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孤獨癥顱腦MRI研究進展,胡冰 副主任醫(yī)師中山大學附屬第三醫(yī)院放射科,廣東省醫(yī)學會第十六次放射醫(yī)學學術會議,國家自然科學基金青年項目,項目編號:31100738李詠梅、胡冰、李建英、孟安啟、易莉、梁亞勇、陳碧媛、李冬蘊,Brain MRI research progress in autism,Bing Hu MDAssociate Chief Physician, Department of Radiology, the Third Affiliated Hospital of SUN Yat-sen University,前言,獲得1989年奧斯卡最佳影片最佳導演最佳原創(chuàng)劇本最佳男主角,雨人巴里萊文森1988年執(zhí)導的一部劇情電影。,目錄,孤獨癥簡介相關學科研究MRI研究進展早期MRI研究00sMRI研究10sMRI研究今年MRI研究參考文獻,目錄,孤獨癥簡介相關學科研究MRI研究進展早期MRI研究00sMRI研究10sMRI研究今年MRI研究參考文獻,1. 孤獨癥簡介,孤獨癥是一種神經系統(tǒng)失調導致的發(fā)育障礙早期不能進行正常的語言表達和社交活動常做出一些刻板、重復性和限制性的動作Autism 一詞源于希臘語autor,原意為自我孤獨癥患者的突出特征 - 自我興趣孤獨癥和自閉癥是 Autism 的兩種譯名男性多于女性,孤獨癥的首次發(fā)現,1943年,在約翰霍普金斯醫(yī)院工作的醫(yī)生Leo Kanner發(fā)表了第一篇關于孤獨癥的論文5 歲男孩Donald是第一個被診斷為孤獨癥的孩子“每當自己一個人的時候,總會感覺自己很幸福,且不愿意其他人打攪他獨處”Leo Kanner,1Kanner L. Autistic disturbances of affective contact. Acta Paedopsychiatr, 1968, 35(4): 100-136.,診斷標準的演變,1973年WHO1980年DSM-III1987年DSM-III-R1989年ICD-101994年DSM-IV2000年DSM-IV-TR2013年DSM-VThe Diagnostic and Statistical Manual of Mental Disorders精神疾病診斷與統(tǒng)計手冊International Classification of Diseases國際疾病分類,DSM-V(2013),統(tǒng)稱為孤獨癥譜系障礙(autistic spectrum disorders, ASD)診斷標準:A. 在各種情景下持續(xù)存在的社會交流和社會交往缺陷,包括在現在或過去有以下表現:(1)社會-情感互動缺陷(2)用于社會交往的非言語交流行為缺陷(3)建立或維持與其發(fā)育水平相符的人際關系缺陷,DSM-V,B. 狹隘、重復的行為方式、興趣或活動內容,包括在現在或過去有以下表現的至少兩項:(1)語言、運動或物體運用刻板或重復 (2)過分堅持某些常規(guī)以及言語或非言語行為的儀式,或對改變的過分抵抗 (3)高度狹隘、固定的興趣,其在強度和關注度上是異常的(4)對感覺刺激反應過度或反應低下,對環(huán)境中的感覺刺激表現出異常的興趣,DSM-V,C. 癥狀必須在兒童早期出現D. 所有癥狀共同限制和損害了日常功能E. 這些癥狀不能用智力發(fā)育障礙或全面發(fā)育遲緩解釋,1Coplan J. Atypicality, intelligence, and age: a conceptual model of autistic spectrum disorder. Dev Med Child Neurol, 2003, 45(10): 712-716.2Coplan J, Jawad AF. Modeling clinical outcome of children with autistic spectrum disorders. Pediatrics, 2005, 116(1): 117-122.,1Coplan J. 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AJR Am J Roentgenol, 1994, 162(1): 123-130.,Courchesne提出假設:孤獨癥的小腦發(fā)育存在著發(fā)育不良和發(fā)育過度兩種類型,00sMRI研究,1Palmen SJ, van Engeland H. Review on structural neuroimaging findings in autism. J Neural Transm (Vienna), 2004, 111(7): 903-929.,TBV,1Palmen SJ, van Engeland H. Review on structural neuroimaging findings in autism. J Neural Transm (Vienna), 2004, 111(7): 903-929.,基于體素的DTI研究,1Barnea-Goraly N, Kwon H, Menon V, et al. White matter structure in autism: preliminary evidence from diffusion tensor imaging. Biol Psychiatry, 2004, 55(3): 323-326.,大腦的不對稱性,1Herbert MR, Ziegler DA, Deutsch CK, et al. Brain asymmetries in autism and developmental language disorder: a nested whole-brain analysis. Brain, 2005, 128(Pt 1): 213-226.,胼胝體,1Vidal CN, Nicolson R, DeVito TJ, et al. Mapping corpus callosum deficits in autism: an index of aberrant cortical connectivity. Biol Psychiatry, 2006, 60(3): 218-225.,DTI of CC,1Alexander AL, Lee JE, Lazar M, et al. 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