帕金森病前驱期基底神经节环路磁共振弥散张量成像的应用研究  

Application of diffusion tensor imaging of the basal ganglia circuit in patients with prodromal Parkinson's disease

作　　者：耿磊[1] 张照婷[2] 许磊 黄海 孙毅[1] 杨伏猛[3] 徐凯 胡春峰 Lei Geng;Zhaoting Zhang;Lei Xu;Hai Huang;Yi Sun;Fumeng Yang;Kai Xu;Chunfeng Hu(Department of Medical Imaging,the Second People's Hospital of Lianyungang,Lianyungang 222000,China;Department of Neurology,the Second People's Hospital of Lianyungang,Lianyungang 222000,China;Medical Laboratory,the Second People's Hospital of Lianyungang,Lianyungang 222000,China;Department of Medical Imaging,the Affiliated Hospital of Xuzhou Medical University,Xuzhou 221002,China)

机构地区：[1]连云港市第二人民医院(连云港市肿瘤医院)(江苏大学连云港临床学院)医学影像科,江苏连云港222000 [2]连云港市第二人民医院(连云港市肿瘤医院)(江苏大学连云港临床学院)神经内科,江苏连云港222000 [3]连云港市第二人民医院(连云港市肿瘤医院)(江苏大学连云港临床学院)检验科,江苏连云港222000 [4]徐州医科大学附属医院医学影像科,江苏徐州221002

出　　处：《中华临床医师杂志（电子版）》2023年第9期995-1003,共9页Chinese Journal of Clinicians(Electronic Edition)

基　　金：江苏大学医教协同创新基金项目资助(JDYY2023087);2022年连云港市卫生健康面上科技项目(202219);连云港市卫生科技项目(202021);连云港市第二人民医院中青年人才成长基金科研课题计划(TQ201906)。

摘　　要：目的探讨基底神经节环路弥散张量成像(DTI)对帕金森病前驱期(pPD)的诊断与病情评估的价值。方法收集2020年1月~2022年12月连云港市第二人民医院神经内科就诊的21例pPD患者作为病例组,同时选取30例健康人群(对照组,HC组)及28例帕金森(PD组)组患者进行对照,所有病例均行MRI平扫及DTI检查,运用DSI studio 软件对所有被检者的DTI图像进行后处理,自动提取各基底节核团各参数(FA、MD、AD、RD)值,对PD、pPD及HC组进行统计学对比分析,并且对各组参数与UPDRS III量表进行相关性分析。结果PD、pPD及HC组组间多个基底神经节核团、多个参数具有统计学差异(P<0.05),以壳核AD=1.28×10-3mm2/s时作为诊断pPD与HC的最佳诊断分界点,曲线下面积为0.805,敏感度为61.9%,特异度90.0%,诊断效能最高。pPD组内多个基底神经节核团、多个参数与UPDRS III量表评分存在相关性(P≤0.05),以丘脑下核AD值(r=0.763,P<0.001)相关系数最高。结论pPD基底节环路相关核团损伤广泛且程度不同,壳核AD值对pPD具有定量诊断价值,丘脑下核AD值可以作为pPD患者疾病严重程度的特征性敏感指标,pPD基底节环路多个相关核团的DTI多个参数值为pPD的早期诊断,早期干预治疗提供有价值的参考。ObjectiveTo assess the value of diffusion-tensor imaging (DTI) of the basal ganglia circuit in the diagnosis and assessment of prodromal Parkinson's disease (pPD).MethodsA total of 21 pPD patients at the Department of Neurology of the Second People's Hospital of Lianyungang City from January 2020 to December 2022 were collected. Meanwhile, 30 healthy people (control group, HC group) and 28 patients with Parkinson's disease (PD group) were also included. All subjects underwent plain MRI scanning and DTI. DSI studio software was used to post-process DTI images of all subjects, and parameters [fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD)] of basal ganglia nuclei were automatically extracted. Statistical comparison and analysis were carried out among PD, pPD, and HC groups, and correlation analysis was carried out between parameters of each group and UPDRS III Scale score.ResultsThere were statistical differences in basal ganglia nuclei and parameters among the PD, pPD, and HC groups (P<0.05). Putamen AD=1.28×10-3 mm2/s was the best diagnostic cut-off point for pPD and HC;the area under the curve was 0.805, the sensitivity was 61.9%, the specificity was 90.0%, and the diagnostic efficiency was the highest. In the pPD group, there were correlations between basal ganglia nuclei and UPDRS III Scale score (P<0.05), and the AD value of the subthalamic nucleus (r=0.763, P<0.001) had the highest correlation coefficient.ConclusionThe lesions of basal ganglia nuclei in pPD patients are extensive and different in severity. AD value in the putamen is valuable for quantitative diagnosis of pPD. AD value in the subthalamic nucleus can be used as a characteristic sensitive index of disease severity in pPD patients. Multiple parameters of DTI in basal ganglia nuclei provide valuable reference for early diagnosis and intervention of pPD.

关 键 词：帕金森病前驱期 扩散张量成像 基底神经节 UPDRS III量表评分 

分 类 号：R742.5[医药卫生—神经病学与精神病学]