头颅CT与MRI单独及联合应用对阿尔兹海默症和血管性痴呆的诊断价值研究-东南大学学报医学版

头颅CT与MRI单独及联合应用对阿尔兹海默症和血管性痴呆的诊断价值研究

单位：1. 兵器工业总医院 CT诊断科, 陕西西安 710065;
2. 兵器工业总医院磁共振诊断科, 陕西西安 710065;
3. 兵器工业总医院普放科, 陕西西安 710065;
4. 西安高新医院神经内科, 陕西西安 710000

分类号：R445.3;R445.2;R749.16

出版年·卷·期（页码）：2025·44·第六期（946-952）

摘要：

目的: 分析头颅电子计算机断层扫描(CT)与磁共振成像(MRI)单独及联合应用对阿尔兹海默症(AD)和血管性痴呆(VD)的诊断价值。方法: 选取2023年1月至2024年12月兵器工业总医院收治的AD患者75例为AD组,VD患者75例为VD组,两组患者均进行头颅CT及MRI检测,对比两组头颅CT及MRI检测差异,采用Kappa一致性检验分析头颅CT与MRI单独及联合检测与金标准诊断结果的一致性。结果: 经CT检测:与VD组相比,AD组的侧脑室最大宽度、外侧裂池最大宽度显著增加(P＜0.05),大脑半球最大横径显著降低(P＜0.05);AD组与VD组的皮质萎缩、侧脑室颞角扩大、腔隙性脑梗死、脑白质变性之间占比差异均具有统计学意义(均P＜0.05);经MRI检测:与VD组相比,AD组的颞角宽度、外侧裂宽度、三脑室宽度及额叶、颞叶血流流速显著增加(P＜0.05),海马高度显著降低(P＜0.05);AD组与VD组的大血管病变累及区、小血管病变累及区、海马萎缩占比之间差异均具有统计学意义(均P＜0.05),CT、MRI联合诊断AD和VD的特异度、阳性预测值、准确度及Kappa值显著高于CT、MRI单独诊断(P＜0.05)。结论: AD和VD的头颅CT及MRI检测之间存在一定差异,且头颅CT及MRI联合应用对AD和VD具有较高诊断价值。

Objective: To analyze the diagnostic value of head computed tomography(CT) and magnetic resonance imaging(MRI) alone and in combination for Alzheimer disease(AD) and vascular dementia(VD). Methods: From January 2023 to December 2024, 75 AD patients in Ordnance Industry General Hospital were considered as the AD group, and 75 VD patients were considered as the VD group. Both groups underwent head CT and MRI examinations, and the differences in head CT and MRI examinations between the two groups were compared. Kappa consistency test was used to analyze the consistency between head CT and MRI alone and in combination with the gold standard diagnostic results. Results: CT examination showed that compared with the VD group, the AD group had greatly increased maximum widths of the lateral ventricle and the lateral fissure pool(P<0.05), and greatly decreased maximum transverse diameter of the cerebral hemisphere(P<0.05). There was a statistically great difference(P<0.05) in the proportions of cortical atrophy, temporal horn enlargement, lacunar infarction, and white matter degeneration between the AD group and VD group. Complying with MRI examination, compared with the VD group, the AD group had greatly increased temporal angle width, lateral fissure width, third ventricle width, frontal and temporal lobe blood flow velocities(P<0.05), and greatly decreased hippocampal height(P<0.05). There was a statistically great difference(P<0.05) in the proportions of large vessel involvement, small vessel involvement, and hippocampal atrophy between the AD group and VD group. The specificity, positive predictive value, accuracy and kappa value of the combined diagnosis of AD and VD by CT and MRI were significantly higher than those of CT and MRI alone(P<0.05). Conclusion: There are certain differences between the head CT and MRI detection of AD and VD, and the combination of head CT and MRI has high diagnostic value for AD and VD.

