血管性帕金森综合征与帕金森病影像学脑白质病变及“燕尾征”改变的差异  

The difference of imaging changes of white matter lesions and‘swallow tail sign’in vascular Parkinson’s syndrome and Parkinson’s disease

作　　者：张绿明[1] 万志荣[1] 韩旭 李继来[1] 王培福[1] ZHANG Lü-ming;WAN Zhi-rong;HAN Xu(Department of Neurology,Aerospace Center Hospital(Peking University Aerospace School of Clinical Medicine),Bejing 100049,China)

机构地区：[1]航天中心医院神经内科,北京100049 [2]航天中心医院影像科,北京100049

出　　处：《临床神经病学杂志》2020年第5期371-374,共4页Journal of Clinical Neurology

基　　金：航天中心医院青年创新基金(2018QN02)

摘　　要：目的探讨血管性帕金森综合征(VP)与帕金森病(PD)影像学脑白质病变(WML)及"燕尾征"改变的差异。方法纳入53例PD、16例VP,收集一般临床资料,评价二组影像学WML特点及SWI序列"燕尾征"征象,计算两组WML程度的差异及黑质致密部背外侧区"燕尾征"的出现率和消失率。结果 VP组多合并脑血管病危险因素,临床常合并认知障碍、球麻痹症状,但静止性震颤少见(P=0.000)。VP组Fazekas分级标准评分深部WML得分高于PD组(P<0.05);但脑室旁WML组间比较差异无统计学意义(P>0.05)。PD组有84.9%的患者出现单侧或双侧"燕尾征"消失,而VP组仅有25.0%(P<0.05),且PD组"燕尾征"平均得分高于VP组(P<0.05)。结论通过计算头颅影像学WML程度及SWI序列"燕尾征"征象消失程度,有助于VP和PD的临床鉴别。Objective To explore the difference of imaging changes of white matter lesions(WML) and ‘swallow tail sign’ in vascular Parkinson’s syndrome(VP) and Parkinson’s disease(PD). Methods Fifty-three PD and 16 VP were included. General clinical data were collected, and the imaging characteristics of WML and SWI sequence ‘swallow tail sign’ were evaluated in the two groups. The differences of WML degree between two groups and the occurrence rate and disappearance rate of ‘swallow tail sign’ in the dorsal-lateral region of the dense part of substantia nigra in two groups were calculated. Results VP was often associated with vascular risk factors. Cognitive impairment and bulbar paralysis were common in VP, but static tremor was rare(P=0.000). The deep WML Fazekas score in VP group was higher than that in PD group(P<0.05). However, there was no difference in paraventricular WML Fazekas score(P>0.05). There were 84.9% patients in PD group had unilateral or bilateral ‘swallow tail sign’ disappearance, while only 25.0% patients in VP group(P<0.05). The average score of ‘swallow tail syndrome’ in PD group was higher than that in VP group(P<0.05). Conclusion It is helpful to distinguish VP from PD by calculating the degree of WML and the degree of disappearance of ‘swallow tail sign’ in SWI sequence.

关 键 词：血管性帕金森综合征 帕金森病 脑白质病变 磁敏感加权成像 燕尾征 

分 类 号：R742.5[医药卫生—神经病学与精神病学]