帕金森病患者基底节核团体积的磁共振成像研究

Magnetic resonance imaging study of basal ganglia volumes in patients with Parkinson＇s disease

目的探讨帕金森病患者磁共振成像上基底节结构的改变及其与临床之间的相关性，筛选辅助早期诊断和病情监测的影像学生物标志物。方法应用3D－T1WI及T2WI序列对2012年12月至2015年5月于我院神经内科就诊的54例帕金森病患者和体检中心招募的35名健康对照者进行扫描，并根据起病症状将帕金森病患者组分为震颤组（n＝35）及强直－少动组（n＝19），利用基于体素的形态学分析方法，对研究对象的基底节核团体积进行分析。结果帕金森病患者的基底节核团体积[尾状核：左侧（5.99±1.78）mm^3，右侧（6.11±1.65）mm^3；壳核：左侧（4.99±1.50）mm^3，右侧（5.56±1.68）mm^3；苍白球：左侧（3.12±0.72）mm^3，右侧（3.23±0.72）mm^3]较健康对照组[尾状核：左侧（6.94±1.00）mm^3，右侧（6.93±0.88）mm^3；壳核：左侧（5.64±0.69）mm^3，右侧（6.03±0.86）mm^3；苍白球：左侧（3.49±0.26）mm^3，右侧（3.60±0.25）mm^3]萎缩，双侧尾状核（左侧：t＝2.871，P＝0.005；右侧：t＝3.045，P＝0.003）、左侧壳核（t＝2.773，P＝0.007）及双侧苍白球（左侧：t＝3.439，P＝0.001；右侧：t＝3.493，P＝0.001）基底节核团体积差异有统计学意义。在疾病早期即出现上述改变，早期以左侧壳核（t＝2.136，P＝0.038）及苍白球萎缩（左侧：t＝2.683，P＝0.010；右侧：t＝2.637，P＝0.011）明显，随病情进展尾状核萎缩（左侧：t＝3.260，P＝0.002；右侧：t＝3.089，P＝0.003）明显。震颤组基底节核团体积与强直－少动组相比未见明显差异。帕金森病患者的双侧基底节核团体积与性别、年龄、MMSE评分、左旋多巴等效剂量、病程、改良Hoehn－Yahr分期、统一帕金森病评定量表第三部分评分、汉密尔顿抑郁量表和汉密尔顿焦虑量表评分未见明确相关。结论帕金森病患者基底节核团体积有萎缩现象，通过磁共振成像测量基底节的结构改变对于帕金森病的早期诊断及病情监测具有一定的提示意义。

ObjectiveTo explore the structural changes of basal ganglia （subcortical nuclei of cerebral hemisphere） in Parkinson′s disease （PD） based on magnetic resonance imaging （MRI） and their relationship with clinical status, and to find neuroimaging biomarkers that are valuable for early diagnosis and disease progression monitoring in PD.MethodsThree-dimensional-T1WI and T2WI were applied to 54 PD patients （35 in tremor-dominant PD group, 19 in akinetic-rigid-dominant PD group） and 35 healthy controls using 3.0 T MRI scanner. Voxel-based morphometry was used to investigate the volume changes of basal ganglia （subcortical nuclei of cerebral hemisphere, including caudate nucleus, putamen, and globus pallidus）.ResultsCompared with the controls （caudate nucleus： left （6.94±1.00） mm^3, right （6.93±0.88） mm^3; putamen： left （5.64±0.69） mm^3, right （6.03±0.86） mm^3; globus pallidus： left （3.49±0.26） mm^3, right （3.60±0.25） mm^3, PD patients （caudate nucleus： left （5.99±1.78） mm^3, right （6.11±1.65） mm^3; putamen： left （4.99±1.50） mm^3, right （5.56±1.68） mm^3; globus pallidus： left （3.12±0.72） mm^3, right （3.23±0.72） mm^3） exhibited volume reduced in bilateral caudate nuclei （left t=2.871, P=0.005; right t=3.045, P=0.003）, left putamen （t=2.773, P=0.007）, and bilateral globus pallidus （left t=3.439, P=0.001; right t=3.493, P=0.001）. Early stage of PD patients exhibited these changes. In addition, atrophy was showed mainly in left putamen （t=2.136, P=0.038） and globus pallidus （left t=2.683, P=0.010; right t=2.637, P=0.011） in the early stage, while in the later stage, caudate nucleus volume reduction （left t=3.260, P=0.002; right t=3.089, P=0.003） was also found. Moreover, no significant differences were found between tremor-dominant PD group and akinetic-rigid-dominant PD group. However, bilateral volume changes of basal ganglia in PD patients were not explicitly relevant to age, gender, Mini-Mental State Examination score, levodopa equivalent doses, disease duration, Hoehn-Yahr stages, Unified Parkinson′s Disease Rating Scale-Ⅲ score, Hamilton Rating Scale for Depression score or Hamilton Rating Scale for Anxiety score.ConclusionsThe phenomenon of reduced basal ganglia volume was found in patients with PD. The measurement of basal ganglia volume by MRI could be an objective way for early diagnosis of PD.