小脑及小脑中脚表观扩散系数值在鉴别多系统萎缩与帕金森病中的价值

The value of apparent diffusion coefficient values of cerebellar and the middle cerebellar peduncles in differential diagnosis of multiple system atrophy and Parkinson disease

目的 探讨小脑及小脑中脚ADC值在鉴别多系统萎缩（MSA）与帕金森病（PD）中的价值.方法 选取经临床诊断为MSA的18例患者（MSA组）,其中发病较早期7例（MSA早期组）,诊断为PD的19例患者（PD组）和年龄匹配的18名正常人（对照组）行常规MR和DWI扫描.DWI采用单次激发自旋回波-平面回波序列,测量ROI为两侧小脑半球、小脑中脚及顶叶白质,运用单因素方差分析对各组3个部位的ADC值进行统计学分析.结果 18例MSA中,MR表现异常11例,其中桥脑十字征8例,延髓、桥脑及小脑萎缩11例,小脑中脚萎缩10例,T2WI见壳核边缘高信号和壳核萎缩2例.MSA组及MSA早期组小脑中脚的ADC值[（0.98±0.07）×103、（0.95±0.05）×103 mm2/s]较PD组[（0.77±0.04）×103 mm2/s]和对照组[（0.78±0.04）×103 mm2/s]均明显升高,差异均有统计学意义（F值分别为91.049、55.301,P值均＜0.01）,MSA组及MSA早期组ADC值分布范围[（0.86～1.13）×103、（0.86～l.02）×103 mm2/s]与PD组[（0.68～0.84）×103 mm2/s]和对照组[（0.69～0.82）×103 mm2/s]均没有交叉.MSA组及MSA早期组小脑的ADC值[（0.95±0.09）×103、（0.92±0.07）×103 mm2/s]较PD组[（0.78±0.05）×103 mm2/s]和对照组[（0.79±0.05）×103 mm2/s]均明显升高,差异均有统计学意义（F值分别为39.274、18.623,P值均＜0.01）,其分布范围[（0.80～1.10）×103、（0.80～0.99）×103 mm2/s]与PD组[（0.72～0.90）×103 mm2/s]和对照组[（0.71～0.87）×103mm2/s]均有交叉.而MSA组及MSA早期组顶叶白质的ADC值与PD组和对照组差别均无统计学意义（P值均＞0.05）.结论 小脑及小脑中脚的ADC值对于这两种疾病的鉴别诊断有重要意义,尤其对于发病较早期常规MR表现正常的MSA患者与PD患者的鉴别诊断有重要意义.

Objective To evaluate the apparant diffusion coefficient （ADC） values of cerebellar and the middle cerebellar peduncles in the differential diagnosis of multiple system atrophy （MSA） and Parkinson disease （PD）. Methods Conventional MRI and DWI were performed in 18 clinically proved MSA patients with 7 cases of early cases （early-stage MSA group）, 19 PD patients （PD group） and 18 agematched normal controls （the control group）. DWI was performed using a single shot-spin echo-echo planar imaging sequences, and ADC values were measured in the ROIs （0. 16 cm2） of the bilateral cerebellum, the middle cerebellar peduncles and cerebral white matter. Then one way ANOVA test was used for statistical analysis. Results Of the 18 MSA patients, 11 had MR abnormalities, 8 had hot-cross bun sign in the pens on T2-weighted images, 11 patients had pontine, cerebellar and medulla oblongata atrophy, 10 patients had atrophy of the middle cerebellar peduncles, 2 patients had hyperintense rim of the putamen and putaminal atrophy on T2-weighted images. The ADC values in the middle cerebellar peduncles were significantly increased in the MSA group[ （0. 98 ±0. 07） × 103 mm2/s] and early-stnge MSA group [ （0. 95 ±0. 05） ×103 mm2/s] as compared to PD group [ （0. 77 ±0. 04） × 103 mm2/s] and control group[ （0. 78 ±0. 04） ×103 mm2/s]. There was statistical significant difference among them （F = 91.049,55. 301, P ＜ 0.01 ）.There was no overlap in the distribution of ADC values of the middle cerebellar peduncles among the MSA group [ （0.86-1.13 ） × 103 mm2/s ], early-stage MSA group [ （0. 86-1.02 ） × 103 mm2/s ] and PD group [ （0. 68-0. 84） × 103 mm2/s] and the control group [ （0. 69-0. 82） × 103 mm2/s]. The ADC values in the cerebellum were significantly increased in the MSA group[ （0. 95 ±0. 09） × 103 mm2/s] and early-stage MSA group [ （0. 92 ±0. 07） × 103 mm2/s] as compared to PD group [ （0. 78 ±0. 05） × 103 mm2/s] and control group[ （0. 79 ± 0. 05 ） × 103 mm2/s ]. Statistically significant difference was found among them （F =39. 274,18. 623 ,P ＜0. 01 ）. There was overlap in the distribution of ADC values of the cerebellum [ MSAgroup（0. 80-1.10） × 103 mm2/s,early stage MSA group （0. 80-0. 99） × 103 mm2/s,PD group（0. 72-0. 90） × 103 mm2/s,control group （0. 71-0. 87） × 103 mm2/s]. There was no significant difference among the ADC values of MSA group, MSA group（early stages） and PD group and the control group in the cerebral white matter（ P ＞ 0. 05 ）. Conclusions ADC values in the cerebellum and the middle cerebellar peduncles have very important significance in differential diagnosis between MSA and PD.