Sabri O, Ringelstein E B, Hellwig D, Schneider R, Schreckenberger M, Kaiser H J, Mull M, Buell U
Departments of Nuclear Medicine, Aachen University of Technology, Germany.
Stroke. 1999 Mar;30(3):556-66. doi: 10.1161/01.str.30.3.556.
Cerebral microangiopathy, indicated on MRI by lacunar infarctions (LI) and deep white matter lesions (DWML), is said to lead to vascular dementia.
Fifty-seven patients with proven cerebral microangiopathy were assessed for changes in regional cerebral blood flow (rCBF) and glucose metabolism (rMRGlu) and compared with 19 age-matched controls. The findings were correlated with results of extensive neuropsychological testing, as well as with MRI findings. A special head holder ensured reproducibility of positioning during rCBF (single-photon emission CT [SPECT]), rMRGlu (positron emission tomography [PET]), and MR imaging. White matter and cortex were quantified with regions of interest defined on MRI and superimposed to corresponding PET/SPECT slices. LI and DWML were graded by number and extent.
Even with severe DWML and multiple LI, rCBF and rMRGlu values were not reduced. ANOVAs identified brain atrophy and neuropsychological deficits as the main determinants for reduced rCBF and rMRGlu values in both cortex and white matter. Neuropsychological deficits correlated well with decreased rCBF and rMRGlu, whereas MRI patterns such as LI and DWML did not. Factor analysis revealed no correlation of LI and DWML with rCBF, rMRGlu, atrophy, and neuropsychological deficits, showing instead positive correlations between rCBF, rMRGlu, and neuropsychological performance and negative correlations of the latter 3 with brain atrophy.
From these data, we conclude that LI and DWML are epiphenomena that may morphologically characterize cerebral microangiopathy but do not in themselves indicate cognitive impairment. Dementia or neuropsychological deficits, by contrast, are reflected exclusively by functional imaging parameters (rCBF, rMRGlu) and cerebral atrophy.
脑微动脉病在MRI上表现为腔隙性脑梗死（LI）和深部白质病变（DWML），据说可导致血管性痴呆。
对57例经证实患有脑微动脉病的患者进行了局部脑血流量（rCBF）和葡萄糖代谢（rMRGlu）变化的评估，并与19例年龄匹配的对照组进行比较。研究结果与广泛的神经心理学测试结果以及MRI检查结果相关。一种特殊的头部固定器可确保在rCBF（单光子发射计算机断层扫描[SPECT]）、rMRGlu（正电子发射断层扫描[PET]）和磁共振成像过程中定位的可重复性。通过在MRI上定义的感兴趣区域对白质和皮质进行定量，并将其叠加到相应的PET/SPECT切片上。根据数量和范围对LI和DWML进行分级。
即使存在严重的DWML和多发LI，rCBF和rMRGlu值也未降低。方差分析确定脑萎缩和神经心理学缺陷是皮质和白质中rCBF和rMRGlu值降低的主要决定因素。神经心理学缺陷与rCBF和rMRGlu降低密切相关，而LI和DWML等MRI表现则不然。因子分析显示LI和DWML与rCBF、rMRGlu、萎缩和神经心理学缺陷无相关性，相反，rCBF、rMRGlu与神经心理学表现呈正相关，后三者与脑萎缩呈负相关。
根据这些数据，我们得出结论，LI和DWML是附带现象，它们可能在形态学上表征脑微动脉病，但本身并不表明存在认知障碍。相比之下，痴呆或神经心理学缺陷仅由功能成像参数（rCBF、rMRGlu）和脑萎缩反映。
