轻度认知障碍中功能磁共振成像标志物的评估。
Evaluation of functional MRI markers in mild cognitive impairment.
作者信息
Zhang Bing, Li Ming, Sun Zong-Zheng, Zhu Bin, Yuan Lei, Wang Yi, Xu Yun
机构信息
Department of Radiology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.
出版信息
J Clin Neurosci. 2009 May;16(5):635-41. doi: 10.1016/j.jocn.2008.07.080. Epub 2009 Mar 4.
We aimed to investigate the use of advanced functional MRI (fMRI) techniques such as proton magnetic resonance spectroscopy ((1)H-MRS) and the apparent diffusion coefficient (ADC) value in diffusion weighted imaging (DWI), in the diagnosis of mild cognitive impairment (MCI). Multiple indicators were combined in order to improve the early diagnostic value of MRS and ADC. We administered MRS and DWI-ADC to 13 patients with Alzheimer's disease (AD), 9 patients with MCI, and 13 control patients. Changes in N-acetylaspartate/creatine and phosphocreatine (NAA/Cr), myoinositol/creatine (mI/Cr), and the ADC values in the hippocampus and the temporoparietal region were compared among groups. The sensitivity and specificity of different markers were analyzed individually and combined with others. All participants were evaluated by the mini mental state examination (MMSE), and the correlation between NAA/Cr, MI/Cr, ADC and the score of MMSE were analyzed separately. The NAA/Cr, mI/Cr and ADC values in the hippocampus among AD, MCI patients, and controls were significantly different (p<0.05). At a fixed specificity of 84.6%, the high sensitivity of 100% and 92.9% in differentiating AD and MCI from normal controls were obtained by combining the three indicators. The receiver operating characteristic plots illustrated that the area under the multimarker curve was the biggest among the all four curves, and the sensitivity of the multimarkers was highest. The best correlation was obtained between ADC and MMSE, rather than between NAA or mI and MMSE. Thus, we found that changes in NAA/Cr, mI/Cr and ADC in the hippocampus and the temporoparietal regions were helpful in the clinical diagnosis of MCI. Furthermore, these changes showed potential in predicting the progression of MCI to AD if the multimarkers were combined.
我们旨在研究先进的功能磁共振成像(fMRI)技术,如质子磁共振波谱((1)H-MRS)和扩散加权成像(DWI)中的表观扩散系数(ADC)值,在轻度认知障碍(MCI)诊断中的应用。为提高MRS和ADC的早期诊断价值,我们综合了多个指标。我们对13例阿尔茨海默病(AD)患者、9例MCI患者和13例对照患者进行了MRS和DWI-ADC检查。比较了各组海马体和颞顶叶区域中N-乙酰天门冬氨酸/肌酸和磷酸肌酸(NAA/Cr)、肌醇/肌酸(mI/Cr)以及ADC值的变化。分别分析了不同标志物的敏感性和特异性,并将其与其他标志物进行组合分析。所有参与者均接受简易精神状态检查(MMSE)评估,并分别分析NAA/Cr、MI/Cr、ADC与MMSE评分之间的相关性。AD、MCI患者和对照组海马体中的NAA/Cr、mI/Cr和ADC值存在显著差异(p<0.05)。在固定特异性为84.6%的情况下,通过组合这三个指标,在区分AD和MCI与正常对照组时获得了100%和92.9%的高敏感性。受试者工作特征曲线表明,多标志物曲线下的面积在所有四条曲线中最大,且多标志物的敏感性最高。ADC与MMSE之间的相关性最佳,而非NAA或mI与MMSE之间。因此,我们发现海马体和颞顶叶区域中NAA/Cr、mI/Cr和ADC的变化有助于MCI的临床诊断。此外,如果将多标志物组合,这些变化在预测MCI向AD的进展方面显示出潜力。