Cerebellar development and clinical outcome in attention deficit hyperactivity disorder.
Cerebellar development and clinical outcome in attention deficit hyperactivity disorder.
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DOI：
10.1176/ajp.2007.164.4.647
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发表时间：
2007-04
期刊：
影响因子：
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通讯作者：
S. Mackie;P. Shaw;R. Lenroot;Ron Pierson;D. Greenstein;Thomas F. Nugent;W. Sharp;J. Giedd;J. Rapoport
中科院分区：
文献类型：
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作者：
S. Mackie;P. Shaw;R. Lenroot;Ron Pierson;D. Greenstein;Thomas F. Nugent;W. Sharp;J. Giedd;J. Rapoport
目的解剖磁共振成像(MRI)研究发现注意缺陷多动障碍(ADHD)儿童的小脑体积小于对照组。然而，这些差异的区域特异性和纵向进展仍有待确定。作者比较了ADHD儿童和对照儿童的小脑半球和小脑虫各叶的体积，并使用一种新的局部小脑体积测量来表征这些差异的发育轨迹。方法采用纵向病例对照研究方法，将36例ADHD患儿分为预后较好组和预后较差组各18例，并与36例健康对照组进行比较。根据基线获得的MR图像和每隔两年进行两次或两次以上的随访扫描，确定六个小脑半球叶、中央白质和三个Vermal分区的体积。全球临床结果的测量和DSM-IV标准被用来定义临床结果。结果在ADHD组，观察到非进行性的小脑棘上叶体积丢失；无论临床结果如何，体积丢失持续存在。临床预后较差的ADHD受试者的左右小脑下后叶体积呈下降轨迹，青春期较对照受试者和预后较好的ADHD受试者逐渐变小。结论：小脑上回体积的减少似乎是ADHD基础上的固定的、非进行性的解剖学改变的重要基础。小脑半球构成了一种更具可塑性、状态特异性的标记，可能被证明是临床干预的目标。
OBJECTIVE Anatomic magnetic resonance imaging (MRI) studies have detected smaller cerebellar volumes in children with attention deficit hyperactivity disorder (ADHD) than in comparison subjects. However, the regional specificity and longitudinal progression of these differences remain to be determined. The authors compared the volumes of each lobe of the cerebellar hemispheres and vermis in children with ADHD and comparison subjects and used a new regional cerebellar volume measurement to characterize the developmental trajectory of these differences. METHOD In a longitudinal case-control study, 36 children with ADHD were divided into a group of 18 with better outcomes and a group of 18 with worse outcomes and were compared with 36 matched healthy comparison subjects. The volumes of six cerebellar hemispheric lobes, the central white matter, and three vermal subdivisions were determined from MR images acquired at baseline and two or more follow-up scans conducted at 2-year intervals. A measure of global clinical outcome and DSM-IV criteria were used to define clinical outcome. RESULTS In the ADHD groups, a nonprogressive loss of volume was observed in the superior cerebellar vermis; the volume loss persisted regardless of clinical outcome. ADHD subjects with a worse clinical outcome exhibited a downward trajectory in volumes of the right and left inferior-posterior cerebellar lobes, which became progressively smaller during adolescence relative to both comparison subjects and ADHD subjects with a better outcome. CONCLUSIONS Decreased volume of the superior cerebellar vermis appears to represent an important substrate of the fixed, nonprogressive anatomical changes that underlie ADHD. The cerebellar hemispheres constitute a more plastic, state-specific marker that may prove to be a target for clinical intervention.