확산텐서영상을 이용한 경도의 알츠하이머병 환자와 경도인지장애 환자의 뇌 백질의 이상평가: Tract-Based Spatial Statistics와 화소기반 형태분석 방법의 비교

Evaluation of White Matter Abnormality in Mild Alzheimer Disease and Mild Cognitive Impairment Using Diffusion Tensor Imaging: A Comparison of Tract-Based Spatial Statistics with Voxel-Based Morphometry

  • 임현경 (울산대학교 서울아산병원 영상의학과) ;
  • 김상준 (울산대학교 서울아산병원 영상의학과) ;
  • 최충곤 (울산대학교 서울아산병원 영상의학과) ;
  • 이재홍 (울산대학교 서울아산병원 신경과) ;
  • 김성윤 (울산대학교 서울아산병원 정신건강의학과) ;
  • 김형준 (한국기초과학지원연구원 자기공명연구부) ;
  • 김남국 (울산대학교 서울아산병원 영상의학과) ;
  • 장건호 (강동경희대학교병원 영상의학과)
  • Lim, Hyun-Kyung (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Kim, Sang-Joon (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Choi, Choong-Gon (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Lee, Jae-Hong (Department of Neurology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Kim, Seong-Yoon (Department of Psychiatry and Health Promotion Center, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Kim, Heng-Jun J. (Division of Magnetic Resonance, Korea Basic Science Institute) ;
  • Kim, Nam-Kug (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Jahng, Geon-Ho (Department of Radiology, Kyung Hee East-West Neo Medial Center, Kyung Hee University College of Medicine)
  • 투고 : 2012.03.19
  • 심사 : 2012.07.05
  • 발행 : 2012.08.31

초록

목적: Tract-based spatial statistics와 화소기반 형태분석 방법을 이용하여 경도의 알츠하이머병 환자와 경도인 지장애 환자에서 확산텐서영상을 이용하여 뇌 백질의 이상을 평가하고자 하였다. 대상과 방법: 21명의 경도의 알츠하이머병 환자와 13명의 경도인지장애 환자, 그리고 16명의 건강한 노인군을 대상으로 확산텐서영상을 시행하였다. 각 참가자마다 분할 비등방도를 구하여 Tract-based spatial statistics를 이용하여 세 그룹간의 비교를 하였다. Tract-based spatial statistics 방법과의 비교를 위하여, 화소기반 형태분석 방법을 이용한 분석도 함께 시행하였다. 결과: Tract-based spatial statistics 분석결과, 경도의 알츠하이머 환자에서 건강한 노인군보다 방사관의 양측 전각과 우측 후각, 후시상방사, 우측 상세로다발, 뇌량체부, 우측 쐐기전소엽이랑에서 분할 비등방도가 유의하게 감소하였다. 화소기반 형태분석에서는 양측 갈고리다발, 좌측 부해마회의 백질, 우측 대상다발에서 추가적으로 분할 비등 방도가 감소되어 있었다. 경도의 알츠하이머 환자군과 경도인지장애 환자군의 비교, 경도인지장애 환자군과 건강한 노인군의 비교연구에서는 분할 비등방도의 유의한 차이는 없었다. 결론: Tract-based spatial statistics 분석결과, 경도의 알츠하이머 환자군에서 건강한 노인군에 비해 뇌 백질의 분할 비등방도가 여러 곳에서 감소되어 있었다. 화소기반 형태분석방법은 tract-based spatial statistics보다 더 많은 곳에서 뇌 백질의 이상을 보였다. 그러나, 인공물 또한 더 많이 관찰되었다.

Purpose : To evaluate white matter abnormalities on diffusion tensor imaging (DTI) in patients with mild Alzheimer disease (AD) and mild cognitive impairment (MCI), using tract-based spatial statistics (TBSS) and voxel-based morphometry (VBM). Materials and Methods: DTI was performed in 21 patients with mild AD, in 13 with MCI and in 16 old healthy subjects. A fractional anisotropy (FA) map was generated for each participant and processed for voxel-based comparisons among the three groups using TBSS. For comparison, DTI data was processed using the VBM method, also. Results: TBSS showed that FA was significantly lower in the AD than in the old healthy group in the bilateral anterior and right posterior corona radiata, the posterior thalamic radiation, the right superior longitudinal fasciculus, the body of the corpus callosum, and the right precuneus gyrus. VBM identified additional areas of reduced FA, including both uncinates, the left parahippocampal white matter, and the right cingulum. There were no significant differences in FA between the AD and MCI groups, or between the MCI and old healthy groups. Conclusion: TBSS showed multifocal abnormalities in white matter integrity in patients with AD compared with old healthy group. VBM could detect more white matter lesions than TBSS, but with increased artifacts.

