中脑磁共振定量测量对进行性核上性麻痹、多系统萎缩和帕金森病的鉴别诊断价值  

Value of quantitative midbrain measurement in differentiating progressive supranuclear palsy from Parkinson＇s disease and multiple system atrophy

作　　者：王含[1] 张一玮 袁晶[1] 徐丹[1] 有慧[2] 李明利[2] 冯逢[2] Wang Han;Zhang Yiwei;Yuan Jing;Xu Dan;You Hui;Li Mingli;Feng Feng(Department of Neurology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医院神经科,100730 [2]中国医学科学院北京协和医院放射科,100730

出　　处：《中华神经科杂志》2018年第8期586-591,共6页Chinese Journal of Neurology

基　　金：国家“十三五”重点研发计划项目（2016YFC0105904XHW）

摘　　要：目的评价磁共振定量测量对于进行性核上性麻痹（PSP）、多系统萎缩和帕金森病的鉴别诊断价值。方法对2017年1—9月在北京协和医院神经科就诊的帕金森综合征患者进行中脑磁共振定量测量，包括中脑短轴宽度（MW）、中脑短轴/脑桥短轴（M/P）、磁共振帕金森指数（MRPI）。比较上述指标在进行性核上性麻痹经典型（PSP－RS）、帕金森病和多系统萎缩帕金森型（MSA－P）3组之间的差异，并比较诊断效能。结果入组的患者中，PSP－RS组10例，帕金森病组49例，MSA－P组15例。PSP－RS组的MW、M/P和MRPI分别为（8.21±1.30）mm、0.49±0.06和15.26±4.53，与MSA－P组[分别为（10.24±0.77）mm、0.65±0.09和7.75±2.71]和帕金森病组[分别为（10.53±0.93） mm、0.62±0.06和9.86±2.46]比较差异均有统计学意义（F＝24.27、18.37、21.47，均P〈0.01）。在调整了年龄、病程及性别之后，协方差分析结果提示，MW、M/P和MRPI的结果与诊断PSP－RS、MSA－P或帕金森病具有显著相关性。受试者工作特征曲线分析显示，MW≤9.4 mm、M/P≤0.57和MRPI〉10.77对于PSP－RS与MSA－P和帕金森病鉴别诊断的敏感度和特异度分别为90.0%与92.1%、80.0%与93.7%、100.0%与82.5%。结论MW、M/P和MRPI对于PSP－RS、MSA－P和帕金森病的鉴别诊断具有较好的价值。ObjectiveTo evaluate the effectiveness of quantitative midbrain measurements in differentiating progressive supranuclear palsy （PSP） from multiple system atrophy （MSA） and Parkinson′s disease （PD）.MethodsQuantitative midbrain measurements, including midbrain width （MW）, midbrain to pons ratio （M/P） and magnetic resonance parkinsonism index （MRPI）, were performed in patients with parkinsonism who were diagnosed in the Movement Disorder Clinic of Peking Union Medical College Hospital during the period of January to September 2017. A cross-sectional study was conducted in the series to evaluate the effectiveness of these quantitative measurements. ResultsTen PSP-RS, 15 MSA-P and 49 PD patients were included in this study. The values of MW, M/P and MRPI in PSP-RS patients were （8.21±1.30） mm, 0.49±0.06 and 15.26±4.53, respectively, with statistically significant difference compared to MSA-P （（10.24±0.77） mm, 0.65±0.09, 7.75±2.71） and PD patients （（10.53±0.93） mm, 0.62±0.06, 9.86±2.46; F=24.27, 18.37, 21.47, all P〈0.01）. After adjusting for age, disease course and gender, analysis of covariance suggested significant correlation between the quantitative midbrain measurements and diagnosis of these diseases. Receiver operating characteristic curve indicated that MW≤9.4 mm, M/P≤0.57 and MRPI〉10.77 showed ideal sensitivity and specificity （90.0% and 92.1%, 80.0% and 93.7%, 100.0% and 82.5%） in differentiating PSP-RS from MSA-P and PD.ConclusionQuantitative measurement of midbrain atrophy is useful in differentiating PSP-RS from MSA-P and PD.

关 键 词：核上麻痹 进行性 磁共振成像 中脑 诊断 鉴别 

分 类 号：R742[医药卫生—神经病学与精神病学]