定量磁敏感图黑质“燕尾征”在帕金森病诊断中的应用价值  

The application value of quantitative susceptibility mapping in evaluating substantia nigra "swallow tail sign" in the diagnosis of Parkinson's disease

作　　者：管晓军 谢非[2] 徐晓俊[1] GUAN Xiao-jun;XIE Fei;XU Xiao-jun(Department of Radiology;Department of Neurology, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang, China)

机构地区：[1]浙江大学医学院附属第二医院放射科,杭州310009 [2]浙江大学医学院附属第二医院神经内科,杭州310009

出　　处：《中国现代神经疾病杂志》2018年第4期247-251,共5页Chinese Journal of Contemporary Neurology and Neurosurgery

基　　金：国家自然科学基金资助项目(项目编号:81371519)~~

摘　　要：目的探讨定量磁敏感图(QSM)显示的黑质"燕尾征"消失征象对帕金森病的诊断价值。方法共76例帕金森病患者和47例性别、年龄相匹配的正常对照者均行头部MRI检查,包括三维高分辨力MRI、扩散张量成像、静息态fMRI和多回波采集的增强T_(2)*加权血管成像(ESWAN),ESWAN图像经处理后获得QSM图,计算帕金森病患者和正常对照者黑质致密部背外侧区"燕尾征"出现率和消失率,并计算"燕尾征"消失征象诊断帕金森病的灵敏度、特异度和准确度。结果 QSM图具有极高的磁化率对比,76例帕金森病患者中73例(96.05%)出现单侧或双侧"燕尾征"消失,47例正常对照者中28例(59.57%)出现单侧或双侧"燕尾征"消失,组间差异有统计学意义(χ~2=26.311,P=0.000)。"燕尾征"消失征象诊断帕金森病的灵敏度为96.05%、特异度为40.43%、准确度为74.80%。结论 QSM图可以准确识别帕金森病患者黑质致密部背外侧区"燕尾征"消失征象,但特异性较低,采用高分辨力MRI和精确定量分析方法有助于提高该项技术在帕金森病诊断中的应用价值。Objective To explore the diagnostic value of substantia nigra ＂swallow tail sign＂ inidentifying Parkinson＇s disease（PD） as visualized by quantitative susceptibility mapping（QSM）. Methods A total of 76 PD patients and 47 sex-and age-matched normal controls were retrospectively enrolled in thestudy. They were performed MRI examination, including three-dimensional high-resolution MRI（3D-HRMRI）, diffusion tensor imaging（DTI）, resting-state functional magnetic resonance imaging（rs-fMRI） andenhanced gradient echo T2＊-weighted angiography（ESWAN）. ESWAN images were used to calculate themap of QSM. A radiologist blinded to the clinical results read the images and determined the existence of ＂swallow tail sign＂ in the dorsolateral part of substantia nigra pars compacta. Then the sensitivity,specificity and accuracy of PD diagnosis according to the disappearing of ＂swallow tail sign＂ was calculated.Results With high contrast of magnetic susceptibility, QSM can display substantia nigra clearly, so as toevaluate the existence or disappering of ＂swallow tail sign＂. Among 76 PD patients, 73（96.05%） showedthe absence of unilateral or bilateral ＂swallow tail sign＂. Among 47 normal subjects, 28（59.57%） showedthe absence of unilateral or bilateral ＂swallow tail sign＂. There was significant difference between 2 groups（χ^2= 26.311, P = 0.000）. The sensitivity, specificity and accuracy of discriminating PD patients from normalsubjects with ＂swallow tail sign＂ were 96.05%, 40.43% and 74.80% respectively. Conclusions Although ＂swallow tail sign＂ can be detected sensitively by QSM in PD patients, the specificity of discriminationbetween PD patients and normal controls is relatively low. The utility of high-resolution MRI and precisequantitative analysis may be helpful to improve its diagnostic value in PD patients.

关 键 词：帕金森病 黑质 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R742.5[医药卫生—诊断学]