Chen Zhi-Ye, Liu Meng-Qi, Ma Lin
Department of Radiology, Chinese PLA General Hospital, Beijing 100853, China;Department of Radiology, Hainan Branch of Chinese PLA General Hospital, Sanya, Hainan 572013, China.
Department of Radiology, Chinese PLA General Hospital, Beijing 100853, China.
Chin Med Sci J. 2018 Mar 30;33(1):20-28. doi: 10.24920/11804.
Objective To investigate cerebral structural signatures of the bulbar- and spinal-onset amyotrophic lateral sclerosis (ALS) using voxel-based morphometry on magnetic resonance imaging. Methods The MR structural images of the brain were obtained from 65 ALS patients (15 bulbar-onset, 50 spinal-onset) and 65 normal controls (NC) on a 3.0T MRI system. Gray matter (GM) volume changes were investigated by voxel-based morphometry, and the distribution of the brain regions with volume changes was compared between ALS and normal controls, as well as between bulbar-onset and spinal-onset ALS based on Neuromorphometrics atlas. Result On voxel-level the decreased volume of brain regions in ALS patients was located in the right precentral gyrus (rPrcGy) and right middle frontal gyrus compared with that in NC. The bulbar-onset ALS presented extra-motor cortex atrophy (fronto-temporal pattern), including left medial orbital gyrus, left inferior temporal gyrus and right middle temporal gyrus; the spinal-onset ALS suffered from motor cortex atrophy (rPrcGy dominance) and extra-motor cortex atrophy (fronto-temporal and extra-fronto-temporal pattern) compared with NC. The spinal-onset ALS featured by GM volume loss of left postcentral gyrus and bulbar-onset ALS featured by GM volume loss of left middle temporal gyrus compared with each other. Conclusions The asymmetric GM atrophy of the motor cortex and extra-motor cortex represents the common MRI structural signatures of spinal-onset ALS, and sole extra-motor cortex atrophy represents the structural signatures of bulbar-onset ALS. The present study also demonstrated that the pattern of GM damage is likely to distribute wider in spinal-onset ALS than in bulbar-onset ALS.
目的 采用基于体素的形态测量法在磁共振成像上研究延髓和脊髓起病的肌萎缩侧索硬化症（ALS）的脑结构特征。方法 在3.0T磁共振成像系统上获取65例ALS患者（15例延髓起病，50例脊髓起病）和65例正常对照（NC）的脑磁共振结构图像。通过基于体素的形态测量法研究灰质（GM）体积变化，并根据神经形态测量图谱比较ALS患者与正常对照之间以及延髓起病和脊髓起病的ALS之间体积变化的脑区分布。结果 在体素水平上，与NC相比，ALS患者脑区体积减小位于右侧中央前回（rPrcGy）和右侧额中回。延髓起病的ALS表现为运动外皮质萎缩（额颞型），包括左侧眶内侧回、左侧颞下回和右侧颞中回；与NC相比，脊髓起病的ALS存在运动皮质萎缩（以rPrcGy为主）和运动外皮质萎缩（额颞型和额颞外型）。脊髓起病的ALS以左侧中央后回GM体积丢失为特征，延髓起病的ALS以左侧颞中回GM体积丢失为特征。结论 运动皮质和运动外皮质的不对称GM萎缩代表脊髓起病ALS常见的磁共振成像结构特征，单纯运动外皮质萎缩代表延髓起病ALS的结构特征。本研究还表明，脊髓起病ALS中GM损伤模式可能比延髓起病ALS分布更广泛。
