磁共振线性测量指标鉴别进行性核上性麻痹与帕金森病的价值  

Utility of linear MR measurements in differential diagnosis of progressive supranuclear palsy from Parkinson disease

作　　者：沈明[1] 程敏[1] 范洋溢[1] 高旭光[1] SHEN Ming;CHENG Min;FAN Yangyi;GAO Xuguang(Department of Neurology,Peking University People's Hospital,Beijing 10044,China)

机构地区：[1]北京大学人民医院神经内科

出　　处：《中国神经精神疾病杂志》2019年第9期518-521,共4页Chinese Journal of Nervous and Mental Diseases

摘　　要：目的比较几种磁共振线性测量指标在鉴别进行性核上性麻痹(progressive supranuclear palsy,PSP)与帕金森病(Parkinson disease,PD)上的应用价值。方法纳入临床可能的和很可能的PSP患者28例、PD患者30例和健康对照30名,测量计算中脑与桥脑直径比(midbrain diameter/pons diameter,Md/Pd)、第三脑室宽度与额角最大间距比(width of third ventricle/distance of frontal horns,V3rd/FH)、中脑被盖部直径(midbrain tegmentum diameter,MTEG)以及大脑脚角度(angle of cerebral peduncle,ACP),并对它们作为PSP诊断指标的敏感性和特异性进行比较。结果 PSP组患者Md/Pd和MTEG小于PD组和健康对照组,V3rd/FH和ACP大于PD组和健康对照组,且差异有统计学意义。PD组与健康对照组的各项指标差异无统计学意义。通过曲线下面积(area under curve,AUC)的计算,Md/Pd诊断PSP的价值最高,其次是MTEG,其中Md/Pd在约登指数最高点诊断PSP的敏感性和特异性分别达到100%和98.2%。结论 Md/Pd、V3rd/FH、MTEG和ACP几种线性测量指标均对PSP与PD的鉴别有诊断价值,Md/Pd敏感性和特异性最高,最适于临床推广应用,MTEG测量也简单直观,敏感性和特异性也比较高,V3rd/FH和ACP对鉴别诊断也有一定的提示作用。Objective The aim of this study was to examine the utility of linear MRI measurements in the differential diagnosis of PSP and Parkinson disease.Method This study recruited 28 patients with PSP, 30 patients with PD and 30 HC.Midbrains and pons diameters were measured followed by the calculation on the ratios(Md/Pd), the ratio of 3rd ventricular widths to frontal horns(V3rd/FH), diameter of midbrain tegmentum(MTEG ) and cerebral peduncle angle(ACP).The sensitivity and specificity of these measurements in differential diagnosis of PSP and PD were compared.Results Significant decrease in Md/Pd and MTEG were detected in the PSP patients compared to PD and HC groups, V3rd/FH and ACPwere enlarged in PSP patients.ROC analysis of four MR linear measurements yielded AUCs of 0.82~0.99.At the cutoff value with the highest Youden index, Md/Pd had the highest sensitivity and specificity.MTEG was superior to V3rd/FH and ACP.Conclusion These four linear measurements are useful for differential diagnosis of PSP from PD and the Md/Pd is an easily applied and specific tool in the diagnosis of PSP.

关 键 词：线性测量 进行性核上性麻痹 帕金森病 鉴别诊断 

分 类 号：R742.5[医药卫生—神经病学与精神病学]