原发性单侧症状帕金森病患者脑黑质DTI和SWI的特点及其预后评估价值

Characteristics of Diffusion Tensor Imaging and Susceptibility Weighted Imaging of Substantia Nigra in Patients with Idiopathic Parkinson's Disease with Unilateral Symptoms(IPDUS)and Their Value in Evaluation of Prognosis

目的研究原发性单侧帕金森病(Parkinson’s disease,PD)患者脑黑质的DTI及SWI特点,探讨PD的亚临床期和早期诊断及预后评估中功能磁共振的临床价值。方法以10例原发单侧症状PD患者为PD组,并将导致其出现症状的症状对侧黑质作为早期PD组,将症状同侧黑质作为亚临床期PD组,另选年龄和性别相匹配的10名健康志愿者为对照组。分别予以磁共振DTI和SWI检查,测量计算双侧黑质区域的ADC值、FA值和CP值,并进行对比分析。结果早期PD组的黑质FA值较亚临床期PD组和健康对照组FA值明显下降(分别为t=-2.424,P=0.038和t=5.112,P=0.001);亚临床期PD组黑质FA值与对照组之间差异也有统计学意义(t=6.214,P=0.002);对照组双侧黑质FA值之间差异无统计学意义(t=-1.187,P=0.301)。早期PD组、亚临床期PD组黑质部位ADC值与对照组之间差异均无统计学意义(分别为t=0.140,P=0.893和t=0.334,P=0.748)。早期PD组、亚临床期PD组与对照组黑质的CP值差异均有统计学意义(t=-3.779,P=0.007,t=-2.132,P=0.041);PD组双侧黑质CP值差异无统计学意义(t=0.332,P=0.749);对照组双侧黑质CP值差异无统计学意义(t=-0.152,P=0.883)。结论 PD患者早期和亚临床期就存在黑质铁异常沉积,并可能存在神经元的缺失或轴突功能受损。黑质部位FA及CP值分析可作为PD早期或亚临床诊断的线索之一,两者具有协同作用。

Objective To investigate the characteristics of diffusion tensor imaging（DTI）and susceptibility weighted imaging（SWI）of substantia nigra（SN）in patients with idiopathic Parkinson＇s disease with unilateral symptoms（IPDUS）and the clinical value of DTI and SWI in the diagnosis of PD at early or subclinical stage and the evaluation of prognosis.Methods Ten patients who were diagnosed as having IPDUS（PD group）were enrolled in this study as well as 10age-and sex-matched healthy volunteers（control group）.Contralateral SN served as early PD group and ipsilateral SN as subclinical PD group.DTI and SWI were performed in each patient and the apparent diffusion coefficient（ADC）,fractional anisotropy（FA）and corrected phase（CP）values of each SN were measured and calculated.Statistic analysis was used for comparison of results between PD group and control group.Results The FA value was significantly lower in early PD group than in subclinical PD group and control group（t=-2.424,P=0.038 and t=5.112,P=0.001respectively）.There was significant difference in the FA value between subclinical PD group and control group（t=6.214,P=0.002）.No significant difference was found in the FA value between the two sides of SN in the control group（t=-1.187,P=0.301）.No significant difference was noted in the ADC value between early PD group or subclinical PD group and control group（t=0.140,P=0.893 and t=0.334,P=0.748）.The CP value of SN was significantly lower in PD groups（P〈0.05）.There was no significant difference in CP value between the two sides of SN in PD group（t=0.332,P=0.749）.No significant statistical difference was demonstrated in CP value between the two sides of SN in the control group（t=-0.152,P=0.883）.Conclusion Abnormal iron deposition in SN occurs in PD patients at early or subclinical stage,with neuron degeneration and/or axon function damage developed.The FA and CP values of SN may be a reliable clue for the diagnosis of PD at early or subclinical stage and they have synergistic effects.