常规磁共振形态测量学在进行性核上性麻痹中的诊断及鉴别诊断价值  

Assessment of conventional magnetic resonance morphological measurements in diagnosis and differential diagnosis of progressive supranuclear paralysis

作　　者：吴铁妤 李川 焦悦 李娟[1] 吴桐 王尚培 陈先文[1] Wu Tieyu;Li Chuan;Jiao Yue;Li Juan;Wu Tong;Wang Shangpei;Chen Xianwen(Department of Neurology,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China)

机构地区：[1]安徽医科大学第一附属医院神经内科,合肥230022

出　　处：《中华老年医学杂志》2023年第2期188-195,共8页Chinese Journal of Geriatrics

基　　金：国家自然科学基金(81971072)。

摘　　要：目的研究常规磁共振形态测量学在进行性核上性麻痹(PSP)不同临床亚型的特征及其诊断和鉴别诊断价值。方法纳入PSP患者45例,其中经典型(PSP-RS)15例、帕金森综合征型(PSP-P)15例、进展性冻结步态型(PSP-PGF)15例。另纳入多系统萎缩帕金森综合征型(MSA-P)15例、原发性帕金森病(PD)30例,健康对照者(HC)40例作为病例对照。测量并计算基于脑磁共振的中脑与脑桥面积比(M/P)、磁共振帕金森综合征指数(MRPI、MRPI2.0)、小脑中脚与小脑上脚宽度比(MCP/SCP)、中脑与脑桥直径比值(MTPR)、大脑脚内侧夹角(Acp)、第三脑室宽度(V3rd)与侧脑室前角最大宽度(FH)比值(V3rd/FH)、蜂鸟征评分(HBS-RS),比较各组差异。通过ROC曲线进行特征分析,明确这些指标在PSP及其各亚型诊断及鉴别诊断价值。结果PSP组的MRPI、MRPI2.0、MCP/SCP、HBS-RS评分大于各对照组(H值分别为69.351、66.776、33.926、84.694,均P<0.05),M/P、MTPR小于各对照组(H值分别为60.101、77.276,均P<0.05),其V3rd/FH高于PD及HC组(F=17.168,P<0.05),但与MSA-P组之间差异无统计学意义(Z=-1.602,P>0.05)。各PSP亚组与各对照组之间的也具有上述差异。PSP亚组间比较,PSP-PGF组Acp大于PSP-RS组(Z=-2.510,P<0.05),HBS-RS评分大于PSP-P组(Z=-2.380,P<0.05),余指标在PSP亚组之间未见差异有统计学意义。M/P、MRPI、MTPR、MRPI2.0、HBS-RS评分诊断PSP及其各亚型时均有较高的准确性,其中HBS-RS评分准确性最高,当截断值为2时,AUC值均高于0.99,敏感度及特异度均在90%以上。PSP及其亚型与MSA-P的最佳鉴别指标为MRPI,当其截断值为9.94时,AUC值均高于0.90,敏感度为100%,特异度为86.67%;而PSP及其亚型与PD最佳鉴别指标为MTPR,AUC值均高于0.95,截断值略有不同。几乎所有MRI形态测量学指标在区分PSP不同亚型的敏感性和特异性都不高。结论磁共振形态测量学指标在PSP及亚型的诊断与MSA-P及PD鉴别诊断上均有较高价值,但在不Objective To study the features as well as the diagnosis and differential diagnosis values by conventional MRI morphometrics in different clinical subtypes of progressive supranuclear palsy(PSP).Methods Forty five patients with PSP were included,comprising three PSP subtypes:15 cases of Richardson's syndrome(PSP-RS),15 cases of Parkinson's syndrome(PSP-P)and 15 cases of progressive frozen gait(PSP-PFG).In addition,three control groups were established:15 cases of multiple system atrophy-Parkinson's syndrome(MSA-P),30 cases of primary Parkinson's disease(PD)and 40 healthy controls(HC).Midbrain area-to-Pons area ratio(M/P),Magnetic Resonance Parkinsonism Index(MRPI,MRPI2.0),width ratio of middle cerebellar peduncle to superior cerebellar peduncle(MCP/SCP),Midbrain-to-Pons ratio(MTPR),Angle of cerebral peduncle(Acp),third ventricle width/frontal horns width ratio(V3rd/FH),and Humming bird sign rating scale(HBS-RS)scores were calculated.Diagnostic sensitivity and specificity were performed by ROC curve to assess the accuracy of these imaging indicators in the diagnosis and differential diagnosis of PSP and its subtypes.Results The MRPI,MRPI2.0,MCP/SCP and HBS-RS scores were significantly higher in PSP group than in other control groups(H=69.351,66.776,33.926 and 84.694,all P<0.05),while M/P and MTPR were significantly lower in PSP group than in other control groups(H=60.101 and 77.276,all P<0.05).PSP group also had higher V3rd/FH compared with PD or HC group(F=17.168,P<0.05),but not with MSA-P group(Z=-1.602,P>0.05).The above differences also existed between each PSP subgroup and control groups.Among PSP subgroups,PSP-PFG subgroup had a larger Acp than did PSP-RS(Z=-2.510,P<0.05),and had higher HBS-RS score than did PSP-P group(Z=-2.380,P<0.05).No significant differences in other MRI morphometric indexes were identified among PSP subtypes.The M/P,MRPI,MTPR,MRPI2.0,HBS-RS score showed good accuracy in diagnosing PSP and its each subgroup,with HBS-RS score being the most accurate indicator,when the cutoff value was 2,t

关 键 词：进行性核上性麻痹 磁共振形态测量学 多系统萎缩 帕金森病 诊断 

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]