血管周围间隙扩散张量成像指数在评估帕金森病患者脑类淋巴系统功能中的价值  

Evaluation of glymphatic system activity by diffusion tensor image analysis along the perivascular spaceindex in Parkinson's disease

作　　者：陈阿梅[1] 温金玉 黄俊祥 成小芳 阮秀杭 方美娥 魏新华[1] CHEN A-mei;WEN Jin-yu;HUANG Jun-xiang(Department of Radiology,Guangzhou First People's Hospital,School of Medicine,South China University of Technology,Guangzhou 510180,China)

机构地区：[1]广州市第一人民医院/华南理工大学第二附属医院放射科,广州510180 [2]广州大学计算机科学与网络工程学院,广州511400 [3]广州市妇女儿童医疗中心麻醉科,广州510620 [4]广州医科大学附属脑科医院放射科,广州510370

出　　处：《放射学实践》2022年第8期954-959,共6页Radiologic Practice

基　　金：广东省医学科研基金(A2022263);广东省自然基金面上项目(2021A1515011288)。

摘　　要：目的:探讨血管周围间隙扩散张量成像(DTI-ALPS)指数在评价帕金森病(PD)患者脑类淋巴系统功能中的价值。方法:自帕金森病进展标记物研究项目(PPMI)基线数据库中选取诊断为PD的153例患者及59例健康志愿者(HC组)纳入本研究,212例被试的临床资料(包括多种认知和运动测试量表评分和脑脊液检查资料)和MRI资料完整。本研究中分析了以下认知和运动测试量表的评估结果:霍普金斯语言学习测试(HVLT;其中包括即刻/总回忆测试、辨别记忆测试和维持记忆测试)、蒙特利尔认知功能评估量表(MoCA)、状态-特质焦虑问卷(STAI)、老年抑郁量表(GDS)、宾夕法尼亚大学嗅觉识别测试(UPSIT)、运动障碍协会统一帕金森病分级量表(MDS-UPDRS)第1~3部分及全部(total)及H-Y分级量表(Hoehn and Yahr stages)。脑脊液生物标记物包括Aβ42、a-syn、t-tau、p-tau、t-tau/Aβ42和p-tau/Aβ42。所有MR图像在Siemens 3.0T磁共振仪上完成采集。利用FSL及Image-J软件在每例被试的各向异性分数(FA)图上,分别在左侧大脑半球侧脑室体部水平的投射纤维区域、联合纤维区域及皮层下纤维区域勾画绘直径5.0 mm的球形感兴趣区,测量每种纤维在X、Y和Z轴方向的扩散率,并根据公式计算DTI-ALPS指数。比较PD组与HC组之间ALPS指数值的差异,并分析PD患者ALPS指数与临床指标及脑脊液生物标记物之间的相关性。结果:与HC组比较,PD组DTI-ALPS指数值显著减低(Z=3.769,P<0.001)。PD组ALPS指数与年龄呈负相关(r=-0.256,P=0.001);在控制年龄、性别及受教育年限三个因素后,PD组ALPS指数与MDS-URDRS-Ⅲ评分呈负相关(r=-0.245,P=0.002),与脑脊液p-tau浓度呈负相关(r=-0.357,P<0.001)。结论:DTI-APLS指数可用于评估PD患者类淋巴系统功能受损情况,在探索PD相关发病机制方面具有较好的应用前景。Objective:To investigate the value of diffusion tensor image analysis along the perivascular space(DTI-ALPS)index on glymphatic system activity in Parkinson′s disease patients.Methods:A total of 153 initially diagnosed PD patients and 59 healthy control subjects(HC)were selected from the Parkinson's Progression Markers Initiative(PPMI)baseline database.The clinical information(including the results of several cognitive and motor scales(CMS)and cerebrospinal fluid biomarkers)and MRI data of each subjects were complete.The scores of Hopkins Verbal Learning Test(HVLT;including immediate/total recall test,discrimination recognition test and retention test),montreal cognitive assessment(MoCA),state-trait anxiety inventory(STAI),geriatric depression scale(GDS),university of pennsylvania smell identification test(UPSIT),movement disorder society unified Parkinson’s disease rating scale(MDS-UPDRS)Ⅰ~Ⅲ and total,and hoehn and yahr(HY)stages were recorded and analyzed.Cerebrospinal fluid biomarkers included amyloid-β(Aβ)42,α-synuclein(α-syn),total tau protein(t-tau),phosphorylated tau protein(p-tau),t-tau/Aβ42 and p-tau/Aβ42.All MRI images were collected on a Siemens 3.0T scanner.Diffusion tensor images were acquired to calculate diffusivities in the x,y,and z axes of the plane of the lateral ventricle body in each subject.The diffusivity along the perivascular spaces as well as projection fibers and association fibers were evaluated respectively to acquire an index for diffusivity along the perivascular space(DTI-ALPS index).Differences in ALPS-index between the PD and HC groups were assessed and further correlation analysis between the DTI-ALPS index and clinical characteristics was conducted in PD patients.Results:The PD group showed significantly lower ALPS-index values compared with HC group.The ALPS-index value was inversely correlated with MDS-UPDRS-Ⅲ score,age and cerebrospinal fluid p-tau level.Conclusion:DTI-ALPS index can be used to evaluate impairment of the lymphatic system in PD patients,which

关 键 词：帕金森病 类淋巴系统 扩散张量成像 血管周围间隙 

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]