Shyu W C, Lin J C, Shen C C, Hsu Y D, Lee C C, Shiah I S, Tsao W L
Department of Neurology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, R.O.C.
Eur J Nucl Med. 1996 Oct;23(10):1338-44. doi: 10.1007/BF01367589.
In 24 patients with vascular dementia of Binswanger's type (VDBT) and 14 age-matched neurologically normal volunteers, we investigated the relationship between clinical features, white matter lesions (leuco-araiosis) and cerebral atrophy on computed tomographic (CT) scan, and regional cerebral blood flow. All subjects underwent the Mini-Mental State Examination of Taiwan, version 1 (MMSE-T1), for assessing the severity of cognitive impairment. The patients were subdivided into two groups, one with mild to moderate (group I, MMSE-T1 scores: 11-24, n=11), and the other with severe dementia (group II, MMSE-T1 scores: below 10, n=13). White matter degeneration was evaluated with densitometric methods. Loss of brain parenchyma was estimated with seven linear measurements (Evan's ratio, third ventricle ratio, width of temporal horn tip, anterior-posterior length of temporal horn, anterior-posterior length of Sylvian fissure and width of frontal interhemispheric fissure) by CT scans. Regional cerebral blood flow was determined with technetium-99m hexamethylpropylene amine oxime (HMPAO) single-photon emission tomography (SPET). In neuroimaging studies, subcortical leuco-araiosis was localized at the frontal region in group I patients and scattered diffusely in group II patients. 99mTc-HMPAO SPET analysis revealed reduction of regional cerebral blood flow in the frontal lobe in group I patients and widespread reduction of regional cerebral blood flow in group II patients. A correlation between frontal leuco-araiosis and perfusion defect of the frontal pole was demonstrated in group I patients, showing findings typical of subcortical dementia. There was no difference in frontal atrophic measurements between group I patients and controls. Ratios of volumes of lost brain parenchyma and leuco-araiosis were significantly higher in group II patients than in the age-matched controls, corresponding to a diffuse cerebral perfusion defect. These results suggest that patients with VDBT have early frontal lobe involvement with posterior progression. Patients with mild VDBT are more likely to show reduction of frontal cerebral blood flow and leuco-araiosis, while those with severe VDBT are more likely to have diffuse leuco-araiosis, cerebral hypoperfusion and brain atrophy.
在24例宾斯旺格型血管性痴呆（VDBT）患者和14名年龄匹配的神经功能正常的志愿者中，我们研究了临床特征、白质病变（脑白质疏松）、计算机断层扫描（CT）上的脑萎缩与局部脑血流量之间的关系。所有受试者均接受了台湾简易精神状态检查表第1版（MMSE-T1），以评估认知障碍的严重程度。患者被分为两组，一组为轻度至中度（第一组，MMSE-T1评分：11 - 24，n = 11），另一组为重度痴呆（第二组，MMSE-T1评分：低于10，n = 13）。采用密度测定法评估白质变性。通过CT扫描，用七项线性测量指标（埃文斯比率、第三脑室比率、颞角尖宽度、颞角前后长度、大脑外侧裂前后长度和额叶半球间裂宽度）估计脑实质的丢失情况。用锝-99m六甲基丙烯胺肟（HMPAO）单光子发射断层扫描（SPET）测定局部脑血流量。在神经影像学研究中，第一组患者的皮质下脑白质疏松位于额叶区域，而第二组患者则广泛散在分布。99mTc-HMPAO SPET分析显示，第一组患者额叶局部脑血流量减少，第二组患者局部脑血流量广泛减少。在第一组患者中，额叶脑白质疏松与额极灌注缺损之间存在相关性，显示出皮质下痴呆的典型表现。第一组患者与对照组在额叶萎缩测量方面无差异。第二组患者脑实质丢失体积与脑白质疏松的比率显著高于年龄匹配的对照组，对应于弥漫性脑灌注缺损。这些结果表明，VDBT患者早期额叶受累并向后发展。轻度VDBT患者更可能出现额叶脑血流量减少和脑白质疏松，而重度VDBT患者更可能出现弥漫性脑白质疏松、脑灌注不足和脑萎缩。
