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目的应用平面回波波谱成像全脑分析检测肌萎缩性侧索硬化症(ALS)病人的脑局部代谢差异。材料与方法 16例(男9例,女7例,平均年龄56.6岁)ALS病人,5例(男4例,女1例,平均年龄62.6岁)可疑ALS病人和10名健康对照受试者(男5名,女5名,平均年龄56.1岁)在签署知情同意书后行平面回波波谱成像。本研究经机构审查委员会批准并符合HIPAA。应用代谢物成像和数据分析系统软件进行数据分析,将代谢物图与标准脑模板进行匹配。应用自动化解剖标记软件将肌酸(Cr)、胆碱(Cho)和N-乙酰天门冬氨酸(NAA)的代谢图分割成81个区域以测量ALS病人的全脑代谢变化。统计分析采用非配对、无校正的双向Student t检验。结果 ALS病人6个区域的NAA/Cho值较对照组显著降低,平均为23%(P≤0.01)。这些区域包括尾状核、舌回、缘上回及右、左上和右下枕叶。ALS病人8个区域的NAA/Cr值显著降低(P≤0.01),平均为16%。这些区域包括尾状核、楔叶、额下岛盖、颞横回、中央前回、罗兰迪克岛盖和上、下枕叶。患病组与对照组的Cho/Cr值在任何区域均无显著差异。结论平面回波波谱成像全脑分析可实现对ALS病人脑局部代谢异常的检测,不仅包括运动皮质,而且还包括一些病生理发现ALS累及的其他区域。
Objective To evaluate the brain metabolism in patients with amyotrophic lateral sclerosis (ALS) by using planar echo-wave tomography whole brain analysis. Materials and Methods Six patients (9 males and 7 females, mean age 56.6 years) with ALS were enrolled in this study. Five ALS patients (4 males and 1 females, mean age 62.6 years) with ALS and 10 healthy control subjects 5 males and 5 females, with an average age of 56.1 years) underwent planar echo spectroscopy after signing informed consent. This study was approved by the Institutional Review Board and complies with HIPAA. Metabolite imaging and data analysis system software was used for data analysis to map metabolite maps to standard brain templates. The metabolic map of creatine (Cr), choline (Cho) and N-acetyl aspartate (NAA) was divided into 81 regions using automated anatomic labeling software to measure whole brain metabolic changes in ALS patients. Statistical analysis was performed using unpaired, uncorrected two-way Student’s t-test. Results The NAA / Cho of 6 ALS patients was significantly lower than that of the control group, with an average of 23% (P≤0.01). These areas include the caudate nucleus, lingual gyrus, superior margin back and right, left upper and lower right occipital lobe. NAA / Cr values were significantly decreased in 8 of ALS patients (P ≤ 0.01) with an average of 16%. These areas include caudate, wedge, frontal island cap, temporal transverse, central anterior, Rolandie’s island cap and upper and lower occipital lobes. There was no significant difference in Cho / Cr between the diseased group and the control group in any region. Conclusion Whole-brain imaging with planar echo spectroscopy allows the detection of abnormal brain metabolism in ALS patients, including not only the motor cortex, but also other areas where ALS is involved in disease management.