de Leon M J, Golomb J, George A E, Convit A, Tarshish C Y, McRae T, De Santi S, Smith G, Ferris S H, Noz M
Department of Psychiatry, New York University Medical Center, NY 10016.
AJNR Am J Neuroradiol. 1993 Jul-Aug;14(4):897-906.
To test the hypothesis that atrophy of the hippocampal formation in nondemented elderly individuals would predict subsequent Alzheimer disease.
We studied 86 subjects at two time points, 4 years apart. At baseline all study subjects were nondemented and included 54 control subjects and 32 persons who had memory complaints and minimal cognitive impairments. All subjects received a CT scan using a protocol designed to image the perihippocampal cerebrospinal fluid (HCSF) accumulating in the fissures along the axis of the hippocampal formation. Blind to the clinical evaluations, we subjectively assessed the presence of HCSF at the baseline. Retrospectively, we examined the predicted association between baseline HCSF and clinical decline as determined across the two evaluations.
At follow-up 25 of the 86 subjects had deteriorated and received the diagnosis of Alzheimer disease. Of the declining subjects, 23 came from the minimally impaired group, and 2 came from the control group. In the minimally impaired group the baseline HCSF measure had a sensitivity of 91% and a specificity of 89% as a predictor of decline. Both control subjects who deteriorated were also correctly identified at baseline. One of these two subjects died, and an autopsy confirmed the presence of Alzheimer disease. M(r) validation studies demonstrated that HCSF is quantitatively related to dilatation of the transverse fissure of Bichat and the choroidal and hippocampal fissures.
Our findings strongly suggest that among persons with mild memory impairments, dilatation of the perihippocampal fissures is a useful radiologic marker for identifying the early features of Alzheimer disease.
检验非痴呆老年人海马结构萎缩能否预测随后发生的阿尔茨海默病这一假设。
我们在两个时间点对86名受试者进行了研究，时间间隔为4年。基线时，所有研究对象均未患痴呆，包括54名对照受试者和32名有记忆主诉及轻度认知障碍的人。所有受试者均接受了CT扫描，扫描方案旨在对沿海马结构轴在脑沟中积聚的海马周围脑脊液（HCSF）进行成像。在对临床评估不知情的情况下，我们在基线时主观评估了HCSF的存在情况。回顾性地，我们检查了基线HCSF与两次评估所确定的临床衰退之间的预测关联。
在随访时，86名受试者中有25人病情恶化并被诊断为阿尔茨海默病。在病情恶化的受试者中，23人来自轻度受损组，2人来自对照组。在轻度受损组中，基线HCSF测量作为衰退预测指标的敏感性为91%，特异性为89%。两名病情恶化的对照受试者在基线时也被正确识别。这两名受试者中有一人死亡，尸检证实存在阿尔茨海默病。M(r)验证研究表明，HCSF与比沙氏横裂、脉络膜裂和海马裂的扩张在数量上相关。
我们的研究结果强烈表明，在轻度记忆障碍患者中，海马周围脑沟扩张是识别阿尔茨海默病早期特征的有用影像学标志物。
