Correlation Between DTI, TCM Symptoms And Vascular Cognitive Impairment With Leukoaraiosis

Objective:Studied and compared the leukoaraiosis (LA) conditions of the vascular mild congnitive impairment (vMCI), vascular dementia (VD) and normal congnitive (NC) on MRI, applied the diffusion tensor imaging technique (DTI) to observe the fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values in different parts of white matter, explored the characteristic changes of cerebral white matter fiber tracts in the vascular congnitive impairment (VCI) patients and assessed the diagnostic value of DTI in the VCI patients. Meanwhile, explored the distribute characteristic of elements of tranditional Chinese medicine (TCM) syndromes in VCI patients and researched the relationship between those elements and DTI, in order to offer evidence in molecule's level of TCM syndromes of VCI.Materials and Methods:98 subjects who had the risk factors with vascular disease were performed DTI scanning through routine MRI at Philips Intera Achieva 1.5T supraconduction Magnetic Resonance scanner and acceped psychological assessment. All subjects had determine the elements of TCM by experienced Chinese medicine doctors. Accorded the psychological assessment results, the subjects were divided into NC, vMCI and VD (three) groups.First, observed the LA conditions, namely white matter hyperin-tensities in subcortical,periventricular (corona radiata or centrum ovale)and basal nuclei (internal capsule or thalamus)on T2WI-FLAIR, and applied Nonparametric Test to compare the grading (Aharon Peretz's) and locations of LA among the three groups. Then, obtained the FA values and ADC values on the ROI of right and left white fiber regions of entorhinal cortex lobe, hippocampus, anterior of cingulum bundle, posteri-or of cingulum bundle, inferior frontal lobe, superior temporal lobe and occipital lobe. Using ANOVA and LSD test compared FA and ADC values of bilateralis ROIs in difference locations lesions in three groups and paired each groups. Finally, analized the elements frequency on TCM syndromes of vMCI and VD groups and compared those with DTI result. Results:1, LA grading:NC group were more in 0 and 1(31,91.18%), vMCI group more in 2 and 3 (39,78.0%), and VD groups more in 3 and 4 (12,92.31%). 2,LA location:NC group were more located in anterior lateral ventricle (7,41.2%), vMCI group were more located in white matter of frontal and parietal lobe(33,71.74%), VD group were more located in the whole white matter (9,69.23%). The difference of LA location in three groups had significantly different statistic (p<0.01).3, (1)FA values: The FA values of right entorhinal cortex lobe,left posterior of cingulum bundle and bilateral inferior frontal lobe's white fiber tracts in three groups had significantle difference (p<0.01). The FA values of white fiber tracts of the right entorhinal cortex lobe and bilateral inferior frontal lobe among the NC and vMCI groups had significantle difference (p<0.01); The FA values of white fiber tracts of the right entorhinal cortex lobe, right hippocampus, bilateral posterior of cingulum bundle bilateral inferior frontal lobe and left occipital lobe among the NC and VD groups had signif icantle difference (p<0.05), especially in bilateral inferior frontal lobe's white fiber. Among the vMCI and VD groups only the value of white fiber tracts on left occipital lobe had significantle difference(p<0.05). (2) ADC values:In NC, vMCI and VD groups, the ADC values of The white fiber tracts of the bilateral entorhinal cortex lobe,left hippocampus,bilateral posterior of cingulum bundle, bilateral inferior frontal lobe, bilateral superior temporal lobe and bilateral occipital lobe in three groups had signif icantle difference (p<0.05), but those datas are lack of specificity.4, Relation of elements on TCM syndromes and FA values:The elements on TCM syndromes distribution frequency of vMCI(50 patients) and VD (13 patients) were deficiency of Yang accounted for 41.27%, deficiency of Yin accounted for38.10%, blood stasis accounted for 20.63%, fire accounted for 17.46%, phlegm accounted for 15.87%, deficiency of Qi accounted for 12%, deficiency of blood accounted for 12%,wind accounted forl.5%. synthesizing the deficiency element accounted for 68.76%. Compared the FA values in inferior frontal lobe with all elements on TCM syndromes were found no significant correlation (p>0.05)Conclusion:1, There is significant correlation between the grading and locations of LA and vascular congnitive impairmen, follow with increasing grading and range of LA lesions the congnitive impairment getting more serious, and developing from anterior to posterior cerebral white matter. 2, Significant difference of FA values in bilateral inferior frontal lobe' s white matter fiber tracks between NC and vMCI groups can imply that DTI could be as an imaging diagnostic method for the diagnosis of vMCI.3, There is significant difference of FA values of white fiber tracts in right entorhinal cortex lobe, right hippocampus, bilateral posterior of cingul-um bundle, bilateral inferior frontal lobe and left occipital lobe between the NC and VD groups, and in left occipital lobe between the vMCI and VD, which could help to imply VD's pathological process。4, Up to now, there is not enough to prove the relationship on elements of TCM syndromes and FA values, it must continuous study go a step of futher.