Diffusion tensor MRI and fiber tractography of cerebellar atrophy in phenytoin users
Diffusion tensor MRI and fiber tractography of cerebellar atrophy in phenytoin users
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DOI：
10.1111/j.0013-9580.2003.43502.x
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发表时间：
2003-12-01
期刊：
影响因子：
5.6
通讯作者：
Kim, DI
中科院分区：
文献类型：
--
作者：
Lee, SK;Mori, T;Kim, DI
目的：弥散张量磁共振成像 (DT-MRI) 的实用性仍存在争议，鼓励开发临床上可行的扫描方案。本研究的目的是通过使用 DT-MRI 来研究苯妥英 (PHT) 诱导的小脑萎缩患者的小脑传入纤维系统，并与其他病因引起的小脑萎缩进行比较。 方法：13 名患者（M/F 比为 7:6；平均年龄为 42.5 岁）和年龄匹配的正常对照 (n = 8) 参与了本研究。患者组由接受 PHT 治疗的癫痫患者 (n = 9) 和临床诊断为橄榄桥小脑萎缩 (OPCA; n = 4) 的患者组成。 DT-MRI 采用 b = 600 s/mm(2) 的扩散加权进行，并生成分数各向异性 (FA) 和颜色编码矢量图。测量并比较 PHT 和 OPCA 患者的小脑中脚 (MCP)、小脑和桥脑横纤维 (TPF) 的 FA。正常受试者的 MCP FA 值为 0.81 +/- 0.07。 TPF 中的 FA 值为 0.69 +/- 0.04，PHT 用户的 MCP 中的 FA 值为 0.84 +/- 0.09，TPF 中的 FA 值为 0.72 +/- 0.08，小脑中的 FA 值为 0.21 +/- 0.04。 OPCA 患者的 MCP FA 值为 0.39 +/- 0.11，TPF 为 0.46 +/- 0.12，小脑为 0.22 +/- 0.07。 PHT 用户仅在小脑中显示出统计上显着的 FA 减少，而 OPCA 显示 MCP、TPF 和小脑中的 FA 显着减少（单向方差分析，p < 0.01）。纤维束的三维重建显示 OPCA 组中脚和横桥纤维内的体积减少和纤维完整性改变，而 PHT 用户的纤维走向模式与对照组相似。结论：PHT 用户的 MCP 和 TPF 表现出正常的方向和各向异性，而 OPCA 表现出受损的值，表明 PHT 直接影响 小脑。 DT-MRI 可以展示脑干和小脑退行性疾病中详细的纤维结构，并深入了解小脑萎缩的病理机制。
Purpose: The usefulness of diffusion tensor magnetic resonance imaging (DT-MRI) is still in debate, and the development of clinically feasible scan protocol is encouraged. The purpose of this study was to investigate the afferent fiber system to the cerebellum in patients with phenytoin (PHT)-induced cerebellar atrophy in comparison with cerebellar atrophy of other etiologies by using DT-MRI.Methods: Thirteen patients (M/F ratio, 7:6; mean age, 42.5 years) and age-matched normal controls (n = 8) participated in this study. The patient group consisted of epilepsy patients who had received PHT therapy (n = 9) and clinically diagnosed as having olivopontocerebellar atrophy (OPCA; n = 4). DT-MRI was performed by using diffusion weighting of b = 600 s/mm(2), and fractional anisotropy (FA) and color-coded vector maps were generated. FA of the middle cerebellar peduncle (MCP), the cerebellum, and transverse pontine fibers (TPF) was measured and compared between PHT and OPCA patients.Normal subjects showed FA values of 0.81 +/- 0.07 in MCP. 0.69 +/- 0.04 in TPF, and PHT users showed FA values of 0.84 +/- 0.09 in MCP, 0.72 +/- 0.08 in TPF, and 0.21 +/- 0.04 in cerebellum. OPCA patients showed FA values of 0.39 +/- 0.11 in MCP, 0.46 +/- 0.12 in TPF, and 0.22 +/- 0.07 in cerebellum. PHT users showed a statistically significant reduction of FA only in cerebellum, whereas OPCA demonstrated significant decrease of FA in MCP, TPF, and cerebellum (one-way analysis of variance, p < 0.01). Three-dimensional reconstruction of fiber tracts demonstrated decreased volume and altered fiber integrity within the peduncles and transverse pontine fibers in the OPCA group, whereas fiber course patterns in PHT users were similar to those in controls.Conclusions: PHT users showed normal orientation and anisotropy of MCP and TPF, whereas OPCA demonstrated impaired values, suggesting that PHT directly affects the cerebellum. DT-MRI can demonstrate detailed fiber configurations in degenerative diseases of brainstem and cerebellum and provides insight into the pathomechanisms of cerebellar atrophy.