Application of quantitative DTI metrics in sporadic CJD.
Application of quantitative DTI metrics in sporadic CJD.
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DOI：
10.1016/j.nicl.2014.01.011
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发表时间：
2014
期刊：
影响因子：
--
通讯作者：
Geschwind MD
中科院分区：
文献类型：
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作者：
Caverzasi E;Henry RG;Vitali P;Lobach IV;Kornak J;Bastianello S;Dearmond SJ;Miller BL;Rosen HJ;Mandelli ML;Geschwind MD
弥散加权成像对于诊断可能的散发性雅各布-克罗伊茨费尔特病（最常见的人类朊病毒病）非常重要。虽然DWI MRI的视觉评估在诊断上是至关重要的，但更客观、可量化的方法可能更精确地识别大脑受累的精确模式。此外，随着时间的推移发生的MRI变化的定量，系统的跟踪可能会提供有关人类朊病毒疾病的潜在组织病理学机制的见解，并提供有用的信息，为临床试验。本研究的目的是：1）定量描述散发性Jakob-Creutzfeldt病灰质（GM）中平均扩散率降低、各向异性分数、萎缩和T1弛豫的平均横截面模式，2）研究平均扩散率和萎缩随时间的变化，3）探索它们与临床量表的关系。26名散发性Jakob-Creutzfeldt病患者和9名对照受试者在同一台扫描仪上进行了MRI检查; 7名sCJD受试者在大约两个月后进行了第二次扫描。皮质和皮质下灰质区域用Freesurfer包裹。计算每个受试者每个区域的平均皮质厚度（或皮质下体积）、T1弛豫和平均扩散率（来自共配准扩散图）。定量横断面分析，某些脑区优先受到平均扩散率降低（顶叶，颞叶，后扣带回，丘脑和深核），但相对保留额叶和枕叶。令人惊讶的是，连续成像显示，平均扩散率不具有随时间的线性或单向降低，而是倾向于最初降低，然后逆转并朝向正常化增加。此外，患者临床功能恶化（基于改良Barthel评分）与平均扩散率增加之间存在强相关性。散发性CJD的定量扩散MRI显示优先区域受累。纵向上，平均扩散率（MD）不线性或单向变化。提出了MD随疾病进展而变化的“模型”。MD增加的阶段显示临床功能显著恶化。MD的相对正常化发生在疾病的后期。
Diffusion Weighted Imaging is extremely important for the diagnosis of probable sporadic Jakob–Creutzfeldt disease, the most common human prion disease. Although visual assessment of DWI MRI is critical diagnostically, a more objective, quantifiable approach might more precisely identify the precise pattern of brain involvement. Furthermore, a quantitative, systematic tracking of MRI changes occurring over time might provide insights regarding the underlying histopathological mechanisms of human prion disease and provide information useful for clinical trials. The purposes of this study were: 1) to describe quantitatively the average cross-sectional pattern of reduced mean diffusivity, fractional anisotropy, atrophy and T1 relaxation in the gray matter (GM) in sporadic Jakob–Creutzfeldt disease, 2) to study changes in mean diffusivity and atrophy over time and 3) to explore their relationship with clinical scales. Twenty-six sporadic Jakob–Creutzfeldt disease and nine control subjects had MRIs on the same scanner; seven sCJD subjects had a second scan after approximately two months. Cortical and subcortical gray matter regions were parcellated with Freesurfer. Average cortical thickness (or subcortical volume), T1-relaxiation and mean diffusivity from co-registered diffusion maps were calculated in each region for each subject. Quantitatively on cross-sectional analysis, certain brain regions were preferentially affected by reduced mean diffusivity (parietal, temporal lobes, posterior cingulate, thalamus and deep nuclei), but with relative sparing of the frontal and occipital lobes. Serial imaging, surprisingly showed that mean diffusivity did not have a linear or unidirectional reduction over time, but tended to decrease initially and then reverse and increase towards normalization. Furthermore, there was a strong correlation between worsening of patient clinical function (based on modified Barthel score) and increasing mean diffusivity. Quantitative diffusion MRI in sporadic CJD shows preferential regional involvement. Longitudinally, mean diffusivity (MD) does not change linearly or unidirectionally. A “model” of MD change with disease progression is proposed. Phases with increasing MD show significant worsening of clinical function. Relative normalization of MD occurs in later phases of disease.