复发缓解型多发性硬化症患者白质退行性病变与认知功能障碍的空间分布
Spatial distribution of white matter degenerative lesions and cognitive dysfunction in relapsing-remitting multiple sclerosis patients.
作者信息
Nowaczyk Natalia, Kalinowska-Łyszczarz Alicja, Paprzycki Włodzimierz, Michalak Sławomir, Kaźmierski Radosław, Pawlak Mikołaj A
机构信息
Department of Health Psychology and Clinical Psychology Institute of Psychology, Adam Mickiewicz University in Poznan, Poland.
Division of Neurochemistry and Neuropathology, Department of Neurology, Poznan University of Medical Sciences (PUMS), 49 Przybyszewskiego Street, Poznan, Poland.
出版信息
Neurol Neurochir Pol. 2019;53(1):18-25. doi: 10.5603/PJNNS.a2018.0001. Epub 2019 Feb 11.
AIM
The aim of this study was to assess degenerative lesion localisation in the course of relapsing-remitting multiple sclerosis (RRMS) and to identify the association between localisation and the frequency of T1-hypointense lesions (black holes) with cognitive dysfunction. We also searched for neuroradiological predictors of cognitive dysfunction in patients. The clinical rationale for the study was previous research, and our own findings suggest that lesion localisation plays an important role in cognitive performance and neurological disability of MS patients.
MATERIAL AND METHODS
Forty-two patients were included in the study. All subjects underwent neuropsychological examination using Raven's Coloured Progressive Matrices, a naming task from the Brief Repeatable Battery of Neuropsychological Tests, and attention to detail tests. Magnetic resonance imaging (MRI) was acquired on 1.5 Tesla scanner and black holes were manually segmented on T1-weighted volumetric images using the FMRIB Software Library. Linear regression was applied to establish a relationship between black hole volume per lobe and cognitive parameters. Bonferroni correction of voxelwise analysis was used to correct for multiple comparisons.
RESULTS
The following associations between black hole volume and cognition were identified: frontal lobes black hole volume was associated with phonemic verbal fluency (t = -4.013, p < 0.001), parietal black hole volume was associated with attention (t = -3.776, p < 0.001), and parietal and temporal black hole volumes were associated with nonverbal intelligence (p < 0.001). The volume of parietal black holes was the best predictor of cognitive dysfunction.
CONCLUSIONS
Our approach, including measurement of focal axonal loss based on T1-volumetric MRI sequence and brief neuropsychological assessment, might improve personalised diagnostic and therapeutic decisions in clinical practice.
目的
本研究旨在评估复发缓解型多发性硬化症（RRMS）病程中的退行性病变定位，并确定病变定位与T1低信号病变（黑洞）频率及认知功能障碍之间的关联。我们还探寻了患者认知功能障碍的神经放射学预测指标。本研究的临床依据是既往研究，且我们自己的研究结果表明病变定位在MS患者的认知表现和神经功能残疾中起重要作用。
材料与方法
42例患者纳入本研究。所有受试者均接受了神经心理学检查，包括使用瑞文彩色渐进矩阵测验、简短可重复神经心理测验电池中的命名任务以及细节注意测试。在1.5特斯拉扫描仪上进行磁共振成像（MRI），并使用FMRIB软件库在T1加权容积图像上手动分割黑洞。应用线性回归来建立每个脑叶黑洞体积与认知参数之间的关系。采用体素分析的Bonferroni校正来校正多重比较。
结果
确定了黑洞体积与认知之间的以下关联：额叶黑洞体积与语音语言流畅性相关（t = -4.013，p < 0.001），顶叶黑洞体积与注意力相关（t = -3.776，p < 0.001），顶叶和颞叶黑洞体积与非言语智力相关（p < 0.001）。顶叶黑洞体积是认知功能障碍的最佳预测指标。
结论
我们的方法，包括基于T1容积MRI序列测量局灶性轴突损失和简短神经心理学评估，可能会改善临床实践中的个性化诊断和治疗决策。
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