Wang Po-Shan, Yeh Chien-Li, Lu Chia-Feng, Wu Hsiu-Mei, Soong Bing-Wen, Wu Yu-Te
Insitute of Biophotonics, National Yang-Ming University, Taipei, Taiwan.
Brain Research Center, National Yang-Ming University, Taipei, Taiwan.
Acta Neurol Belg. 2017 Mar;117(1):213-220. doi: 10.1007/s13760-016-0724-0. Epub 2016 Nov 23.
It has been assumed that cognitive disorder and visual-spatial disturbance in multiple system atrophy of the predominantly cerebellar type (MSA-C) are attributable to degradation of cerebellar function. The purpose of this study was to use diffusion tensor imaging (DTI) tractography to determine if patients with MSA-C characterized in part by visual-spatial disorders and cognitive disorders have changes of the structural connectivity network of nerve fibers, and to further describe the structural connectivity network. The study included 20 patients with MSA-C and 30 age- and sex-matched healthy controls. A 1.5T magnetic resonance imaging (MRI) scanner was used to obtain images for DTI tractography. Image preprocessing was done by large deformation diffeomorphic metric mapping. Whole-brain connectivity analysis was carried out. The patients had decreased numbers of long association fibers connecting the right parietal lobe to the frontal lobe. The commissural fibers and short association fibers connecting the bilateral frontal and occipital lobes and the number of short association fibers at the bilateral frontal and occipital region were also decreased significantly. The patients had a significant decrease in fiber density in the cerebellum compared to the healthy subjects. Our results provide DTI evidence suggesting that frontal and occipital white matter is involved in patients with MSA-C. This finding may correlate with their clinical symptoms such as cognitive disturbance as well as visual-spatial impairment. Therefore, cognitive disturbance and visual-spatial deficits in MSA-C might not be due to cerebellar lesions only as is widely believed but also involve cerebral lesions.
一般认为，以小脑型为主的多系统萎缩（MSA-C）中的认知障碍和视觉空间障碍可归因于小脑功能退化。本研究的目的是使用弥散张量成像（DTI）纤维束成像来确定部分以视觉空间障碍和认知障碍为特征的MSA-C患者的神经纤维结构连接网络是否发生变化，并进一步描述该结构连接网络。该研究纳入了20例MSA-C患者和30例年龄及性别匹配的健康对照者。使用1.5T磁共振成像（MRI）扫描仪获取用于DTI纤维束成像的图像。图像预处理通过大变形微分同胚度量映射完成。进行全脑连接性分析。患者连接右顶叶与额叶的长联合纤维数量减少。连接双侧额叶和枕叶的连合纤维和短联合纤维以及双侧额叶和枕叶区域的短联合纤维数量也显著减少。与健康受试者相比，患者小脑的纤维密度显著降低。我们的结果提供了DTI证据，表明额叶和枕叶白质在MSA-C患者中受累。这一发现可能与其认知障碍以及视觉空间损害等临床症状相关。因此，MSA-C中的认知障碍和视觉空间缺陷可能并非如广泛认为的那样仅由小脑病变所致，还涉及脑病变。
