磁共振脑桥面积测量在鉴别C型多系统萎缩与帕金森病的诊断价值

Area measurement of the pons by MRI in differential diagnosis between cerebellar dominant multiple system atrophy and Parkinson's disease

目的:探讨MRI测量脑桥面积在鉴别小脑型多系统萎缩(MSA-C)与帕金森病(PD)中的临床诊断价值。方法:对21例临床拟诊的MSA-C患者(MSA-C组)、21例年龄及性别相匹配PD患者(PD组)和21例正常人(正常对照组)行头颅常规MRI扫描。在横轴面T2WI上对"十字征"进行评分,在矢状面测量所有受试对象的脑桥面积,分析"十字征"评分与脑桥面积的相关性。结果:MSA-C组常规MR T2WI"十字征"评分:0分(1例),1分(6例),2分(7例),3分(7例)。PD组出现1例脑桥"十字征"信号,而正常对照组未出现脑桥"十字征"信号。MR T2WI测量MSA-C组脑桥面积均小于PD组和正常对照组脑桥面积。T2WI"十字征"评分与脑桥萎缩程度之间呈现一致相关性(r=-0.49,P<0.05),即脑桥萎缩程度越严重,MSA-C"十字征"越明显。当脑桥面积阈值为448mm2时,敏感度为95%,特异度为100%。脑桥面积越小,越倾向于诊断MSA-C。结论:磁共振成像测量脑桥面积大小对MSA-C与PD的鉴别有一定价值,对诊断MSA-C及评估MSA-C脑桥萎缩程度具有重要的临床意义。

Objective：To explore the value of area measurement of the pons by MRI in differential diagnosis between cerehellar dominant multiple system atrophy （MSA-C） and Parkirlson＇s disease （PD）. Methods：Conventional MRI examina-tions were performed in 21 clinically diagnosed MSA patients, 21 age-matched PD patients, and 21 normal controls using 3. 0T MR scanner. The cross signs were graded on the axial T2 WI images. The area of the pons was measured on the sagittal T2WI images. The correlation between scores of the cross sign and area of the pons was analyzed. Results： The scores of cross sign in 21 patients with MSA-C were： 0 in one case,1 in 6 cases,2 in 7 cases,and 3 in 7 cases. All of the scores of the cross sign in PD patients and controls were 0,except only one PD patient was scored as 1. The areas Of the pons in MSA-C were smaller than those of PD and controls. There was a correlation between appearances of the cross sign and atrophy of the pons （r=-0.49 ,P^0.05） where MSA-C patients with a smaller area of the pons tended to have a higher grade. When the area of the pons was 448mm^2 ,its sensitivity and specificity was 95 % and 100%, respectively. Conclusion：Area measure-ment of the pons by MRI has significant value in diagnosis of MSA-C and in evaluation of atrophy of MSA-C;it has certain values in differential diagnosis between MSA-C and PD.