Hagiwara M
Second Department of Internal Medicine, Nippon Medical School, Tokyo, Japan.
Nihon Ika Daigaku Zasshi. 1990 Jun;57(3):265-75. doi: 10.1272/jnms1923.57.265.
For the evaluation of differential diagnosis and estimation of the functional prognosis for vascular dementia (VD), the usefulness of computed tomography (CT) and magnetic resonance imaging (MRI) in detecting cerebro-vascular lesions was compared. Then the correlations between the degrees of mental function (Hasegawa's dementia rating scale: HDRS, activity of daily living: ADL, troublesome behaviors: TB) and the CT findings of vascular dementia were examined retrospectively. A hundred and seventeen dementia patients (male: 79 cases, female: 38 cases; mean-age 69.5 +/- 10.9 years old), diagnosed using DSM-III criteria, were scored according to Hachinski's ischemic score (I.S.) by clinical course and symptoms. Both MRI and CT were carried out on 56 dementia cases (male: 21 cases, female: 35 cases; mean-age 78.0 +/- 7.4 years old) at the chronic stage of the cerebro-vascular accidents to compare the detectiveness of vascular lesions. In 90 vascular dementia patients on whom only CT was carried out, the imagings were classified according to number, size, and localization. The correlation between these parameters and the degree of dementia were examined retrospectively. MRI was more useful and sensitive than CT for differentiating VD from DAT (dementia of Alzheimer type), since MRI was superior to CT in detecting small infarcts or lacunaes on the perforating area or white matter. Cases with positive findings on CT or MRI but clinically diagnosed as DAT by I.S. showed poorer ADL.(ABSTRACT TRUNCATED AT 250 WORDS)
为评估血管性痴呆(VD)的鉴别诊断及功能预后,比较了计算机断层扫描(CT)和磁共振成像(MRI)在检测脑血管病变方面的效用。然后回顾性研究了血管性痴呆患者的精神功能程度(长谷川痴呆评定量表:HDRS)、日常生活活动能力(ADL)、行为问题(TB)与CT表现之间的相关性。117例根据DSM-III标准诊断的痴呆患者(男性79例,女性38例;平均年龄69.5±10.9岁),根据哈金斯基缺血评分(I.S.)按临床病程和症状进行评分。对56例脑血管意外慢性期的痴呆患者(男性21例,女性35例;平均年龄78.0±7.4岁)进行了MRI和CT检查,以比较血管病变的检出率。对仅进行CT检查的90例血管性痴呆患者,根据病变数量、大小和部位对图像进行分类。回顾性研究这些参数与痴呆程度之间的相关性。MRI在区分VD与阿尔茨海默型痴呆(DAT)方面比CT更有用、更敏感,因为MRI在检测穿通区或白质的小梗死灶或腔隙方面优于CT。CT或MRI有阳性发现但根据I.S.临床诊断为DAT的患者ADL较差。(摘要截短于250字)