磁共振测量黑质致密带宽度在帕金森病和血管性帕金森综合征鉴别诊断上的应用  

The application of measurement of the width of pars compacta of substantia nigra in differential diagnosis on Parkinson's disease and vascular parkinsonism on MRI

作　　者：黄海东[1] 邓敬兰[1] 宦怡[2] 杨春敏[2] 葛雅丽[2] 赵海涛[2] 

机构地区：[1]第四军医大学西京医院核医学科,西安710033 [2]第四军医大学西京医院放射科,西安710033

出　　处：《临床神经病学杂志》2004年第1期11-13,共3页Journal of Clinical Neurology

摘　　要：目的　探讨在常规磁共振 (MRI)上测量黑质致密带 (SNc)宽度及其与中脑直径的比值对帕金森病 (PD)和血管性帕金森综合征 (VP)的诊断和鉴别诊断价值。方法　对 6 0例PD患者 (Hoehn Yahr分级为Ⅰ～Ⅱ级 38例、Ⅲ级 14例、Ⅳ级 8例 )、6 0例VP患者 (Hoehn Yahr分级为Ⅰ～Ⅱ级 2 6例、Ⅲ级 2 0例、Ⅳ级 14例 )和6 0名正常老年人对照组进行MRI常规轴位T2 WI上测量SNc宽度和中脑直径以及计算两者的比值 ,并对结果进行比较分析。结果　PD患者比VP患者和正常对照组SNc宽度明显变窄 ,SNc宽度和中脑直径的比值明显降低 (P <0 0 5 ) ,而VP患者与正常对照组相比差异无显著性。并且PD患者在早期 (Ⅰ～Ⅱ级 )其SNc宽度已经变窄 ,SNc宽度与中脑直径的比值已经降低 ,随病情加重其SNc宽度更加变窄 (P <0 0 5 )、SNc宽度与中脑直径的比值更加降低 ;而VP患者在早中期 (Ⅰ～Ⅲ级 )其SNc宽度以及SNc宽度和中脑直径的比值无明显改变 ,仅在后期 (Ⅳ级 )其SNc宽度有轻度变窄、SNc宽度与中脑直径的比值有轻度降低 (P <0 0 5 )。结论　在常规MRI上测量SNc宽度以及SNc宽度与中脑直径的比值对PD和VP的诊断和鉴别诊断具有临床应用价值。Objective To evaluate the value of measurement of the width of pars compacta of substantia nigra(SNc) and SNc's ratio to midbrain diameter in diagnosing Parkinson's disease(PD) and differentiating PD from vascular parkinsonism(VP) on routine MRI.Methods The width of SNc, midbrain diameter, and SNc's ratio to midbrain diameter were measured in 60 patients with PD (38 patients with Hoehn-Yahr stage Ⅰ～Ⅱ, 14 patients with Hoehn-Yahr stage Ⅲ, and 8 patients with Hoehn-Yahr stage Ⅳ), 60 patients with VP (26 patients with Hoehn-Yahr stage Ⅰ～Ⅱ, 20 patients with Hoehn-Yahr stage Ⅲ, and 14 patients with Hoehn-Yahr stage Ⅳ), and 60 age-matched heathly control subjects by means of routine axial T 2-weighted MRI. The results of measurement were analyzed and compared.Results Significant reduction was found in the width of SNc and SNc's ratio to midbrain diameter in PD compared those in VP and control subjects(P<0.05), However,no obvious difference between VP and control subjects. Furthermore, the width of SNc and SNc's ratio to midbrain diameter reduced at Ⅰ～Ⅱ stage of PD. The extent of reduction in the width of SNc and SNc's ratio to midbrain diameter was closely related to the stage of PD(P<0.05). The width of SNc and SNc's ratio to midbrain diameter did not reduce atⅠ～Ⅲ stage of VP. The reduction was only seen at Ⅳ stage of VP(P<0.05).Conclusion Measurement of the width of SNc and SNc's ratio to midbrain diameter on MRI is a reliable means to diagnose PD and differentiate PD from VP.

关 键 词：磁共振 黑质致密带 帕金森病 血管性帕金森综合征 鉴别诊断 脑萎缩 

分 类 号：R742.5[医药卫生—神经病学与精神病学] R445.2[医药卫生—临床医学]