多模态MRI对帕金森病及多系统萎缩鉴别诊断价值研究  

The study on the value of multimodal MRI in differential diagnosis of Parkinson's disease and multiple system atrophy

作　　者：王宗英 于文文[1] 吴晓丽[1] 谭栋 王文丽 王琦[1] WANG Zongying;YU Wenwen;WU Xiaoli;TAN Dong;WANG Wenli;WANG Qi(Department of Radiology,Weifang People's Hospital,Weifang,Shandong Province 261041,China)

机构地区：[1]潍坊市人民医院放射科,山东潍坊261041

出　　处：《实用放射学杂志》2023年第9期1396-1400,共5页Journal of Practical Radiology

摘　　要：目的 探讨多模态 MRI对帕金森病(PD)与多系统萎缩(MSA)的鉴别诊断价值.方法 选取符合诊断标准的 20 例 PD患者及 15 例 MSA患者,均行常规 MRI、扩散张量成像(DTI)、磁共振波谱(MRS)及磁敏感加权成像(SWI)检查.比较 PD与 MSA患者脑桥、小脑中脚及小脑各向异性分数(FA)值、表观扩散系数(ADC)值及扩散张量纤维束成像(DTT)图纤维束形态;脑桥、小脑中脚及小脑 N-乙酰天门冬氨酸/肌酸(NAA/Cr)值、胆碱/Cr(Cho/Cr)值及肌醇(mlns)/Cr 值;壳核、苍白球、红核及黑质 SWI 低信号强度分级.结果 MSA患者脑桥、小脑中脚、小脑FA值(0.39±0.03、0.39±0.04、0.12±0.02)均较PD患者(0.44±0.06、0.52±0.08、0.23±0.57)减小,DTT图显示相应部位纤维束均较PD稀疏、减少.MSA患者脑桥、小脑中脚、小脑NAA/Cr值(1.52±0.50、0.70±0.37、1.00±0.28)均较PD患者(1.99±0.20、1.56±0.25、1.77±0.21)减小,小脑 mlns/Cr 值(1.69±0.21)较 PD 患者(1.04±0.21)增大.MSA患者壳核、黑质 SWI序列低信号强度分级(1.67±0.66、1.87±0.63)较PD患者(1.17±0.70、1.00±0.79)增高.DTI序列中小脑中脚 FA值[曲线下面积(AUC)、敏感性及特异性分别为 0.962、100%、90.9%]和 MRS序列中 NAA/Cr值(AUC、敏感性及特异性分别为 0.956、85.7%、97.4%)与其他联合指标相比较对其两者鉴别意义较高,联合诊断 AUC、敏感性及特异性分别为 0.973、92.7%、93.9%.结论 多模态 MRI对PD与 MSA鉴别诊断提供依据,尤其是 DTI 序列中的小脑中脚 FA 值联合 MRS序列中的 NAA/Cr值鉴别两者效能更高,可进一步指导临床.Objective To investigate the role of multimodal MRI in the differential diagnosis of Parkinson's disease(PD)and multiple system atrophy(MSA).Methods Twenty PD patients and 15 MSA patients who satisfied the diagnostic criteria were selected,and all of them underwent conventional MRI,diffusion tensor imaging(DTI),magnetic resonance spectroscopy(MRS)and susceptibility wgighted imaging(SWI)examinations.The fractional anisotropy(FA)values,apparent diffusion coefficient(ADC)values and fiber bundle morphology in diffusion tensor tractography(DTT)of pons,middle cerebellar peduncle and cerebellum;the values of N-acetylaspartate/creatine(NAA/Cr),choline/Cr(Cho/Cr)and mlns/Cr of pons,middle cerebellar peduncle and cerebellum;low signal intensity grading of putamen,globus pallidus,red nucleus and substantia nigra in SWI were compared between PD and MSA patients.Results FA values of pons,middle cerebellar peduncle,and cerebellum in MSA patients(0.39±0.03,0.39±0.04,0.12±0.02)were lower than those in PD patients(0.44±0.06,0.52±0.08,0.23±0.57).Compared with PD,DTT showed that the fiber tracts in MSA patients were more sparse and fewer.In contrast to PD patients(1.99±0.20,1.56±0.25,1.77±0.21),MSA patients had lower NAA/Cr values for the pons,middle cerebellar peduncle,and cerebellum(1.52±0.50,0.70±0.37,1.00±0.28)as well as higher mlns/Cr values(1.69±0.21)in the cerebellum than PD patients(1.04±0.21)did.In SWI,the low signal intensity grading of putamen and substantia nigra in MSA patients(1.67±0.66,1.87±0.63)were higher than those in PD patients(1.17±0.70,1.00±0.79).The FA values[area under the curve(AUC),sensitivity and specificity were 0.962,100%,90.9%,respectively] in DTI and NAA/Cr values(AUC,sensitivity and specificity were 0.956,85.7%and 97.4%,respectively)in MRS of middle cerebellar peduncle had greater significance in differential diagnosis of PD and MSA,compared with other combined indexes,which can be applied as combination.The AUC,sensitivity and specificity of combination were 0.973,92.7%and 93.9%,re

关 键 词：帕金森病 多系统萎缩 多模态磁共振成像 

分 类 号：R742[医药卫生—神经病学与精神病学] R445.2[医药卫生—临床医学]