키워드

참고문헌

  1. Petersen RC, Doody R, Kurz A, et al. Current concepts in mild cognitive impairment. Arch Neurol 2001;58:1985-1992
  2. Leifer D, Buonanno FS, Richardson EP. Clinicopathologic correlations of cranial magnetic resonance imaging of periventricular white matter. Neurology 1990;40:911-918
  3. de Leeuw FE, Barkhof F, Scheltens P. White matter lesions and hippocampal atrophy in Alzheimer's disease. Neurology 2004; 62:310-312
  4. Bozzali M, Falini A, Franceschi M, et al. White matter damage in Alzheimer's disease assessed in vivo using diffusion tensor magnetic resonance imaging. J Neurol Neurosurg Psychiatry 2002;72:742-746
  5. Sydykova D, Stahl R, Dietrich O, et al. Fiber connections between the cerebral cortex and the corpus callosum in Alzheimer's disease: a diffusion tensor imaging and voxel-based morphometry study. Cereb Cortex 2007;17:2276-2282
  6. Yoshita M, Fletcher E, Harvey D, et al. Extent and distribution of white matter hyperintensities in normal aging, MCI, and AD. Neurology 2006;67:2192-2198
  7. Serra L, Cercignani M, Lenzi D, et al. Grey and white matter changes at different stages of Alzheimer's disease. J Alzheimers Dis 2010;19:147-159
  8. Chetelat G, Desgranges B, Landeau B, et al. Direct voxel-based comparison between grey matter hypometabolism and atrophy in Alzheimer's disease. Brain 2008;131:60-71
  9. Xie S, Xiao JX, Gong GL, et al. Voxel-based detection of white matter abnormalities in mild Alzheimer disease. Neurology 2006;66:1845-1849
  10. Medina D, DeToledo-Morrell L, Urresta F, et al. White matter changes in mild cognitive impairment and AD: a diffusion tensor imaging study. Neurobiol Aging 2006;27:663-672
  11. Stahl R, Dietrich O, Teipel SJ, Hampel H, Reiser MF, Schoenberg SO. White matter damage in Alzheimer disease and mild cognitive impairment: assessment with diffusion-tensor MR imaging and parallel imaging techniques. Radiology 2007;243:483-492
  12. Takahashi S, Yonezawa H, Takahashi J, Kudo M, Inoue T, Tohgi H. Selective reduction of diffusion anisotropy in white matter of Alzheimer disease brains measured by 3.0 Tesla magnetic resonance imaging. Neurosci Lett 2002;332:45-48
  13. Salat DH, Greve DN, Pacheco JL, et al. Regional white matter volume differences in nondemented aging and Alzheimer's disease. Neuroimage 2009;44:1247-1258
  14. Stoub TR, deToledo-Morrell L, Stebbins GT, Leurgans S, Bennett DA, Shah RC. Hippocampal disconnection contributes to memory dysfunction in individuals at risk for Alzheimer's disease. Proc Natl Acad Sci U S A 2006;103:10041-10045
  15. Chaim TM, Duran FL, Uchida RR, Perico CA, de Castro CC, Busatto GF. Volumetric reduction of the corpus callosum in Alzheimer's disease in vivo as assessed with voxel-based morphometry. Psychiatry Res 2007;154:59-68
  16. Smith SM, Jenkinson M, Johansen-Berg H, et al. Tract-based spatial statistics: voxelwise analysis of multi-subject diffusion data. Neuroimage 2006;31:1487-1505
  17. McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA work group under the auspices of department of health and human services task force on Alzheimer's disease. Neurology 1984;34:939-944
  18. Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-198
  19. Smith SM, Nichols TE. Threshold-free cluster enhancement: addressing problems of smoothing, threshold dependence and localisation in cluster inference. Neuroimage 2009;44:83-98
  20. Wakana S, Jiang H, Nagae-Poetscher LM, van Zijl PC, Mori S. Fiber tract-based atlas of human white matter anatomy. Radiology 2004;230:77-87
  21. Wakana S, Caprihan A, Panzenboeck MM, et al. Reproducibility of quantitative tractography methods applied to cerebral white matter. Neuroimage 2007;36:630-644
  22. Mori S, Wakana S, van Zijl PCM, Nagae-Poetscher LM. MRI atlas of human white matter. Amsterdam, The Netherland: Elsevier: 2005. p 15-237
  23. Bosch B, Arenaza-Urquijo EM, Rami L, et al. Multiple DTI index analysis in normal aging, amnestic MCI and AD. Relationship with neuropsychological performance. Neurobiol Aging 2010 Apr 3. [Epub ahead of print]. doi:10.1016/ j.neurobiolaging.2010.02.004
  24. Liu Y, Spulber G, Lehtimaki KK, et al. Diffusion tensor imaging and tract-based spatial statistics in Alzheimer's disease and mild cognitive impairment. Neurobiol Aging 2011;32:1588-1571
  25. Stricker NH, Schweinsburg BC, Delano-Wood L, et al. Decreased white matter integrity in late-myelinating fiber pathways in Alzheimer's disease supports retrogenesis. Neuroimage 2009;45:10-16
  26. Balthazar ML, Yasuda CL, Pereira FR, Pedro T, Damasceno BP, Cendes F. Differences in grey and white matter atrophy in amnestic mild cognitive impairment and mild Alzheimer's disease. Eur J Neurol 2009;16:468-474
  27. Zhuang L, Wen W, Zhu W, et al. White matter integrity in mild cognitive impairment: a tract-based spatial statistics study. Neuroimage 2010;53:16-25
  28. Salat DH, Tuch DS, van der Kouwe AJ, et al. White matter pathology isolates the hippocampal formation in Alzheimer's disease. Neurobiol Aging 2010;31:244-256
  29. Fellgiebel A, Scheurich A, Bartenstein P, Muller MJ. FDG-PET and CSF phospho-tau for prediction of cognitive decline in mild cognitive impairment. Psychiatry Res 2007;155:167-171
  30. Acosta-Cabronero J, Williams GB, Pengas G, Nestor PJ. Absolute diffusivities define the landscape of white matter degeneration in Alzheimer's disease. Brain 2010;133:529-539
  31. Smith CD, Chebrolu H, Andersen AH, et al. White matter diffusion alterations in normal women at risk of Alzheimer's disease. Neurobiol Aging 2010;31:1122-1131
  32. Damoiseaux JS, Smith SM, Witter MP, et al. White matter tract integrity in aging and Alzheimer's disease. Hum Brain Mapp 2009;30:1051-1059