基于定量磁化率图像观察帕金森病患者黑质体-1退变的研究  

Study of nigrosome-1 degeneration on imaging by quantitative susceptibility mapping in Parkinson's disease patients

作　　者：贺娜英[1] 许洪敏 黄沛[2] 陈生弟[2] 严福华[1] 凌华威[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院放射科,上海200025 [2]上海交通大学医学院附属瑞金医院神经内科,上海200025

出　　处：《诊断学理论与实践》2017年第2期147-151,共5页Journal of Diagnostics Concepts & Practice

摘　　要：目的:分析基于定量磁化率图像(quantitative susceptibility mapping,QSM)上黑质体-1结构的退变情况(即可见度)诊断帕金森病(Parkinson′s disease,PD)的诊断效能。方法:本研究为回顾性研究,共纳入2个被试群体。被试群体Ⅰ,共入组44例早期原发性PD患者和35名性别、年龄匹配的健康志愿者对照,于3T MRI上采集三维多回波GRE序列。被试群体Ⅱ,共入组43例原发性PD患者和48名性别、年龄相匹配的健康志愿者对照,于3T MRI上采集三维多回波GRE序列。基于梯度回波序列数据重建QSM。由2名放射科医师在不了解被试者分组情况下,基于QSM图像独立评判黑质体-1结构征象可见度,分为可见、疑似可见、不可见3种类型,根据双侧黑质体-1结构征象可见度将被试分为正常组、PD组和诊断不确定组。最后以被试者的临床诊断为金标准,计算基于黑质体-1结构征象的测评结果评价QSM图像诊断PD的灵敏度、特异度、阳性预测率、阴性预测率和准确率。结果:在被试群体Ⅰ中,42例PD患者诊断准确,10名健康志愿者诊断准确,基于黑质体-1结构征象诊断PD的灵敏度为95.5%,特异度为28.6%,阳性预测率为65.6%,阴性预测率为100%,准确率为66.0%。在被试群体Ⅱ中,42例PD患者诊断准确,29名健康志愿者诊断准确,基于黑质体-1结构征象诊断PD的灵敏度为97.7%,特异度为60.4%,阳性预测率为75.0%,阴性预测率为100%,准确率为78.0%。结论:QSM图像可被用于观察PD患者黑质体-1结构退变情况,基于QSM图像上的黑质体-1结构征象诊断PD患者具有较高的阴性预测率。Objectives：To assess the diagnostic performance of nigrosome-1 degeneration on imaging by quantitative susceptibility mapping（QSM） for Parkinson＇s Disease（PD）. Methods：Two cohorts（Cohort Ⅰ and Cohort Ⅱ） of patients were analyzed retrospectively in this study. For Cohort Ⅰ,forty-four early idiopathic PD patients and 35 age-and gendermatched healthy controls were recruited,and a three-dimensional 8-echo GRE sequence was acquired on a 3T MR scanner. For Cohort Ⅱ,43 patients with idiopathic PD and 48 healthy gender-and age-matched controls were recruited. For each subject,a three-dimensional 16-echo GRE sequence was scanned. Then QSM was reconstructed from GRE data for all the subjects. Two neuro-radiologists who were blind to the diagnosis evaluated separately the visibility of nigrosome-1on quantitative susceptibility mapping. There were three presenting types：present,possible present,and absent. Then all the subjects were classified into three groups based on the visibility of nigrosome-1：normal group,PD group,and nondiagnostic group. Clinical diagnosis was taken as the gold standard,and diagnostic performance of QSM for PD was assessed. Results：For Cohort Ⅰ,42/44 PD and 10/35 controls were correctly classified,while there were 42/43 PD and 29/48 controls correctly classified in Cohort Ⅱ. Sensitivity of nigrosome-1 degeneration on imaging by QSM for diagnosing PD was 95.5%,specificity was 28.6%,positive predictive value（PPV） was 65.6%,negative predictive value（NPV） was100% and accuracy rate was 66.0% in Cohort Ⅰ. While for cohort Ⅱ,the sensitivity,specificity,positive predictive value,negative predictive value and accuracy rate were 97.7%,60.4%,75.0%,100 % and 78.0%,respectively. Conclusions：QSM imaging could be used as a diagnostic tool for PD,which is feasible to assess the nigrosome-1 degeneration with a high negative predictive value.

关 键 词：帕金森病 黑质体-1 定量磁化率图像 

分 类 号：R445.2[医药卫生—影像医学与核医学]