基于黑质和蓝斑的神经黑色素磁共振成像鉴别帕金森病和多系统萎缩的研究  

Substantia nigra and locus coeruleus neuromelanin magnetic resonance imaging differentiates Parkinson's disease and multiple system atrophy

作　　者：刘雨 贺娜英[1] 严福华[1] LIU Yu;HE Naying;YAN Fuhua(Department of Radiology,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200001,China)

机构地区：[1]上海交通大学医学院附属瑞金医院放射科,上海200001

出　　处：《磁共振成像》2025年第4期6-11,共6页Chinese Journal of Magnetic Resonance Imaging

基　　金：国家自然科学基金项目(编号:82271954)。

摘　　要：目的 运用神经黑色素(neuromelanin,NM)-MRI比较帕金森病(Parkinson's disease,PD)和多系统萎缩(multiple system atrophy,MSA)患者的黑质(substantia nigra,SN)和蓝斑(locus coeruleus,LC)的NM退变情况。材料与方法 回顾性分析114例被试(包括38例PD患者、38例MSA患者和38例年龄匹配的健康对照(healthy control,HC))的临床及影像资料。第一部分基于脑模板自动检测方法,分割出双侧SN,并测量SN相对对比度、体积以及个体校正后体积(即SN体积除以其颅内总体积)。第二部分基于人工手动标注的方法,测量出LC相对对比度。采用单因素方差分析结合Bonferroni校正进行事后多重比较,分析SN和LC的NM指标的组间差异。最后采用逻辑回归的方法,将SN和LC的NM测量指标建模。运用受试者工作特征(receiver operating characteristic,ROC)曲线评估单个NM测量指标以及逻辑回归模型对疾病的诊断及鉴别诊断效能,并计算曲线下面积(area under the curve,AUC)。结果 与HC相比,PD和MSA患者的SN体积及校正后体积、SN相对对比度、LC相对对比度均减低(Bonferroni校正,P均<0.001)。值得注意的是,与PD患者相比,MSA患者的SN体积(Bonferroni校正,P<0.001)、SN校正后体积(Bonferroni校正,P<0.001)、LC相对对比度(Bonferroni校正,P<0.001)减低。SN校正后体积对区分MSA和HC、PD和HC的AUC分别达到0.981和0.950,结合SN和LC的NM测量指标的逻辑回归模型对区分MSA和PD的AUC达到0.817。结论 基于NM-MRI的SN体积测量以及SN和LC对比度测量为PD和MSA的诊断及鉴别诊断提供了客观、定量的影像学信息。Objective:To use neuromelanin(NM)-MRI of the substantia nigra(SN) and locus coeruleus(LC) to compare NM loss in patients with Parkinson's disease(PD) and multiple system atrophy(MSA).Materials and Methods:A total of 114 subjects(including 38 patients with PD,38 patients with MSA,and 38 age-matched healthy controls(HCs)) were retrospectively collected.In the first part,voxels-of-interests(VOIs) of the bilateral SN were automatically traced based on a brain template detection method.Relative contrast ratio(rCR),volume and corrected volume(SN volume divided by the total intracranial volume) of the SN territory were measured.In the second part,rCR of the LC was measured using manually drawn regions-of-interests(ROIs) within the structure.One-way analysis of variance combined with Bonferroni correction was used to conduct post-hoc multiple comparisons to analyze the intergroup differences of the NM-related parameters.The NM parameters of the SN and LC were combined to generate a model using logistic regression method.Receiver operating characteristic(ROC) curve was used to evaluate the diagnostic performance of different single NM parameters and logistic regression model,and the area under the curve(AUC) was calculated.Results:Compared to HCs,volume,corrected volume and rCR of the SN,and rCR of the LC were significantly reduced in PD and MSA patients(Bonferroni correction,all P < 0.001).Of note,MSA had significantly lower SN volume and LC rCR than PD(Bonferroni correction,P < 0.001,respectively).The AUC of the corrected volume of the SN to distinguish MSA and HC,PD and HC reached as high as 0.981 and 0.950,respectively.The AUC of the logistic regression model combining the NM measurement of the SN and LC to distinguish MSA and PD reached 0.817.Conclusions:The NM volume and contrast measures of the SN and contrast measures of the LC provided subjective and quantitative information to better facilitate differential diagnosis between PD and MSA.

关 键 词：帕金森病 多系统萎缩 磁共振成像 神经黑色素 黑质 蓝斑 

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]