神经影像学对老年性认知障碍的诊断价值

发布时间：2018-03-04 06:17

本文选题：阿尔茨海默病　切入点：磁共振成像　出处：《吉林大学》2012年博士论文　论文类型：学位论文

【摘要】：老年性认知障碍是困扰老年人的常见性疾病，目前我国老年人口数已占总人口数的10.15%，随着国家老龄化的不断深入，老年性认知障碍的发病人数将会逐年增加，估计到2050年，我国老年人口将增加到4亿，而痴呆患者将超过2000万，因此，防治老年性的发生刻不容缓，对于这方面的研究也应该有长足的进步，本研究即围绕这一中心展开一系列研究。目的：比较阿尔茨海默病(AD)与健康老年人、轻度认知障碍(MCI)患者的颅脑影像学改变，寻求一种AD的影像学诊断依据；探讨白质纤维束在轻度认知障碍（MCI）和阿尔茨海默病（AD）中的改变，为MCI和早期AD的诊断提供理论基础；比较阿尔茨海默病(AD)与健康老年人、轻度认知障碍(MCI)患者的代谢物浓度变化，以探求AD患者的脑部代谢的病理性改变。方法：选取12例MCI患者、18例AD患者及20例健康的志愿者，进行常规MR冠状位1mm薄层扫描，利用西门子工作站进行三维重建，分别进行哈氏值(HI)，，脑室指数(VI)，前角指数(FHI)，三脑室宽(TVW)，皮层脑沟宽度(CSW)，外侧裂宽度（LFW）等线性指标的测量和海马体积的测量；行常规MR和DTI序列扫描，分别对其进行白质评级和感兴趣区域（上纵束、下纵束、钩束、胼胝体压部、胼胝体膝部、内囊前肢、内囊膝部、内囊后肢、扣带回前部、扣带回后部）FA和ADC值的测量并统计分析；行常规MR扫描和MRS扫描，利用西门子工作站进行后处理，并对其测量的各种数据进行统计学分析。结果：线性测量指标HI, FHI, TVW,LFW均具有显著的统计学意义(P0.05)，海马标准化体积存在组间差异(P0.05)，且大于一定年龄后，海马体积随年龄增加而不断减小(P0.05)、两性间海马体积不具有显著性差异(P0.05)，MCI组和AD组的海马体积具有侧别差异(P0.05)；白质损伤评级与年龄变化具有相关性，MCI与AD之间的白质评级有显著性差异（P0.05），DTI序列扫描，三组之间的上纵束、下纵束、扣带回后部、胼胝体膝部FA值均存在组间差异（P0.01），白质评级与上纵束、下纵束的FA值存在相关性（P0.05），与上纵束、胼胝体膝部、内囊前肢ADC值存在相关性（P0.05）；三组代谢物比值的组间差异均不受侧别、性别、年龄的影响(P0.05)，三组受试对象中丘脑NAA/Cr表现为明显的组间差异(P0.05)，其他感兴趣区域的代谢物比值均不存在显著性差异(P0.05)。结论：颅脑的影像学改变在诊断AD中具有明显的特异性，线性指标和海马体积的联合诊断可有效提高AD的诊断率。MCI病人和早期AD病人的白质出现了明显的损伤性改变，因而利用上纵束、下纵束、扣带回后部、胼胝体膝部的FA值作为白质损伤的指标来辅助诊断AD具有重要的临床价值。白质评级中MCI组与AD组存在显著性差异，因而可作为判断MCI转归的依据指标。大脑的MRS扫描在AD的诊断中具有一定的价值，通过对一些代谢物比值的测定，可以为临床诊断提供参考。
[Abstract]:Senile cognitive impairment is a common disease that puzzles the elderly. At present, the elderly population in our country has accounted for 10.15% of the total population. With the deepening of aging in our country, the incidence of senile cognitive impairment will increase year by year. It is estimated that by 2050, the number of senile cognitive disorders will increase year by year. The elderly population in China will increase to 400 million, while the dementia patients will exceed 20 million. Therefore, it is urgent to prevent and cure the occurrence of senile disease. The research in this field should also make great progress. Objective: to compare the craniocerebral imaging changes between Alzheimer's disease (AD) and healthy elderly patients with mild cognitive impairment (MCI) and to find a diagnostic basis for AD. To investigate the changes of white matter fiber bundle in patients with mild cognitive impairment (MCI) and Alzheimer's disease (AD), and to provide a theoretical basis for the diagnosis of MCI and early AD. In order to explore the pathological changes of brain metabolism in patients with mild cognitive impairment (MCI), 18 AD patients with MCI and 20 healthy volunteers were selected for conventional coronal 1 mm thin slice Mr scanning. Three dimensional reconstruction was carried out by Siemens workstation. The linear indexes such as Hihler's value, ventricular index (VI), anterior angle index (FHI), third ventricle width (TVWN), cortical sulcus width (CSW), lateral fissure width (LFW), and hippocampal volume were measured. Routine Mr and DTI sequences were performed to evaluate the white matter and area of interest (superior longitudinal bundle, inferior longitudinal bundle, hook bundle, splenium callosum, genu of corpus callosum, anterior limb of internal capsule, knee of internal capsule, posterior limb of internal capsule, anterior part of cingulate gyrus). The FA and ADC values of posterior cingulate gyrus were measured and statistically analyzed, conventional Mr scan and MRS scan were performed, and the postprocessing was performed by Siemens workstation. Results: the linear measurement indexes HIH, FHI, TVWN LFW all had significant statistical significance (P 0.05). There was a significant difference in the standardized volume of hippocampus between groups and was larger than that after a certain age. The hippocampal volume decreases with age. There is no significant difference in hippocampal volume between the two sexes. The hippocampal volume in P0.05 MCI group and AD group is different from that in AD group (P0.05), and there is a correlation between white matter damage rating and age change. There was significant difference in quality rating (P 0.05 / DTI scan). The FA values of upper longitudinal bundle, lower longitudinal bundle, posterior cingulate gyrus, genu of corpus callosum were significantly different among the three groups (P 0.01). There was a correlation between the white matter rating and the upper longitudinal bundle and the FA value of the lower longitudinal bundle (P 0.05), and with the superior longitudinal bundle, the genu of corpus callosum, and the knee of corpus callosum. There was a correlation between the ADC values of the anterior limb of the internal capsule and the ratio of metabolites in the three groups, and there was no difference in the ratio of metabolites between the three groups. The NAA/Cr of thalamus in the three groups was significantly different among the three groups, but there was no significant difference in the ratio of metabolites in other regions of interest. Conclusion: the imaging changes of brain have obvious specificity in the diagnosis of AD. The combination of linear index and hippocampal volume can effectively improve the diagnostic rate of AD. The white matter of patients with MCI and early AD patients has obvious damage changes, so the upper longitudinal bundle, the lower longitudinal bundle, the posterior cingulate gyrus, and the posterior cingulate gyrus can be used. The FA value of the genu of corpus callosum as a marker of white matter injury has important clinical value in the diagnosis of AD. There is a significant difference between the MCI group and AD group in the white matter rating. The brain MRS scan has certain value in the diagnosis of AD. By measuring the ratio of some metabolites, it can provide a reference for clinical diagnosis.
【学位授予单位】：吉林大学
【学位级别】：博士
【学位授予年份】：2012
【分类号】：R445.2;R749.1

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