Castellanos F X, Giedd J N, Marsh W L, Hamburger S D, Vaituzis A C, Dickstein D P, Sarfatti S E, Vauss Y C, Snell J W, Lange N, Kaysen D, Krain A L, Ritchie G F, Rajapakse J C, Rapoport J L
Child Psychiatry Branch, National Institute of Mental Health, Bethesda, Md, USA.
Arch Gen Psychiatry. 1996 Jul;53(7):607-16. doi: 10.1001/archpsyc.1996.01830070053009.
Anatomic magnetic resonance imaging (MRI) studies of attention-deficit hyperactivity disorder (ADHD) have been limited by small samples or measurement of single brain regions. Since the neuropsychological deficits in ADHD implicate a network linking basal ganglia and frontal regions, 12 subcortical and cortical regions and their symmetries were measured to determine if these structures best distinguished ADHD.
Anatomic brain MRIs for 57 boys with ADHD and 55 healthy matched controls, aged 5 to 18 years, were obtained using a 1.5-T scanner with contiguous 2-mm sections. Volumetric measures of the cerebrum, caudate nucleus, putamen, globus pallidus, amygdala, hippocampus, temporal lobe, cerebellum; a measure of prefrontal cortex; and related right-left asymmetries were examined along with midsagittal area measures of the cerebellum and corpus callosum. Interrater reliabilities were .82 or greater for all MRI measures.
Subjects with ADHD had a 4.7% smaller total cerebral volume (P = .02). Analysis of covariance for total cerebral volume demonstrated a significant loss of normal right > left asymmetry in the caudate (P = .006), smaller right globus pallidus (P = .005), smaller right anterior frontal region (P = .02), smaller cerebellum (P = .05), and reversal of normal lateral ventricular asymmetry (P = .03) in the ADHD group. The normal age-related decrease in caudate volume was not seen, and increases in lateral ventricular volumes were significantly diminished in ADHD.
This first comprehensive morphometric analysis is consistent with hypothesized dysfunction of right-sided prefrontal-striatal systems in ADHD.
注意力缺陷多动障碍（ADHD）的解剖磁共振成像（MRI）研究因样本量小或仅对单个脑区进行测量而受到限制。由于ADHD的神经心理学缺陷涉及一个连接基底神经节和额叶区域的网络，因此测量了12个皮质下和皮质区域及其对称性，以确定这些结构是否最能区分ADHD。
使用1.5-T扫描仪获取了57名5至18岁患有ADHD的男孩和55名健康匹配对照的脑部解剖MRI，扫描层厚为2毫米且连续。测量了大脑、尾状核、壳核、苍白球、杏仁核、海马体、颞叶、小脑的体积；前额叶皮质的测量值；以及相关的左右不对称性，同时还测量了小脑和胼胝体的矢状中面积。所有MRI测量的评分者间信度均为0.82或更高。
患有ADHD的受试者的全脑总体积小4.7%（P = 0.02）。对全脑总体积进行协方差分析显示，ADHD组尾状核正常的右>左不对称性显著丧失（P = 0.006），右侧苍白球较小（P = 0.005），右侧前额叶区域较小（P = 0.02），小脑较小（P = 0.05），以及正常的侧脑室不对称性逆转（P = 0.03）。未观察到ADHD组尾状核体积随年龄正常减少的情况，且侧脑室体积的增加在ADHD组中显著减少。
这首次全面的形态计量学分析与ADHD中右侧前额叶-纹状体系统功能障碍的假设一致。
