MHE brain structure and function injury.
【作者单位】：白求恩国际和平医院放射科;第三军医大学西南医院放射科;第三军医大学西南医院感染科;
【基金】：河北省自然科学基金(H2014505007)
【分类号】：R575.3;R445.2

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