Volumetric MRI analysis comparing subjects having attention-deficit hyperactivity disorder with normal controls
Volumetric MRI analysis comparing subjects having attention-deficit hyperactivity disorder with normal controls
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DOI：
10.1212/wnl.48.3.589
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发表时间：
1997-03-01
期刊：
影响因子：
9.9
通讯作者：
Biederman, J
中科院分区：
文献类型：
--
作者：
Filipek, PA;SemrudClikeman, M;Biederman, J
目的：采用基于MRI的形态测量学方法，验证注意缺陷多动障碍（ADHD）患者左侧尾状核和右侧前额叶/额叶/和/或后顶叶半球存在发育异常的先验假设，与神经化学、神经元回路和注意网络假设以及既往影像学研究结果雅阁。设计：病例对照研究。设定：学术医学中心，参与者：15名患有ADHD的男性受试者（年龄12.4 +/- 3.4岁）和15名男性正常对照（年龄14.4 +/- 3.4岁），年龄，智商和惯用手组匹配。主要结局指标：大脑半球、皮质、白色物质、脑室、尾状核、丘脑、中央灰核、杏仁核和海马的整体和半球区域体积（单位：cm（3））。结果如下：尽管大脑半球体积相似，但ADHD受试者的（1）左侧总尾状核和尾状头体积较小（p < 0.04），具有反向不对称性（2）右前上（额）区整体（3）双侧前下区整体（p <0.04）;（4）双侧胼胝体后（顶枕）区白色（p < 0.03）。在探索性分析中注意到ADHD对刺激物反应的可能结构相关性，在反应者中发现最小和对称的尾状核，以及最小的左前上皮层体积，但在无反应者中发现尾状核不对称和最小的胼胝体后白色物质体积。结论，这项研究是第一个报道ADHD中局部半球结构异常的研究。这与额-纹状体和顶叶功能异常的理论模型一致，并且与对刺激性药物的反应的可能不同的形态学基质一致。
Objective: To test by MRI-based morphometry the a priori hypotheses that developmental anomalies exist in attention-deficit hyperactivity disorder (ADHD) in left caudate and right prefrontal/frontal/ and/or posterior parietal hemispheric regions, in accord with neurochemical, neuronal circuitry and attentional network hypotheses, and prior imaging studies. Design: Case-control study. Setting: Academic medical center, Participants: Fifteen male subjects with ADHD without comorbid diagnoses (aged 12.4 +/- 3.4 years) and 15 male normal controls (aged 14.4 +/- 3.4), group-matched for age, IQ, and handedness. Main outcome measures: Global and hemispheric regional volumes (in cm(3)) of cerebral hemispheres, cortex, white matter, ventricles, caudate, lenticulate, central gray nuclei, insula, amygdala, and hippocampus. Results: Despite similar hemispheric volumes, ADHD subjects had smaller volumes of (1) left total caudate and caudate head (p < 0.04), with reversed asymmetry (p < 0.03); (2) right anterior-superior (frontal) region en bloc(p < 0.03) and white matter (p < 0.01); (3) bilateral anterior-inferior region en bloc(p < 0.04); and (4) bilateral retrocallosal (parietal-occipital) region white matter (p < 0.03). Possible structural correlates of ADHD response to stimulants were noted in an exploratory analysis, with the smallest and symmetric caudate, and smallest left anterior-superior cortex volumes found in the responders, but reversed caudate asymmetry and the smallest retrocallosal white matter volumes noted in the nonresponders, Conclusions, This study is the first to report localized hemispheric structural anomalies in ADHD, which are concordant with theoretical models of abnormal frontal-striatal and parietal function, and with possible differing morphologic substrates of response to stimulant medication.