进行性核上性麻痹与多系统萎缩的头部MRI和FDG-PET比较  

The Comparison between Progressive Supranuclear Palsy and Multiple System Atrophy in MRI and FDG-PET

作　　者：冯涛[1] 王拥军[1] 芦林龙[1] 李伟[1] 马锐华[1] 史伟雄[1] 欧阳巧红[2] 段中响[2] 

机构地区：[1]首都医科大学附属北京天坛医院神经内科,北京100050 [2]解放军总医院第一附属医院核医学科,北京100073

出　　处：《中国神经免疫学和神经病学杂志》2007年第6期351-354,I0003,共5页Chinese Journal of Neuroimmunology and Neurology

摘　　要：目的对比研究进行性核上性麻痹(PSP)与多系统萎缩(MSA)的脑干MRI表现和头部葡萄糖代谢特征。方法对11例PSP患者、37例MSA患者和43例健康对照进行头部MRI平扫检查,并计算MRI正中矢状面T1加权像上中脑截面面积,其中5例PSP和19例MSA进行了18F-FDG PET检查。结果(1)MRI:11例PSP正中矢状位T1加权像均可见中脑上缘平坦或凹陷表现,呈"蜂鸟征",而MSA患者和健康对照组未见上述表现。37例MSA患者中有34例轴位T2加权像桥脑可见"十字征"样长T2异常信号。PSP患者正中矢状位T1加权像上中脑截面面积分别低于MSA组和健康对照组(P<0.01)。(2)PET:PSP组主要表现为对称性额叶低代谢;MSA组主要表现为额、顶、颞叶普遍低代谢,纹状体对称性代谢降低,丘脑代谢高于纹状体。结论PSP中脑MRI特征和头部葡萄糖代谢特征与MSA和健康对照有明确差异,有助于PSP与MSA的鉴别诊断。Objective To investigate the magnetic resonance imaging （MRI） abnormalities and feature of fluorodeoxyglucose（FDG） metabolism in the brain of patients with progressive supranuclear palsy （PSP）. Methods 11 patients with PSP, 37 patients with multiple system atrophy（MSA）and 43 age-matched normal control subjects were prospectively studied with plain MRI. 5 patients with PSP and 19 patients with MSA were prospectively studied with ^18F-FDG PET. Results The atrophy of the rostral midbrain and hummingbird sign were demonstrated in all of the PSP patients studied, but were not observed neither in patients with MSA nor in normal controls. The area of the midbrain on mid-sagittal plain MRI of the patients with PSP was significantly smaller than that of patients with MSA and that of normal controls respectively. The patients with PSP had prominent symmetrical decrease of glucose metabolism in frontal cortices. The patients with MSA had prominent symmetrical decrease of glucose metabolism in striatum, frontal cortices and temporal cortices. In MSA the striatum showed significant glucose hypometabolism compared with thalamus. Conclusions The assessment of the mid-sagittal plain MRI and 18F-FDG PET images may be a useful adjunct to a clinical examination when making a differential diagnosis between PSP and MSA.

关 键 词：进行性核上性麻痹 磁共振 正电子发射计算机断层扫描 

分 类 号：R742.5[医药卫生—神经病学与精神病学]