Department of Neurology, Konkuk University Hospital, Seoul, Korea.
J Neuroimaging. 2011 Oct;21(4):317-24. doi: 10.1111/j.1552-6569.2010.00527.x. Epub 2010 Oct 26.
Patients with small vessel disease show high-signal intensity on T2-weighted magnetic resonance (MR) images that represent ischemic cell damage. However, despite a similar degree of ischemic change, the amount and the severity of clinical presentations may vary. We investigated the clinical correlations of ischemic changes using voxel-based morphometric analyses of diffusion tensor imaging (DTI).
Twenty-seven MCI and 34 dementia patients were included who all had significant small vessel disease on magnetic resonance imaging (MRI). In all patients, neuropsychological tests, a rating on the Pyramidal and Extrapyramidal scale (PEPS) for motor deficits, and 3-Tesla MRI including DTI scans were performed. Voxel-based analysis of the fractional anisotropy and mean diffusivity maps were computed.
Cognitive scores correlated with the DTI abnormalities in supratentorial areas with regional specificity according to each cognitive test. Unexpectedly, cognitive deficits in most neuropsychological tests, even in some frontal tasks, were associated with disruption of posterior white matter integrities. Motor deficits correlated with both supra- and infratentorial lesions.
Our findings suggest that in patients with small vessel disease who show cognitive and motor impairments, a specific distribution of fiber tract damage is more related with clinical deficits than is the severity of the total ischemia.
小血管疾病患者的 T2 加权磁共振（MR）图像上呈现高信号强度，代表缺血性细胞损伤。然而，尽管存在相似程度的缺血性改变，但临床表现的程度和严重程度可能会有所不同。我们使用基于体素的形态计量学分析扩散张量成像（DTI）来研究缺血性改变的临床相关性。
纳入了 27 例 MCI 和 34 例痴呆患者，这些患者在磁共振成像（MRI）上均有明显的小血管疾病。所有患者均进行了神经心理学测试、针对运动缺陷的锥体束和锥体外系量表（PEPS）评分，以及 3-Tesla MRI 包括 DTI 扫描。计算了各向异性分数和平均弥散度图的基于体素的分析。
认知评分与额顶叶区域的 DTI 异常相关，且根据每项认知测试具有区域特异性。出乎意料的是，大多数神经心理学测试中的认知缺陷，甚至一些额部任务，都与后白质完整性的破坏有关。运动缺陷与幕上和幕下病变均相关。
我们的研究结果表明，在表现出认知和运动障碍的小血管疾病患者中，纤维束损伤的特定分布与临床缺陷的相关性大于总缺血的严重程度。
