延髓发病型及脊髓发病型肌萎缩侧索硬化症脑部磁共振结构特征变化

doi:10.24920/11804

摘要/Abstract

摘要： 目的采用基于体素的形态测量学技术探索延髓发病型及脊髓发病型肌萎缩侧索硬化症患者脑部磁共振成像结构特征。方法对65例肌萎缩侧索硬化症患者（15例延髓型,50例脊髓型）及65名健康对照在3.0T磁共振扫描仪上行磁共振脑部结构成像。采用基于体素的形态测量学技术探索脑部灰质体积变化,采用神经形态学模版对体积变化脑区的体积进行计算。结果与正常对照组比较,肌萎缩侧索硬化症患者在体素水平脑部灰质体积减少的脑区主要分布于右侧中央前回及额中回;延髓发病型肌萎缩侧索硬化症患者脑体积改变主要局限在运动皮层外萎缩（额-颞叶模式）,而脊髓发病型肌萎缩侧索硬化症患者则主要表现为运动皮层萎缩（主要为右侧中央前回）及运动皮层外萎缩（额-颞叶模式及额-颞叶外模式）。两个肌萎缩侧索硬化症亚型间比较,脊髓发病型表现以左侧中央后回灰质体积减少为特征,延髓发病型表现以左侧颞中回灰质体积减少为特征。结论运动皮层及运动皮层外灰质非对称性萎缩是脊髓发病型肌萎缩侧索硬化症患者脑部结构改变的特征,运动皮层外灰质萎缩是延髓发病型肌萎缩侧索硬化症患者脑部结构改变的特征。脊髓发病型灰质萎缩模式分布较延髓发病型更为广泛。

关键词: 肌萎缩侧索硬化症, 灰质, 磁共振成像, 中央前回, 基于体素的形态测量学

Abstract: Objective To investigate cerebral structural signatures of the bulbar- and spinal-onset amyotrophic lateral sclerosis (ALS) using voxel-based morphometry on magnetic resonance imaging.Methods The MR structural images of the brain were obtained from 65 ALS patients (15 bulbar-onset, 50 spinal-onset) and 65 normal controls (NC) on a 3.0T MRI system. Gray matter (GM) volume changes were investigated by voxel-based morphometry, and the distribution of the brain regions with volume changes was compared between ALS and normal controls, as well as between bulbar-onset and spinal-onset ALS based on Neuromorphometrics atlas.Results On voxel-level the decreased volume of brain regions in ALS patients was located in the right precentral gyrus (rPrcGy) and right middle frontal gyrus compared with that in NC. The bulbar-onset ALS presented extra-motor cortex atrophy (fronto-temporal pattern), including left medial orbital gyrus, left inferior temporal gyrus and right middle temporal gyrus; the spinal-onset ALS suffered from motor cortex atrophy (rPrcGy dominance) and extra-motor cortex atrophy (fronto-temporal and extra-fronto-temporal pattern) compared with NC. The spinal-onset ALS featured by GM volume loss of left postcentral gyrus and bulbar-onset ALS featured by GM volume loss of left middle temporal gyrus compared with each other.Conclusions The asymmetric GM atrophy of the motor cortex and extra-motor cortex represents the common MRI structural signatures of spinal-onset ALS, and sole extra-motor cortex atrophy represents the structural signatures of bulbar-onset ALS. The present study also demonstrated that the pattern of GM damage is likely to distribute wider in spinal-onset ALS than in bulbar-onset ALS.

Key words: amyotrophic lateral sclerosis, gray matter, magnetic resonance imaging, precentral gyrus, voxel-based morphometry

Chen Zhiye,Liu Mengqi,Ma Lin. Gray Matter Volume Changes over the Whole Brain in the Bulbar- and Spinal-onset Amyotrophic Lateral Sclerosis: a Voxel-based Morphometry Study[J].Chinese Medical Sciences Journal, 2018, 33(1): 20-28.

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Groups	Volume of rPrcGy			Volume of rMidFroGy
Groups	means±SD		95% CI	means±SD		95% CI
NCs	12.14±1.33		11.68-12.30	18.71±2.41		17.84-18.97
ALS	11.36±1.34		11.19-11.81	17.64±2.61		17.38-18.51
F value	4.76			1.26
P value^*	0.03			0.27
Groups	TGMV		TIV		fGMV
Groups	means±SD	95% CI	means±SD	95% CI	means±SD		95% CI
NCs	610.75±56.74	589.83-617.29	1423.72±127.38	1385.11-1453.02	0.43±0.02		0.42-0.43
ALS	574.72±64.43	578.18-605.64	1393.96±144.74	1364.66-1432.57	0.42±0.02		0.41-0.43
F value	1.36		0.69		0.41
P value^*	0.25		0.41		0.52

Groups	n	Volume of lMedOrbGy		Volume of lInfTemGy		Volume of rMidTemGy
Groups	n	means±SD	95% CI	means±SD	95% CI	means±SD	95% CI
NCs	65	4.40±0.57	4.08-4.64	10.00±1.00	9.39-10.59	14.14±1.97	13.09-14.76
bulbar-onset ALS	15	4.15±0.51	3.91-4.47	8.94±1.17	8.35-9.55	13.49±1.46	12.87-14.54
F value		0.70		6.19		0.14
P value^*		0.41		0.02		0.71
Groups	n	TGMV		TIV		fGMV
Groups	n	means±SD	95% CI	means±SD	95% CI	means±SD	95% CI
NCs	65	610.75±56.74	589.83-617.29	1423.72±127.38	1385.11-1453.02	0.43±0.02	0.42-0.43
bulbar-onset ALS	15	577.18±65.12	554.32-614.58	1366.53±133.84	1309.04-1441.14	0.42±0.02	0.41-0.44
F value		0.07		0		0.32
P value^*		0.80		0.98		0.58

Anatomic region	MNI-space			K value	P value	T value
Anatomic region	X	Y	Z	K value	P value	T value
Left Thalamus Proper	-21	-21	12	928	0.000	5.58
Right Precentral Gyrus	48	-9	57	2753	0.000	5.46
Left Superior Frontal Gyrus	-18	54	6	4582	0.000	5.35
Left Postcentral Gyrus	-54	-8	33	4032	0.000	5.15
Right Middle Frontal Gyrus	42	53	9	1015	0.000	4.88
Left Central Operculum	-54	2	3	633	0.000	4.27
Right Superior Frontal Gyrus	23	54	21	351	0.000	4.24
Right Middle Occipital Gyrus	32	-75	41	215	0.000	4.15
Left Supramarginal Gyrus	-45	-48	24	141	0.000	4.14
Left Precuneus	-5	-65	27	1157	0.000	4.06
Left Middle Occipital Gyrus	-29	-80	15	293	0.000	4.00
Left Medial Precentral Gyrus	0	-18	75	220	0.000	3.97
Right Superior Frontal Gyrus	26	33	47	123	0.000	3.96
Right Middle Temporal Gyrus	60	-20	-8	274	0.000	3.95
Right Angular Gyrus	57	-48	18	166	0.000	3.87
Left Angular Gyrus	-48	-60	35	153	0.000	3.78
Left Inferior Frontal Angular Gyrus	-48	26	6	130	0.000	3.74
Left Fusiform Gyrus	-32	-33	-29	177	0.000	3.70
Left Superior Frontal Gyrus	-17	39	48	300	0.000	3.69
Left Superior Parietal Lobule	-26	-54	56	176	0.000	3.67

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