1H MRSI AND PERFUSION MRI OF SIVD

简而言之，本项目（共120名受试者，分为6组，每组20人）的研究结果如下：与老年对照（CN）相比，伴有腔隙的痴呆患者（+L，其中许多人患有皮质下缺血性血管性痴呆（SIVD））皮质灰质（cGM）和海马中的n -乙酰天冬氨酸[NAA]减少，与无腔隙的D（其中许多人患有阿尔茨海默病）的变化相似。2)与非丘脑凹窝患者相比，丘脑凹窝患者额叶cGM [NAA]降低。3)cGM [NAA]与L数量和白质病变（WML）百分比成比例降低。4) MMSE和特定神经心理测试与cGM相关[NAA]。综上所述，这些发现有力地支持了cGM [NAA]在D时减少的观点，并且这种减少在程度和位置上与皮层下梗死成正比。我们将减少的cGM[NAA]解释为皮质下梗死的损伤、大小减少或皮质神经元数量减少。该项目将通过使用短TE 1H磁共振成像测量肌醇（一种被认为是阿尔茨海默病的标志物）和使用动脉自旋标记灌注MRI定量皮质和皮质下灌注来扩展这些发现。样本量约为60名受试者/组，尸检后进行阿尔茨海默病和/或梗死的最终病理诊断。所有受试者将进行MRI分割和海马体积成像，以及多层短时间TE 1H MRI。其他相关目标有：1)测定SIVD和AD患者NAA、肌醇和灌注改变的相对程度。2)。确定皮层下梗死和皮层神经元损伤对痴呆的相对影响程度。3)。建立可靠区分SIVD和AD的生前分类方法。4)。建立SIVD和AD患者认知能力下降的可靠指标。该项目将有助于确定皮层下梗死对认知的影响，预测皮层下梗死对认知能力下降的影响，并有助于区分SIVD和AD。这项工作的意义在于，将为SIVD和AD的发病机制提供新的认识，提高这两种疾病的临终诊断，并为临床治疗试验的结果评估提供方法。

Briefly, the findings of this project (total of 120 subjects, divided into 6 groups of 20 each) were: 1.) Reduced N-acetyl aspartate [NAA] in cortical gray matter (cGM) and hippocampus of demented patients (D) with lacunes (+L many of whom have subcortical ischemic vascular dementia (SIVD)) compared to elderly controls (CN), similar to changes in D without lacunes (many of whom have Alzheimer's). 2) Frontal cGM [NAA] was reduced to patients with thalamic lacunes, compared to those with non thalamic L. 3) cGM [NAA] was reduced in proportion to number of L and to % white matter lesions (WML). 4) MMSE and specific neuropsychological tests correlated with cGM [NAA]. Taken together, these finding strongly support the view that cGM [NAA] is reduced in D, and that this reduction is proportional in extent and location to subcortical infarction. We interpret the reduced cGM[NAA] to indicate either injury, reduced size, or reduced number, or cortical neurons, in response to subcortical infarction. This project will extend these findings by using short TE 1H MRSI to measure myo-inositol (a putative marker of Alzheimer's disease) and by using arterial spin labeled perfusion MRI to quantitate cortical and subcortical perfusion. The sample size will be about 60 subjects/group, followed autopsy for final pathological diagnosis of Alzheimer's and/or infarction. All subjects will have MRI with segmentation and hippocampal voluming, and multi-slice short TE 1H MRSI. Other related goals are to: 1.) Determine the relative extent that NAA, myoinositol, and perfusion are altered in SIVD and AD. 2.) To determine the relative extent to which subcortical infarction and cortical neuron damage contribute to dementia. 3.) To develop antemortem classification methods which reliably distinguish between SIVD and AD. 4.) To establish reliable products of cognitive decline in SIVD and AD. This project will help determine the effects of subcortical infarction on cognition, predict the effects of subcortical infarction our cognitive decline, and help distinguish between SIVD and AD. The significance is that this work will provide new understanding concerning the pathogenesis of SIVD and AD, improve the antemortem diagnosis of both disorders, and provide methods for evaluation the results of clinical treatment trials.