帕金森病脑内铁沉积含量磁敏感成像临床研究

Susceptibility weighted imaging evaluation of brain iron content in patients with parkinson’s disease

目的应用磁敏感加权成像技术相位图测定帕金森病(PD)患者脑内铁沉积含量,并探讨其在临床研究中的意义。方法应用磁敏感加权成像技术测定20例PD患者(PD组)和25名健康人(对照组)各感兴趣区域(ROI)中双侧苍白球(GP)、壳核(Pu)、尾状核(CN)、前脑白质、黑质(SN)和红核(RN)的相位值,并分析相位值与脑内铁沉积含量及PD临床指标的相关性。结果对照组的相位值与脑内铁沉积定量研究数据呈负相关(r=-0.932,P=0.007)。对照组不同性别间各ROI的相位值的差异均无统计学意义(P值均>0.05);CN的相位值与年龄呈负相关(r=-0.562,P=0.004),其他ROI的相位值与年龄和性别均不相关(P值均>0.05)。PD组症状严重侧肢体对侧的黑质网状(SNr)中部(-0.19896±0.18746,t=3.137,P=0.006)和黑质网状(SNr)侧部(-0.17324±0.14542,t=2.288,P=0.034)的相位值均显著小于症状较轻侧肢体对侧(-0.09725±0.10176、-0.06879±0.11243,P值均<0.05),其他ROI的相对值的差异均无统计学意义(P值均>0.05)。PD统一评分量表第三部分中单侧肢体得分与对应的各ROI的相位值均不相关(P值均>0.05);SNr侧部(r=-0.584,P=0.009)、RN(r=-0.640,P=0.003)的相位值分别与病程呈负相关;其他ROI的相位值与患者的年龄、病程均不相关(P值均>0.05)。两组不同性别和年龄间的相位值的差异均无统计学意义(P值均>0.05)。PD组在SNr侧部上的相位值(-0.01371±0.10595)显著小于对照组(-0.0057±0.0975,t=-2.828,P=0.008),两组间其他ROI的相位值间的差异均无统计学意义(P值均>0.05)。结论应用磁敏感加权成像技术测定脑内铁沉积含量对PD的临床诊断具有一定的应用价值,脑内铁沉积含量与病程及肢体运动障碍严重程度有关。

Objective To compare the iron deposition quantified by susceptibility weighted imaging （SWI） in several cerebral regions between Parkinson＇s disease patients and control subjects, and evaluate the possibilities of clinical application. Methods 20 patients with PD and 25 healthy adults performed MR examination with a 3.0 tesla magnet. The regions of interest （ROI） evaluated included globus pallidus （GP）, putamen （Pu）, caudate nucleus （ON）, anterior white matter, substantia nigra pars reticulate （SNr）, substantia nigra pars compacta （SNc） and red nucleus （RN）, and corresponding signals and phase values were measured. Results In healthy adults, there was negative correlation between phase value and brain iron deposition （r = -0. 932, P =0. 007）; there was no significant difference in phase value between male and female （P〉O. 05）; there was negative correlation between phase value and age （r = -0. 562, P = 0. 004）; the phase value in other ROI has no correlation with age and sex （all P〉O. 05）. In PD patients the phase values of medial SNr （ t=3. 137, P = 0. 006） and lateral SNr （ t = 2. 288, P = 0. 034） opposite the clinically more affected side （ - 0. 198 96 ± 0. 187 46, - 0. 173 24 - 0. 145 42） were smaller than those opposite the less affected side （ - 0. 097 25 ±0. 101 76, -0. 068 79± 0.112 43） in patients; the phase value of other ROI has no significant difference （all P〈 0.05）] there was no correlation between phase value and scores of unilateral limbs in UPDRS Ⅲ there was negative correlation between phase value of lateral SNc （ r = - 0. 584, P = 0. 009） and RN （ r = - 0. 640, P = 0. 003） and course of disease in patients. The phase value of lateral SNc in PD patients were smaller than those in control subjects （t= 2. 828, P = 0. 008）. The phase value of other ROI has no significant difference （all P〉 0.05）. Conclusions It has application value of clinical diagnosis of PD that detect of the brain iron deposition using SWl, Iron deposition correlates with courses of PD disease, and it more affected side was more than those opposite the less affected side in patients.