Abstract:

Objective　To analyze the clinical features of white matter diffusion tensor imaging (DTI) and resting state functional magnetic resonance imaging (rs-fMRI) in patients with relapse-remitting multiple sclerosis (RRMS). Methods　One hundred and two patients with RRMS treated at Xi'an Qinhuang Hospital from March 2023 to March 2025 were selected as the research objects and set as an observation group, including 37 males and 65 females who were (38.25±18.36) years old. One hundred healthy individuals who underwent physical examination during the same period were selected as a control group, including 46 males and 54 females who were (37.45±17.78) years old. Both groups underwent DTI and rs-fMRI examinations. The parameters of DTI and rs-fMRI were analyzed, including the mean diffusivity (MD), fractional anisotropy (FA), and fMRI regional homogeneity (ReHo) of protein resting-state of the cingulum bundle (CCG), anterior limb of internal capsule (ALIC), posterior limb of internal capsule (PLIC), external capsule EC), superior longitudinal fasciculus (SLF), superior fronto-occipital fasciculus (SFOF), inferior fronto-occipital fasciculus (IFOF), inferior longitudinal fasciculus (ILF), uncinate fasciculus (UF), genu of corpus callosum (gCC), splenium of corpus callosum (sCC), etc.; the Expanded Disability Status Scale (EDSS) was used to quantify the degree of neurological impairment; the subjects' conditions were evaluated by the paced auditory serial addition test (PASAT) and the Modified Fatigue Impact Scale (MFIS). The Kolmogorov-Smirnov test was used to judge the data distribution. t test was used for the data of normal distribution. The independent-sample permutation test (5 000 permutations) was used to statistically analyze the data of brain function imaging. Results　The score of PASAT in the observation group was lower than that in the control group (87.44±12.37 vs. 100.43±8.54), with a statistical difference (P<0.05). The scores of EDSS and MFIS in the observation group were 87.44±12.37 and 100.43±8.54, and the scores in the control group 0 and 0, indicating that the observation group had obvious neurological function disorder and fatigue, while the control group were normal. The FA values of bilateral CCG, bilateral ALIC, bilateral PLIC, bilateral EC, bilateral SLF, bilateral SFOF, bilateral IFOF, bilateral ILF,  bilateral UF, gCC and sCC in the observation group were all lower than those in the control group; while the MD values of bilateral CCG, bilateral ALIC, bilateral PLIC, bilateral EC, bilateral SLF, bilateral SFOF, bilateral IFOF, bilateral ILF, bilateral UF, gCC and sCC in the observation group were all higher than those in the control group (all P < 0.05). The regional homogeneities (ReHo) of corpus callosum, internal capsule, radiative crown, pontine cross tract, and cingulate tract in the observation group were lower than those in the control group (all P<0.05). The global white matter network in the observation group showed compensatory increase in functional connection density. The nodal efficiency of specific fiber bundles (gCC and right upper longitudinal tract Ⅲ segment) in the observation group was lower than that in the control group (P<0.05). Conclusion　The combination of DTI and rs-fMRI can evaluate the structure and function of the white matter in patients with RRMS, and provide evidences for the early diagnosis and treatment of the disease.

Key words:

Relapsing-remitting multiple sclerosis, White matter structure of brain, Diffusion tensor imaging, Resting state functional magnetic resonance imaging

摘要：

目的　分析复发缓解型多发性硬化（RRMS）患者脑白质扩散张量成像（DTI）定量及静息态功能磁共振成像（rs-fMRI）的临床特点。方法　采用前瞻性研究，选取西安秦皇医院在2023年3月至2025年3月收治的102例RRMS患者作为研究对象，设置为观察组，其中男37例，女65例，年龄（38.25±18.36）岁。另选取同期健康体检者100例作为对照组，其中男46例，女54例，年龄（37.45±17.78）岁。两组均采用DTI、rs-fMRI检查，分析两者参数，包括扣带束（CCG）、内囊前肢（ALIC）、内囊后肢（PLIC）、外囊（EC）、上纵束（SLF）、上枕额束（SFOF）、下额枕束（IFOF）、下纵束（ILF）、钩束（UF）、胼胝体膝部（gCC）、胼胝体压部（sCC）等部位的平均扩散率（MD）、各向异性分数（FA）及蛋白质静息态fMRI局部一致性（ReHo）等图像，采用扩展残疾状态量表（EDSS）量化神经功能损害程度，进步式听觉累加测试（PASAT）及修正的疲劳影响尺度（MFIS）评估受试者状态。使用Kolmogorov-Smirnov检验判断数据分布，正态分布的计量资料采用t检验，脑功能成像数据的统计分析采用两独立样本置换检验（5 000次置换）。结果　观察组患者的PASAT得分为（87.44±12.37）分，对照组为（100.43±8.54）分，差异有统计学意义（P<0.05）；观察组EDSS得分（3.40±1.26）分，MFIS得分（11.57±3.78）分，对照组均为0，观察组存在明显的神经功能障碍和疲劳症状，对照组正常。观察组双侧CCG、双侧ALIC、双侧PLIC、双侧EC、双侧SLF、双侧SFOF、双侧IFOF、双侧ILF、双侧UF、gCC、sCC的FA值均低于对照组；观察组双侧CCG、双侧ALIC、双侧PLIC、双侧EC、双侧SLF、双侧SFOF、双侧IFOF、双侧ILF、双侧UF、gCC、sCC的MD值均高于对照组（均P<0.05）。观察组患者的胼胝体、内囊、放射冠、脑桥交叉束、CCG等区域的ReHo均低于对照组（均P<0.05）；观察组患者全局白质网络呈现功能连接密度代偿性高于对照组，特定纤维束（gCC及右侧SLF Ⅲ段）节点效率低于对照组（均P<0.05）。结论　DTI结合rs-fMRI可以更全面地评估RRMS患者的脑白质结构和功能异常，为疾病早期诊断和治疗提供依据。

关键词:

复发缓解型多发性硬化, 脑白质结构, 扩散张量成像, 静息态功能磁共振成像