视神经脊髓炎结构和数字工作记忆多模态MRI研究

Neuromyelitis optica (NMO) was commonly considered as a disease that mainly affected the optic nerve and spinal cord. Cognitive function in NMO patients is not clear. Conventional MRI revealed lesions outside Optic Nerve and the spinal cord. Many advanced MRI techniques, such as diffusion tensor imaging (DTI) detected structural abnormalities in normal-appearing brain tissue,which provided a objective basis for the assessment of cognitive function.Clinical studies reported NMO patients with cognitive impairment，while fMRI was not performed. The Paced Auditory Serial Addition Test (PASAT) had a much broader application in Multiple Sclerosis (MS) research. The PASAT required subjects to continuously add consecutive pairs of digits, thus drawing on several cognitive functions such as sustained attention, working memory, auditory information processing speed and calculation ability. We chose to employ a modified version of the PASAT as a probe，combined with DTI，susceptibility weighted imaging(SWI), analyzed specific MR index of cerebral lesions and normal-appearance brain tissue, explored the cognitive process of abnormal structure and cortex remodeling mechanism, and provided an objective basis for the clinical neuromodulation therapy.

视神经脊髓炎（neuromyelitis optica，NMO）是一种原发性中枢神经系统炎性脱髓鞘疾病，表现为视神经炎、脊髓炎反复发作。目前NMO患者认知功能改变机制尚不明确。最新临床研究发现NMO患者认知评分减低，常规MRI检出脑内视神经、脊髓以外病灶，扩散张量成像等研究还发现表现正常脑实质结构异常，但未进行认知fMRI评价。我们推测NMO患者执行认知任务需要动员、募集额外脑区，以代偿结构性病损导致的神经功能受损。听觉节奏序列附加测试(paced auditory serial,PASAT)评测持续注意、工作记忆、信息加工和处理等认知功能。本研究实施改良PASAT同时进行fMRI扫描，联合扩散张量成像、磁敏感加权成像检查，分析反映颅脑病灶和表现正常实质脑隐匿性病灶演变特异性MR指标，探讨认知处理过程发生异常的结构和脑皮层重塑机制，为临床实施神经调控提供客观依据。

视神经脊髓炎（neuromyelitis optica，NMO）是一种原发性中枢神经系统炎性脱髓鞘疾病，表现为视神经炎、脊髓炎反复发作。脑MRI表现分为未见异常、非特异性病灶、类多发性硬化病灶和NMO特异性病灶，NMO特异性病灶位于下丘脑、脑桥和脑室周围，与水通道蛋白-4的主要分布区一致。听觉节奏序列附加测试(paced auditory serial, PASAT)要求被试连续相加，评测持续注意、工作记忆、信息加工和处理等认知功能。NMO患者执行认知任务需要动员、募集额外脑区。磁共振传递成像研究发现，表现正常脑灰质存在隐匿性病灶，表现正常脑白质未见明确异常。磁敏感加权成像检查，脑桥黑质存在明显铁沉积。本研究初步显示NMO患者结构损害和脑皮层重塑机制，为临床实施神经调控提供了客观依据。