多系统萎缩和帕金森病患者的磁共振影像学分析

MRI features of patients with multiple system atrophy and Parkinson＇s disease

目的探讨多系统萎缩（multiple system atrophy，MSA）和帕金森病（Parkinson disease，PD）的磁共振成像（MRI）影像学特点，为早期诊断和鉴别诊断提供依据。方法回顾性分析经临床确诊的24例MSA、30例PD和30例健康人的MRI资料，观察指标包括：（1）T2WI信号改变：十字征（即脑桥基底部十字样高信号）、裂隙征（即壳核外侧缘裂隙样高信号）；（2）脑室、脑池扩大：四脑室、桥池、延池；（3）脑实质萎缩：延髓、脑桥、小脑中脚、壳核萎缩。并测量中脑面积、脑桥面积和小脑中脚宽度。结果MSA患者中均出现至少1项MRI异常指标，并表现一定的分型差异。敏感性较高的指标是：小脑中脚萎缩（79．2％）、脑桥萎缩（79．2％）和十字征（75．0％）；特异性和阳性预测值高的指标是：十字征（均为100％）、裂隙征（均为100％）、小脑中脚萎缩（93．3％和90．1％）、脑桥萎缩（96．7％和95．0％）。MSA组脑桥面积、中脑面积及小脑中脚宽度分别为（288．7±75．4）mm2、（127．8±25．8）mm2及（10．7±2．8）mm，与PD组[分别为（477．5±54．3）mm2、（145．9±21．6）mm2及（16．2±1．3）mm、对照组[分别为（454．5±36．8）mm2、（146．4±17．4）mm2及（16．7±1．2）mm]比较，差异有统计学意义（P〈0．05）。结论MRI有助于MSA的诊断及其与PD的鉴别诊断，对MSA的分型具有一定的价值。

Objective To explore the MRI features of patients with multiple system atrophy （MSA） and Parkinson＇s disease （PD） for providing early evidence in differential diagnosis. Methods The MRI features of 24 patients with MSA, 30 patients with PD and 30 healthy people as controls were retrospectively analyzed. Abnormal intensil y in MRI included the hot-cross bun sign and the slitlike changes. The atrophies of brain included cerebellar, middle cerebellar peduncles, medulla oblongata and pon. Cerebral ventricle dilatation included fourth ventricle and cisterna pontis. The midbrain area, pons area and middle cerebellar peduncles width were measured. Results All patients with MSA had at least one of the features observed on MR images, and there were some differences in the subtypes of MSA. The high sensitive features were the atrophies of middle cerebellar peduncles （79.2~）, the atrophies of pons （7!）.2~） and the hot-cross bun sign （75.0%）. The parameters with high specificity and high posilive predictive value were hot-cross bun sign （both 100%）, the slit-like sign （both 100~）, the alrophies of middle cerebellar peduncles （93.3% and 90.1%）, and the atrophies of pons （96.7~ and 95.0~）. MSA group had the statistically significantly decreased values of pons area, midbrain area and middle cerebellar peduncles width [（288. 7±75. 4） mm2, （127.8±25.8） mm2 and （10.7±2.8） mm, respectively], as compared with PDgroup [（477.5±54.3） mm2, （145.9±21.6） mm2 and （16.2±1.3） mm, respectively] and healthy group [（454.54±36.8） mm2 , （146.44±17.4） mm2 and （16.74±1.2） ram, respectively] （all P〈0.05）. Conclusions The routine MRI is helpful in differential diagnosis between MSA and PD and has some values in diagnosing the subtypes of MSA.