Biomedical MR Science Center, Shiga University of Medical Science, Seta, Ohtsu, Shiga 520-2192, Japan.
Eur J Radiol. 2012 Sep;81(9):2375-9. doi: 10.1016/j.ejrad.2011.05.031. Epub 2011 Jun 25.
Dementia due to hypertensive vascular disease is a potential target to treat prophylactively before it progresses insidiously. Binswanger's disease (BD) is a type of subcortical vascular dementia, but its clinical features and pathophysiology are still obscure. We therefore tried to find a topographic distribution of brain atrophy in BD by morphometric analysis.
Twenty patients with BD, 50 patients with AD, and 80 elderly controls were recruited. We contrasted the gray matter atrophy of BD to that of AD to identify a pathognomic pattern using magnetic resonance imaging. We used DARTEL (diffeomorphic anatomical registration through exponential Lie algebra) for voxel-based morphometry, expecting that its sophisticated algorithm would work well to deal with the subjects with brain atrophy.
Atrophy of cortices was predominant in the posterior cortices in AD but was in the anterior cortices in BD. Atrophy of amygdala and hippocampus was similar in each disease. In contrast, thalamus, caudate nucleus, insula, anterior cingulate cortex, and frontal cortices were significantly more atrophied in BD than in AD (z-score >3).
We demonstrated topographic patterns of brain atrophy in BD. Since affected regions of BD match with the anatomical connections of frontal-subcortical circuits, it seems reasonable to suppose that BD pathology is the result of hypertensive vascular disease and subsequent regression from the white matter injuries.
由于高血压血管性疾病导致的痴呆是一种有潜力的目标，可以在其进行隐匿性进展之前进行预防性治疗。Binswanger 病（BD）是一种皮质下血管性痴呆，但它的临床特征和病理生理学仍不清楚。因此，我们试图通过形态计量学分析来寻找 BD 中脑萎缩的拓扑分布。
我们招募了 20 名 BD 患者、50 名 AD 患者和 80 名老年对照组。我们对比了 BD 和 AD 的灰质萎缩，以磁共振成像（MRI）来识别一种特征性的模式。我们使用 DARTEL（基于指数李代数的可变形解剖配准）进行体素形态计量学，期望其复杂的算法能够很好地处理有脑萎缩的受试者。
AD 中皮质萎缩主要位于后皮质，而 BD 中则位于前皮质。杏仁核和海马体的萎缩在每种疾病中相似。相比之下，丘脑、尾状核、脑岛、前扣带回皮质和额叶皮质在 BD 中比 AD 中明显更萎缩（z 分数>3）。
我们展示了 BD 中脑萎缩的拓扑模式。由于 BD 受影响的区域与额皮质下回路的解剖连接相匹配，因此可以合理地假设 BD 病理学是高血压血管性疾病和随后的白质损伤退行性病变的结果。
