Sabri O, Hellwig D, Schreckenberger M, Cremerius U, Schneider R, Kaiser H J, Doherty C, Mull M, Ringelstein E B, Buell U
Department of Nuclear Medicine, Aachen University of Technology, Germany.
J Nucl Med. 1998 Jan;39(1):147-54.
Cerebral microangiopathy, indicated in MRI by lacunar infarctions (LIs) and deep white matter lesions (DWMLs), is said to be accompanied by vascular dementia, which is reportedly caused by LI and DWML.
To confirm this assumption, 57 patients with cerebral microangiopathy were assessed for changes in regional cerebral blood flow (rCBF) and glucose utilization (rMRGlu) in both white matter and cortex, and these findings were correlated to the results of extensive neuropsychological testing (cognitive, mnestic and attentiveness tests), as well as to MRI findings. A special head holder ensured reproducibility of positioning during measurement of rCBF (99mTc-HMPAO SPECT) and rMRGlu (18F-FDG PET) and MRI. White matter and cortex were quantified with regions of interest defined on MRI and superimposed to corresponding PET/SPECT slices. The rMRGlu was calculated according to Sokoloff, and rCBF was determined from normalization to the cerebellum. LI and DWML were graded by number and extent. Brain atrophy was classified as no to slight inner and/or outer atrophy (Group A) or moderate-to-severe inner and outer atrophy (Group B).
Even in severe DWMLs and in multiple LIs, rCBFs and rMRGlu values were not reduced. Analysis of variance identified atrophy and neuropsychological deficits as the main determinants for reduced rCBF and rMRGlu values (p < 0.05). However, 60% of patients (19 of 31) with neuropsychological deficits in attentiveness tests and 61% of patients (23 of 38) with mnestic deficits belonged to Group A and revealed decreased rCBF and rMRGlu values. Neuropsychological deficits correlated well with decreased rCBF and rMRGlu, whereas MRI patterns, such as LI and DWML, did not.
We conclude that LI and DWML are epiphenomena that morphologically characterize cerebral microangiopathy. Dementia or neuropsychological deficits, however, are exclusively reflected by functional criteria (rCBF and rMRGlu), as long as cerebral atrophy does not occur.
脑微血管病变在磁共振成像（MRI）上表现为腔隙性脑梗死（LI）和深部白质病变（DWML），据说伴有血管性痴呆，据报道血管性痴呆是由LI和DWML引起的。
为证实这一假设，对57例脑微血管病变患者的白质和皮质区域脑血流量（rCBF）和葡萄糖利用率（rMRGlu）变化进行评估，并将这些结果与广泛的神经心理学测试（认知、记忆和注意力测试）结果以及MRI结果相关联。一种特殊的头部固定器可确保在测量rCBF（99mTc-HMPAO单光子发射计算机断层扫描）、rMRGlu（18F-氟代脱氧葡萄糖正电子发射断层扫描）和MRI期间定位的可重复性。利用MRI上定义的感兴趣区域对白质和皮质进行量化，并将其叠加到相应的PET/SPECT切片上。rMRGlu根据索科洛夫法计算，rCBF通过与小脑归一化来确定。LI和DWML根据数量和范围分级。脑萎缩分为无至轻度的内侧和/或外侧萎缩（A组）或中度至重度的内侧和外侧萎缩（B组）。
即使在严重的DWML和多发性LI中，rCBF和rMRGlu值也未降低。方差分析确定萎缩和神经心理学缺陷是rCBF和rMRGlu值降低的主要决定因素（p<0.05）。然而，在注意力测试中有神经心理学缺陷的患者中，60%（31例中的19例）以及在记忆测试中有缺陷的患者中，61%（38例中的23例）属于A组，且rCBF和rMRGlu值降低。神经心理学缺陷与rCBF和rMRGlu降低密切相关，而LI和DWML等MRI模式则不然。
我们得出结论，LI和DWML是脑微血管病变的形态学特征性附带现象。然而，只要不发生脑萎缩，痴呆或神经心理学缺陷仅由功能标准（rCBF和rMRGlu）反映。