参考文献：

[1] GRAFF-RADFORD J,YONG K X X,APOSTOLOVA L G,et al.New insights into atypical Alzheimer's disease in the era of biomarkers[J].Lancet Neurol,2021,20(3):222-234.
[2] TWAROWSKI B,HERBET M.Inflammatory processes in Alzheimer's disease-pathomechanism,diagnosis and treatment:a review[J].Int J Mol Sci,2023,24(7):6518.
[3] LIU Z,CHENG L,ZHANG L,et al.Emerging role of mesenchymal stem cells-derived extracellular vesicles in vascular dementia[J].Front Aging Neurosci,2024,16:1329357.
[4] MACOIR J.Language impairment in vascular dementia:a clinical review[J].J Geriatr Psychiatry Neurol,2024,37(2):87-95.
[5] ZHAO Q,DU X,CHEN W,et al.Advances in diagnosing mild cognitive impairment and Alzheimer's disease using(11)C-PIB-PET/CT and common neuropsychological tests[J].Front Neurosci,2023,17:1216215.
[6] MARTUCCI A,DI GIULIANO F,MINOSSE S,et al.MRI and clinical biomarkers overlap between glaucoma and Alzheimer's disease[J].Int J Mol Sci,2023,24(19):14932.
[7] CASTELLAZZI G,CUZZONI M G,COTTA RAMUSINO M,et al.A machine learning approach for the differential diagnosis of Alzheimer and vascular dementia fed by MRI selected features[J].Front Neuroinform,2020,14:25.
[8] 中国微循环学会神经变性病专委会,中华医学会神经病学分会神经心理与行为神经病学学组,中华医学会神经病学分会神经康复学组,等.阿尔茨海默病康复管理中国专家共识(2019)[J].中华老年医学杂志,2020,39(1):9-19.
[9] 中国卒中学会血管性认知障碍分会.中国血管性认知障碍诊治指南(2024版)[J].中华医学杂志,2024,104(31):2881-2894.
[10] 林轩民.MRI诊断血管性痴呆和阿尔茨海默病的价值观察[J].影像研究与医学应用,2020,4(17):105-106.
[11] 夏君燕,李亚男,章隽,等.老年性痴呆患者血清miR-375、SP1水平与认知功能的相关性[J].东南大学学报(医学版),2023,42(2):257-266.
[12] AMPIL E R,ONG P A,KRESPI Y,et al.A review of SaiLuoTong(MLC-SLT) development in vascular cognitive impairment and dementia[J].Front Pharmacol,2024,15:1343820.
[13] WANG Y,XIE D,MA S,et al.Exploring the common mechanism of vascular dementia and inflammatory bowel disease:a bioinformatics-based study[J].Front Immunol,2024,15:1347415.
[14] PERNECZKY R,DOM G,CHAN A,et al.Anti-amyloid antibody treatments for Alzheimer's disease[J].Eur J Neurol,2024,31(2):e16049.
[15] CAULEY K A,HU Y,FIELDEN S W.Pediatric head CT:automated quantitative analysis with quantile regression[J].AJNR Am J Neuroradiol,2021,42(2):382-388.
[16] MIRKIN S,ALBENSI B C.Should artificial intelligence be used in conjunction with neuroimaging in the diagnosis of Alzheimer's disease?[J].Front Aging Neurosci,2023,15:1094233.
[17] CUSTODERO C,CIAVARELLA A,PANZA F,et al.Role of inflammatory markers in the diagnosis of vascular contributions to cognitive impairment and dementia:a systematic review and meta-analysis[J].Geroscience,2022,44(3):1373-1392.
[18] KAZA E,GUENETTE J P,GUTHIER C V,et al.Image quality comparisons of coil setups in 3T MRI for brain and head and neck radiotherapy simulations[J].J Appl Clin Med Phys,2022,23(12):e13794.
[19] HUANG D,GUO Y,GUAN X,et al.Recent advances in arterial spin labeling perfusion MRI in patients with vascular cognitive impairment[J].J Cereb Blood Flow Metab,2023,43(2):173-184.
[20] YANG X,CHEN C,WANG A,et al.Imaging,genetic,and pathological features of vascular dementia[J].Eur Neurol,2023,86(4):277-284.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录