不同亚型多系统萎缩的影像学诊断  

Imaging Characteristics of Different Subtypes in Multiple System Atrophy

作　　者：黄碧娟[1] 王晏佳 刘丰韬 游斌[1] 刘学玲 李郁欣[2,3] HUANG Bi-juan;WANG Yan-jia;LIU Feng-tao;YOU Bin;LIU Xue-ling;LI Yu-xin(Department of Radiology,Fuzhou Second Hospital,Fuzhou 350007,China;Department of Radiology,Huashan Hospital,Fudan University,Shanghai 200040,China;Institute of Functional and Molecular Medical Imaging,Fudan University,Shanghai 200040,China;Department of Neurology,Huashan Hospital,Fudan University,Shanghai 200040,China)

机构地区：[1]福州市第二医院放射科,福州350007 [2]复旦大学附属华山医院放射科,上海200040 [3]复旦大学医学功能与分子影像研究所,上海200040 [4]复旦大学附属华山医院神经内科,上海200040

出　　处：《中国临床神经科学》2023年第2期146-152,共7页Chinese Journal of Clinical Neurosciences

基　　金：福建省创伤骨科急救与康复临床医学研究中心项目(编号:2020Y2014)。

摘　　要：目的探讨高分辨MR T1WI结构像和Flair图像对多系统萎缩(MSA)不同亚型[小脑共济失调亚型(MSA-C)和帕金森亚型(MSA-P)]的鉴别诊断价值。方法回顾性分析经临床确诊的24例MSA-C(MSA-C组)患者和12例MSAP(MSA-P组)患者,另选择20例年龄、性别相匹配的健康对照者(对照组)的MRI检查结果。高分辨MR T1WI结构像用于测量3组的双侧小脑中脚宽度,Flair图像用于判读壳核后部是否存在萎缩以及壳核的线样铁沉积。结果(1)对照组、MSA-C组与MSA-P组的双侧小脑中脚宽度平均值组间比较均P<0.05;MSA-C组双侧小脑中脚宽度平均值最小(P<0.05),但MSA-P组与对照组比较差异无显著性(P=0.08)。以双侧小脑中脚宽度平均值1.02 cm鉴别MSA-C和MSA-P的曲线下面积(AUC)为0.93,敏感度为100%,特异度为87.5%,准确率为88.9%。(2)壳核后部萎缩:对照组、MSA-C组和MSA-P组出现壳核后部萎缩的比例分别为2.50%、10.41%和45.83%,组间比较均P<0.05。(3)壳核线样铁沉积:对照组、MSA-C组和MSA-P组出现壳核线样铁沉积的比例分别为7.50%、16.67%和50.00%,组间比较均P<0.05。MSA-P出现壳核后部萎缩和线样铁沉积的比例最高(P<0.05),但MSA-C组与对照组间比较P>0.05。结论不同亚型MSA具有相对特异的影像学表现,MSA-C型小脑中脚萎缩更加明显,MSA-P型出现壳核后部萎缩和线样铁沉积的概率更高,可以作为两亚型的鉴别要点。Aim To explore the value of high-resolution MR T1WI and FLAIR images in the discriminative diagnosis of different subtypes of multiple system atrophy[cerebellar ataxia subtype(MSA-C)and Parkinson’s disease subtype(MSA-P)].Methods MRI images were retrospectively analyzed in 24 MSA-C,12 MSA-P,which is diagnosed clinically and 20 age-and gender-matched control group.High-resolution MR T1WI images were used to measure the width of bilateral middle cerebellar peduncle(MCP)among the three groups.FLAIR images were used to identify whether there were atrophy in the posterior putamen and linear iron deposition in the putamen.Results①Group comparisons among the control group,MSA-C group and MSA-P group using average width of bilateral middle cerebellar peduncle(all P<0.05),and it was the smallest in MSA-C group(P<0.05),but no significant average bilateral MCP width in distinguishing MSA-P from the control,resulting a sensitivity,specificity and accuracy of 100%,87.50%and 88.9%,respectively.②Posterior putamen atrophy:the incidences of posterior putamen atrophy in the control group,MSA-C group and MSA-P group were 2.50%,10.41%and 45.83%,respectively.Comparisons among the three groups were all significantly different(all P<0.05).③Linear iron deposition of the putamen:the incidence of linear iron deposition in the control group,MSA-C group and MSA-P group were 7.50%,16.67%and 50.00%,respectively.Comparisons among the three groups were all significantly different(all P<0.05).The occurrence rate of posterior putamen atrophy and linear iron deposition was higher in MSA-P group than MSA-C group or the control group(P<0.05),but there was no significant difference between MSA-C group and the control group(P>0.05).Conclusion There were characteristic findings in different subtypes of MSA,with more pronounced atrophy of MCP in MSA-C,and higher occurrence rate of posterior putamen atrophy and linear iron deposition in putamen for MSA-P,which could be used as the imaging biomarkers for the discrimination.

关 键 词：多系统萎缩 磁共振成像 铁沉积 

分 类 号：R742.5[医药卫生—神经病学与精神病学] R442.2[医药卫生—临床医学]