Department of Neurology and Neurological Science, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
Division of Ultra-High Field MRI, Institute for Biomedical Sciences, Iwate Medical University, Iwate, Japan.
Brain Imaging Behav. 2018 Apr;12(2):309-323. doi: 10.1007/s11682-017-9698-7.
Left hemispatial neglect (neglect) is an impaired state of spatial attention. We aimed to reconstruct structural connectivity in the spatial attention network and to identify disconnection patterns underlying neglect. We enrolled 59 right-handed patients who had their first-ever infarction in the right hemisphere and classified them into neglect group (34 patients with neglect) and control group (25 patients without neglect). The neglect group was further subcategorized into 6 subgroups based on infarcted vascular territories. Diffusion tensor imaging data were obtained from all patients. Fractional anisotropy maps were compared between neglect group/subgroups and the control group by using non-parametric voxel-based analysis, generating a lesion path mask. Probabilistic tractography analysis using the lesion path mask reconstructed the following structural connectivity in the spatial attention network, which is specifically damaged in neglect patients: (1) superior longitudinal fasciculus (SLF) I connecting the superior parietal lobule/intraparietal sulcus with the superior frontal gyrus/frontal eye field (SFG/FEF) (dorsal attention network); (2) SLF III/the arcuate fasciculus (AF) and the extreme capsule/inferior fronto-occipital fasciculus (IFOF) connecting the right inferior parietal lobule/temporoparietal junction/superior temporal gyrus (IPL/TPJ/STG) with the middle frontal gyrus/inferior frontal gyrus (ventral attention network); (3) the thalamic radiations to the spatial attention-related cortices; and (4) SLF II and IFOF interconnecting dorsal and ventral attention networks. Individual analysis indicated that isolated damage in SLF I, SLF II, SLF III/AF or the thalamic radiations to IPL/TPJ/STG due to posterior cerebral artery infarction, or simultaneous damage in four thalamic radiations due to anterior choroidal artery infarction, underlies different phenotypes of neglect.
左侧空间忽略（忽略）是一种空间注意力受损的状态。我们旨在重建空间注意力网络的结构连接，并确定忽略的分离模式。我们招募了 59 名首次在右半球发生梗死的右利手患者，并将他们分为忽略组（34 名忽略患者）和对照组（25 名无忽略患者）。忽略组进一步根据梗死的血管区域分为 6 个亚组。所有患者均获得弥散张量成像数据。通过非参数体素基分析比较忽略组/亚组和对照组之间的各向异性分数图，生成病变路径掩模。使用病变路径掩模进行概率追踪分析，重建空间注意力网络中的以下结构连接，这些连接在忽略患者中受到特异性损伤：（1）连接顶上回/顶间沟与额上回/额眼区（背侧注意力网络）的上纵束（SLF）I；（2）连接右顶下小叶/颞顶联合区/颞上回与额中回/额下回的 SLF III/弓状束（AF）和极囊/下额枕束（IFOF）（腹侧注意力网络）；（3）丘脑辐射至与空间注意力相关的皮质；（4）连接背侧和腹侧注意力网络的 SLF II 和 IFOF。个体分析表明，由于大脑后动脉梗死导致的 SLF I、SLF II、SLF III/AF 或丘脑辐射至 IPL/TPJ/STG 的孤立损伤，或由于前脉络膜动脉梗死导致的 4 条丘脑辐射的同时损伤，是不同忽略表型的基础。
