脑深部核团MR弥散张量成像对帕金森病不同运动亚型的鉴别诊断价值  

Differential diagnosis value of magnetic resonance diffusion tensor imaging of deep brain nuclei for different motor subtypes of Parkinson's disease

作　　者：栾炜 陈飞 张扬[3] 赵辉[3] 朱小倩 陈文倩 孙艺 闫娴 王正阁[4] 张鑫[4] 青钊 张冰[1,5] Luan Wei;Chen Fei;Zhang Yang;Zhao Hui;Zhu Xiaoqian;Chen Wenqian;Sun Yi;Yan Xian;Wang Zhengge;Zhang Xin;Qing Zhao;Zhang Bing(Department of Radiology,Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University,Nanjing 210008,China;Department of Radiology,the Sixth Affiliated Hospital of Nantong University(Yancheng Third People's Hospital),Yancheng 224005,China;Department of Neurology,the Affiliated Drum Tower Hospital of Nanjing University Medical School,Nanjing 210008,China;Department of Radiology,the Affiliated Drum Tower Hospital of Nanjing University Medical School,Nanjing 210008,China;Institute of Brain Science,Nanjing University,Nanjing 210008,China)

机构地区：[1]南京医科大学鼓楼临床医学院影像科,南京210008 [2]南通大学第六附属医院(盐城市第三人民医院)影像科,盐城224005 [3]南京大学医学院附属鼓楼医院神经内科,南京210008 [4]南京大学医学院附属鼓楼医院影像科,南京210008 [5]南京大学脑科学研究院,南京210008

出　　处：《中华解剖与临床杂志》2021年第4期379-386,共8页Chinese Journal of Anatomy and Clinics

基　　金：国家自然科学基金(81720108022,81801265);江苏医药职业学院临床学院科研项目(20209105);南京市医学科技发展项目(YKK17079)。

摘　　要：目的:探讨脑深部核团MR弥散张量成像(DTI)在帕金森病(PD)不同运动亚型中的鉴别诊断价值。方法:回顾性研究。纳入2017年10月—2019年12月南京大学医学院附属鼓楼医院47例PD患者的临床及MRI资料。按照统一PD评定量表第三部分(UPDRS Ⅲ)运动功能评分,将47例PD患者分为震颤为主型(TD)组30例和非震颤为主型(NTD)组17例;另外选择同期受检且无认知障碍者24例为正常对照(NC)组。对两组PD患者及NC组进行常规MR平扫及DTI检查,测量各受试者双侧黑质、红核、尾状核头、丘脑、苍白球、壳核的DTI参数,包括各向异性分数(FA)、平均扩散率(MD)、轴向扩散系数(DA)和径向扩散系数(DR)。比较各核团DTI参数在三组间的差异。分析存在TD和NTD组间差异的DTI参数单独及联合应用对TD和NTD的鉴别诊断效能,以及这些参数与PD病程、Hoehn-Yahr(H-Y)分级、UPDRS评分、震颤评分和非震颤评分的相关性。结果:TD、NTD两组黑质、尾状核头、丘脑、苍白球及壳核的FA值均低于NC组( P值均<0.05),其中黑质和尾状核头FA值在TD和NTD组分别为0.49±0.08、0.56±0.08和0.22±0.04、0.19±0.03,差异均有统计学意义( P值均<0.05)。NTD组尾状核头MD、DA和DR值分别为(0.72±0.04)×10 -3 mm 2/s、(0.90±0.05)×10 -3 mm 2/s和(0.65±0.02) ×10 -3 mm 2/s,均高于NC组的(0.67±0.04)×10 -3 mm 2/s、(0.84±0.05)×10 -3 mm 2/s和(0.60 ± 0.03 )×10 -3 mm 2/s,且MD和DA值高于TD组的(0.69±0.05)×10 -3 mm 2/s和(0.85±0.05) ×10 -3 mm 2/s,差异均有统计学意义( P值均<0.05)。受试者操作特征(ROC)曲线分析显示,黑质FA值和尾状核头FA、MD、DA值联合应用鉴别TD和NTD的曲线下面积(AUC)、灵敏度、特异度和约登指数分别为0.896、88.2%、80.0%和0.682,其中AUC值明显高于各参数的单独应用,差异均有统计学意义( P值均<0.05)。黑质FA值与病程、UPDRS Ⅲ评分和震颤评分呈负相关( r=-0.484、-0.343和-0.618, P值均<0.05),尾状核头FObjective To investigate the differential diagnostic value of magnetic resonance(MR)diffusion tensor imaging(DTI)of deep brain nuclei for different motor subtypes of Parkinson's disease(PD).Methods The clinical and MR data of 47 patients with PD and 24 normal controls(NC)admitted to the Affiliated Drum Tower Hospital of Nanjing University Medical School were retrospectively analyzed.According to the third part of unified Parkinson's disease rating scale(UPDRSⅢ),patients with PD were divided into 30 cases in the tremor dominant(TD)group and 17 cases in the non-tremor dominant(NTD)group.Routine MR scanning and DTI examination were performed on patients with PD and the NC group.DTI parameters of bilateral substantia nigra,red nucleus,caudate head,thalamus,globus pallidus,and putamen were measured,including fractional anisotropy(FA),mean diffusivity(MD),axial diffusivity(DA),and radial diffusivity(DR).The DTI parameters of each nucleus were compared among the three groups to analyze the single and united differential diagnostic efficacy of DTI parameters with differences between TD and NTD groups,and the correlations of these parameters with the course of disease,Hoehn-Yahr(H-Y)grade,UPDRSⅢscore,tremor score,and non-tremor score.Results The FA values of substantia nigra,caudate head,thalamus,globus pallidus,and putamen in the TD and NTD groups were lower than those in the NC group(all P values<0.05),the FA values of substantia nigra and caudate head of TD and NTD groups were(0.49±0.08 vs.0.56±0.08)and(0.22±0.04 vs.0.19±0.03),respectively,and both differences were statistically significant(all P values<0.05).The MD,DA,and DR values of caudate head in the NTD group were(0.72±0.04)×10-3 mm2/s,(0.90±0.05)×10-3 mm2/s,and(0.65±0.02)×10-3 mm2/s,respectively,which were higher than those in the NC group([0.67±0.04]×10-3 mm2/s,[0.84±0.05]×10-3 mm2/s,and[0.60±0.03]×10-3 mm2/s,respectively),the MD and DA values were higher than those in the TD group([0.69±0.05]×10-3 mm2/s and[0.85±0.05]×10-3 mm2/s),and al

关 键 词：帕金森病 神经核 磁共振成像 弥散张量成像 

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]