帕金森病CT表现及微电极导向脑内核团毁损术后CT影像分析

CT Findings in Parkinson's Disease and CT Analysis After Operation of Microelectrode Guided Thalamotomy and/or Pallidotomy

目的 探讨帕金森病（PD）的CT表现及微电极导向脑内核团毁损术后CT影像特点。资料与方法 （1）对240例PD患者术前CT影像进行回顾性分析。（2）30例PD患者在术后3～12个月（平均6．5个月）CT扫描，观测脑内核团毁损灶33个（其中3例患者为双侧手术）：右苍白球腹后内侧核（gpi）毁损灶14个、左Gpi核毁损灶6个，右丘脑腹外侧核（Vim）毁损灶2个、左Vim核毁损灶11个，对毁损灶最大层面积、术侧CT值（任意值）、健侧对应点CT值（标准值）测量，并算出毁损灶与健侧CT值的差值。结果 （1）PD的CT表现主要为中央型弥漫性脑萎缩，以脑室系统扩大为主，轻度脑萎缩46．67％（112／240），中度脑萎缩40％（96／240），重度脑萎缩3．33％（8／240），正常10％（24／240）。（2）33个毁损靶灶之圆形占27．27％（9／33）；类圆形占60．61％（20／33）；片状不规则形占12．12％（4／33）。毁损灶的面积Gpi核平均（28．01±2．15）mm^2，Vim核平均为（14．03±1．24）mm^2，两者对比有显著性差异（P〈0．01）；毁损灶Gpi核CT值较健侧平均下降（11．80±0．87）HU，Vim核CT值较健侧平均下降（10．80±1．28）HU，两者亦有差异性（P〈0．05）。结论 PD患者术前CT扫描对掌握手术适应证较重要，重度脑萎缩患者提示不宜做外科手术治疗。术后CT扫描观察毁损灶之形态、面积、密度变化等影像学改变，有利于对手术疗效、并发症等评估提供一定证据。

Objective To discuss CT findings of PD and CT features after operation of microelectrode guided thalamotomy and/ or pallidotomy. Materials and Methods （1） CT findings in 240 patients with PD were retrospectively analyzed before operation. （2） CT scan was performed in 30 cases of PD 3 to 12 months later after surgery. 33 lesions of Thalamotomy and/or Pallidotomy were observed in which 3 cases were operated in both sides. There were 14 lesions in fight Gpi, 6 cases of left Gpi lesions, 2 lesions in fight Vim and 11 lesions in IeR Vim. Observe was focused on the largest size of lesions, CT values of operated side and normal side, comparing the CT value between the lesions and normal side. Results （ 1 ） CT findings in PD were mainly diffused middle brain atrophy, low grade brain atrophy were 46.7%, middle were 40%, serious brain atrophy were 3.3%, normal were 12.1%. （2） In 33 lesions, the morphology of circular were 27.27%, oval were 60.61%, patch were 12.12%. The size of Gpi＇s lesion were meanly 28.01± 2.15mm^2 and Vim＇s were 14.03 ± 1. 24mm^2. Significant difference was existed in the two groups. CT value of Gpi＇s and Vim were decreased compared with normal side 11 .80 ± 0.87HU, 10.80 ±1.28HU respectively, and difference in CT values was existed between the two group compared to normal side. Conclusion CT scanning to patients with PD is of great value in master indication of surgery before operation, serious brain atrophy indicate that surgery is not adopted, CT can provide some information in evaluation of surgery and complication, such as the surface morphology, size, density change.