The role of MRI in dementia.

P Pantano, F Caramia, A Pierallini
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引用次数: 14

Abstract

Neuroimaging techniques aimed at studying structural changes of the brain may provide useful information for the diagnosis and the clinical management of patients with dementia. Magnetic resonance imaging (MRI) may show abnormalities amenable to surgical treatment in a significant percentage of patients with cognitive impairment. MRI may also assist the differential diagnosis in dementia associated with metabolic or inflammatory diseases.MRI has the potential to detect focal signal abnormalities which may assist the clinical differentiation between Alzheimer's disease (AD) and vascular dementia (VaD). Severe temporal atrophy, hyperintensities involving the hippocampal or insular cortex, and gyral hypointense bands are more frequently noted in AD. Basal ganglionic/thalamic hyperintense foci, thromboembolic infarctions, confluent white matter and irregular periventricular hyperintensities are more common in VaD. The high sensitivity of MRI in detecting T2 hyperintense lesions and the low specificity off white matter lesions have resulted in a poor correlation between MRI findings and both neuropathological and clinical manifestations. In particular, MRI has disclosed a series of white matter focal changes in the elderly population, which are not necessarily associated with cognitive dysfunction. The recent advent of a new MRI method sensitive to the microstructural changes of white matter, the so-called diffusion tensor imaging, may be helpful in correlating clinical manifestations with white matter abnormalities.

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MRI在痴呆中的作用。
旨在研究大脑结构变化的神经影像学技术可能为痴呆症患者的诊断和临床治疗提供有用的信息。核磁共振成像(MRI)可以显示出相当比例的认知障碍患者可接受手术治疗的异常。MRI也有助于代谢性或炎症性疾病相关痴呆的鉴别诊断。MRI有可能发现局灶性信号异常,这可能有助于阿尔茨海默病(AD)和血管性痴呆(VaD)的临床鉴别。严重的颞叶萎缩,涉及海马或岛叶皮质的高信号,以及脑回低信号带在AD中更为常见。基底节节/丘脑高强度病灶、血栓栓塞性梗死、汇合白质和不规则心室周围高强度在VaD中更为常见。MRI对T2高信号病变的高敏感性和对白质病变的低特异性导致MRI表现与神经病理和临床表现的相关性较差。特别是,MRI揭示了老年人的一系列白质局灶性变化,这些变化不一定与认知功能障碍有关。最近出现了一种新的对白质微结构变化敏感的MRI方法,即所谓的弥散张量成像,可能有助于将临床表现与白质异常联系起来。
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