脑体积测量在P型多系统萎缩和帕金森病的鉴别诊断中的价值

Value of cerebral volume measurements in differential diagnosing parkinsonian variant of multiple system atrophy and Parkinson's disease

目的研究感兴趣区(region of interest,ROI)手工测量法和基于体素的形态测量法(voxel-based morphometry,VBM)测量P型多系统萎缩(MSA-P)和帕金森病(PD)患者脑体积的差异,探索两种疾病鉴别诊断的可行方法。方法选取P型多系统萎缩20例作为MSA-P组,帕金森病41例作为PD组,联合应用ROI和VBM脑体积测量方法测量两组脑体积,对两组纹状体核团体积以及全脑灰质体积进行比较。结果 ROI方法提示MSA-P组较PD组双侧壳核体积显著减小(P=0.01);VBM结果显示,与PD组比较,MSA-P组出现多处皮层及皮层下结构萎缩(Puncorr<0.001)。结论联合应用两种体积测量方法具有更高的稳定性及可信度,提示MSA-P组的壳核、小脑和颞叶较PD组萎缩显著,可作为两者鉴别诊断的重要影像学依据。

Objective To study the difference between brain volumes of parkinsonian variant of multiple system atrophy（ MSA-P） and Parkinson’s disease（ PD） by utilizing region of interest（ ROI） and voxel-based morphometry（ VBM） methods,finds out the feasible methods to differential diagnose the two diseases. Methods 20 patients of parkinsonian variant of multiple system atrophy were selected as MSA-P group and 41 patients of Parkinson’s disease as PD group,whose cerebral volumes were measured by combining ROI and VBM,comparing the volumes of striatal nucleus and gray matter in whole brain of the two groups.Results The results of ROI indicated significantly decrease in the volume of the bilateral putamen of the MSA-P patients compared with the PD patients（ P = 0. 01）; the results of VBM indicated several cortical and subcortical atrophies in MSA-P（ Puncorr〈 0. 001）. Conclusion This study revealed that the combination of ROI and VBM has higher stability and reliability and indicated prominently atrophy in putamen,cerebellum and temporal of MSA-P group when compared to that of PD group,which can provide an important imaging basis for the differential diagnosis of MSA-P and PD.