“燕尾征”消失对帕金森病、原发性震颤及帕金森病叠加综合征的诊断价值  

Diagnostic value of“swallow tail sign”disappearance in Parkinson’s disease,essential tremor and Parkinsonian-plus syndrome

作　　者：张绿明[1] 万志荣[1] 王桂华[1] 韩旭 赵飞[2] 王培福[1] ZHANG LU-ming;WAN Zhi-rong;WANG Gui-hua(Department of Neurology,Aerospace Center Hospital,Peking University Aerospace School of Clinical Medicine,Beijing 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》2021年第3期194-197,共4页Journal of Clinical Neurology

基　　金：航天医科科研基金(2020YK11)。

摘　　要：目的探讨磁敏感加权成像(SWI)"燕尾征"消失对帕金森病(PD)、特发性震颤(ET)及帕金森病叠加综合征(PPS)的诊断价值。方法对53例PD患者(PD组)、22例ET患者(ET组)、20例PPS患者(PPS组)及44例非运动障碍患者(对照组)行头颅MRI SWI序列成像。计算各组黑质致密部背外侧区"燕尾征"评分及消失率,采用ROC曲线计算"燕尾征"消失的敏感度、特异度、曲线下面积。结果与对照组比较,PD组、PPS组"燕尾征"评分显著升高(P=0.000,P=0.001)。与ET组比较,PD组、PPS组"燕尾征"评分显著升高(P=0.001,P=0.029)。PD组与PPS组"燕尾征"评分差异无统计学意义(P=0.499)。ROC曲线显示PD组、PPS组与对照组相比,"燕尾征"消失具有较高的敏感度和特异度,曲线下面积大于0.7,具有一定的诊断价值(P=0.000,P=0.003)。PD组与ET组"燕尾征"消失分析对PD与ET有鉴别诊断价值(P=0.001)。结论SWI序列"燕尾征"消失易出现在PD和PPS中;该征象对PD和PPS有一定的诊断价值,有助于鉴别PD和ET,但对PD和PPS鉴别诊断价值有限。Objective To explore the diagnostic value of susceptibility weighted imaging(SWI)"swallow tail sign"disappearance in Parkinson’s disease(PD),essential tremor and Parkinsonian-plus syndrome(PPS).Methods Fifty-three PD patients,22 essential tremor(ET),20 PPS patients and 44 controls were included.All subjects underwent head MRI scans including SWI.The score and disappearance rate of"swallow tail sign"in the dorsal-lateral region of the dense part of substantia nigra in each group were calculated,and the sensitivity、specificity and the area under curves of the disappearance sign of"swallow tail sign"were calculated by using the ROC curve.Results Compared with the control group,the scores of"swallow tail sign"in PD group and PPS group were significantly increased(P=0.000,P=0.001).Compared with ET group,the scores of"swallow tail sign"in PD group and PPS group were significantly increased(P=0.001,P=0.029).There was no significant difference between PD group and PPS group(P=0.499).The ROC curve showed that the disappearance of"swallow tail sign"in the PD group and the PPS group had a higher sensitivity and specificity than that in the control group,the area under the curve was greater than 0.7,and had a certain diagnostic value(P=0.000,P=0.003).The disappearance of"swallow tail sign"in PD group and ET group analysis had differential diagnostic value for PD and ET(P=0.001).Conclusions The disappearance of"swallow tail sign"in SWI sequence is more likely to occur in PD and PPS patients.This sign has certain diagnostic value for PD and PPS,which can also help to differentiate PD and ET,but the value of differential diagnosis for PD and PPS is limited.

关 键 词：帕金森病 特发性震颤 帕金森叠加综合征 燕尾征 磁敏感加权成像 

分 类 号：R742.5[医药卫生—神经病学与精神病学]