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目的明确脑淀粉样血管病(CAA)患者白质损害的影像学特征,以及与其他脑小血管病(CSVD)标志物的相关性。方法回顾性分析2014年12月至2016年12月收集的28例很可能的CAA患者(CAA组)和56例合并CSVD危险因素的健康老年人(非CAA组)在临床信息,影像学标志物和白质损害之间的差异;白质损害分别从脑网络连接改变和定量白质高信号(WMH)体积的严重程度和分布特征(后-前部梯度)进行评估,以弥散张量成像中各向异性分数(FA)作为测量脑网络连接参数。分析CAA患者白质损害与脑微出血灶(CMBs)、血管周间隙(PVS)、CSVD积分等影像标志物的相关性。结果白质损害方面,与非CAA组比较,CAA组的全脑WMH体积(P<0.001)和后-前部梯度(P=0.004)增加,FA后部均值(P=0.037)和后-前部梯度(P=0.004)降低。相关性分析表明:CAA组的全脑FA均值与WMH体积无相关性(P=0.151),而两组的后-前部梯度线性相关(P=0.029);全脑FA均值与脑叶CMBs数目(P=0.036)、CSVD积分(P=0.049)存在相关性,但这一相关性未在WMH体积中发现。结论脑网络连接下降、WMH体积增加是CAA白质损害的重要影像学标志物,具有后部分布为主的显著特征。脑网络连接下降可在一定程度上反映CAA的病理改变和疾病严重程度。
Objective To clarify the imaging features of white matter lesion in patients with cerebral amyloid angiopathy (CAA) and its correlation with other cerebrovascular disease (CSVD) markers. Methods A retrospective analysis of 28 probable CAA patients (CAA group) and 56 healthy elderly patients (non-CAA group) with CSVD risk factors collected from December 2014 to December 2016 in clinical information, imaging markers And white matter damage; white matter damage was assessed from changes in brain network connectivity and the severity and distribution of white matter hyperintensities (post-anterior gradients), respectively, to diffuse the anisotropy of tensor imaging Score (FA) as a measure of brain network connection parameters. To analyze the correlation between white matter damage and imaging markers such as cerebral microvascular hemorrhage (CMBs), perivascular space (PVS) and CSVD integral in CAA patients. Results Compared with non-CAA group, the WMH volume (P <0.001) and the posterior-anterior gradient (P = 0.004) increased in the CAA group. The posterior-mean anterior (FA) Gradient (P = 0.004) decreased. Correlation analysis showed that there was no correlation between FA and WMH volume in CAA group (P = 0.151), while the posterior-anterior gradient was linearly related to CAA (P = 0.029) (P = 0.036), CSVD score (P = 0.049), but this correlation was not found in the WMH volume. Conclusions The decrease of brain network connection and the increase of volume of WMH are important imaging markers of white matter damage in CAA, with prominent features of posterior distribution. Decreased brain network connection may reflect the pathological changes of CAA and the severity of the disease to a certain extent.