Li Shasha, Chen Qin, Yu Bo, Xue Kaiqing, Luo Cheng, Xu Yanming, Gong Qiyong, He Chengqi, Zhou Dong, He Li, Yao Dezhong
Department of Neurology, West China Hospital of Sichuan University, No. 37 Guo-xue-xiang Street, Chengdu, Sichuan, P. R. China.
Amyotroph Lateral Scler. 2009 Oct-Dec;10(5-6):280-7. doi: 10.3109/17482960902893342.
The purpose of this study was to explore cerebral structural and functional changes in amyotrophic lateral sclerosis (ALS) patients with or without dysphagia compared with healthy adults. In total, five ALS patients with dysphagia, five ALS patients without dysphagia and 10 healthy controls were evaluated using diffusion tensor magnetic resonance imaging (DTI) and event-related functional magnetic resonance imaging (fMRI) while laryngeal swallow-related movements were recorded. The fMRI data were analysed using the general linear model to gain the differential statistical map (two-sample t-test) for each group. Maps of fractional anisotropy (FA) and mean diffusivity (MD) were calculated within the masks that corresponded to the different statistical functional maps of intergroup comparisons. During the voluntary saliva swallowing, prominent activation of foci corresponded to the primary sensorimotor (SM) cortex in both ALS and controls, while decreased activation of the SM cortex was observed in ALS patients with dysphagia. DTI analysis revealed that FA was significantly reduced and MD was typically increased in the posterior limb of the internal capsule, thalamus, and anterior cingulate gyrus, as well as in the insula of ALS patients compared with controls. However, in ALS patients with dysphagia, FA and MD were more sensitive to these changes than ALS patients without dysphagia. This study highlights the potential of DTI and fMRI for monitoring structural degeneration and functional changes in patients with ALS. This study is the first to demonstrate that cerebral activation map changes correspond to distribution patterns of diffusion abnormalities. Combined non-invasive neuroimaging techniques may be useful tools to assess prognosis and study rehabilitation strategies for dysphagic ALS patients, especially for patients who are MRI-negative by conventional methods.
本研究的目的是探讨与健康成年人相比，有或无吞咽困难的肌萎缩侧索硬化症（ALS）患者的脑结构和功能变化。总共对5名有吞咽困难的ALS患者、5名无吞咽困难的ALS患者和10名健康对照者进行了评估，采用扩散张量磁共振成像（DTI）和事件相关功能磁共振成像（fMRI），同时记录与喉部吞咽相关的动作。使用一般线性模型分析fMRI数据，以获得每组的差异统计图（双样本t检验）。在对应于组间比较的不同统计功能图的掩码内计算分数各向异性（FA）和平均扩散率（MD）图。在自主吞咽唾液期间，ALS患者和对照组中与初级感觉运动（SM）皮层相对应的焦点均有明显激活，而有吞咽困难的ALS患者中观察到SM皮层的激活减少。DTI分析显示，与对照组相比，ALS患者内囊后肢、丘脑、前扣带回以及岛叶的FA显著降低，MD通常升高。然而，与无吞咽困难的ALS患者相比，有吞咽困难的ALS患者的FA和MD对这些变化更敏感。本研究强调了DTI和fMRI在监测ALS患者结构退变和功能变化方面的潜力。本研究首次证明脑激活图变化与扩散异常的分布模式相对应。联合非侵入性神经成像技术可能是评估吞咽困难的ALS患者预后和研究康复策略的有用工具，特别是对于那些通过传统方法MRI呈阴性的患者。
