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目的初步探讨磁共振扩散张量成像(DTI)在肌萎缩侧索硬化症(ALS)诊断中的临床意义。方法16例有明确上运动神经元(UMN)损害体征者作为A组,4例仅有下运动神经元(LMN)损害体征者作为B组,15名健康志愿者为对照组。行轴位DTI扫描,选取感兴趣区(ROI)测量各向异性分数(FA)和平均扩散系数(ADC)。结果与对照组比较,A组内囊后肢水平FA值降低(t= 3．452,P=0．002),ADC值增大(t=2．670,P=0．012);其他ROI的FA、ADC值差异无统计学意义。与对照组比较,B组内囊后肢水平FA值有下降趋势(U=11,P=0．057);与A组比较差异无统计学意义(U=29,P=0．777)。A组内囊后肢水平FA值与ALS功能评分呈正相关(r=0．577,P=0．019),与锥体束征评分呈负相关(r=-0．．789,P=0．000),与年龄、病程、病情进展速度无相关性;ADC值与以上指标间均无相关性。结论DTI可以客观而定量地评价锥体束病变,为ALS的诊断提供有价值的信息。
Objective To investigate the clinical significance of magnetic resonance diffusion tensor imaging (DTI) in the diagnosis of amyotrophic lateral sclerosis (ALS). Methods Sixteen patients with signs of impairment of upper extremity motor neurons (UMNs) as group A, four patients with impairment of LMNs as group B, and 15 healthy volunteers as controls. Axial DTI scan, select the region of interest (ROI) measured anisotropy fraction (FA) and average diffusion coefficient (ADC). Results Compared with the control group, the FA value of hind limbs in group A decreased (t = 3.452, P = 0.002) and the ADC value increased (t = 2.670, P = 0.012) FA, ADC value difference was not statistically significant. Compared with the control group, the FA value of the hind limbs in the group B had a decreasing trend (U = 11, P = 0.057). There was no significant difference between the two groups (P = 0.777). The FA value of hind limbs in group A was positively correlated with ALS functional score (r = 0.577, P = 0.019), and negatively correlated with pyramidal tract sign (r = -0..789, P = 0). 000), but not with age, duration of disease and progression of disease; ADC value had no correlation with the above indexes. Conclusion DTI can objectively and quantitatively evaluate pyramidal tract lesions and provide valuable information for the diagnosis of ALS.