3 T MR的T2WI和磁敏感成像序列对帕金森病、进行性核上性麻痹帕金森型及多系统萎缩帕金森型的鉴别价值

The differential diagnosis value of 3 T MR conventional sequence and susceptibility weighted imaging for Parkinson’s disease,Parkinsonian variant of progressive supranuclear palsy and Parkinsonian variant of multiple system atrophy

目的评估脑部壳核、齿状核、红核、苍白球在磁敏感成像(SWI)的低信号强度与低信号层数,黑质燕尾征的消失及额颞叶萎缩程度对帕金森病(PD)、进行性核上性麻痹帕金森型(PSP-P)及多系统萎缩帕金森型(MSA-P)的鉴别诊断价值。方法采用MRI的T2WI和SWI序列对30名健康对照、80例PD患者、22例PSP-P患者及17例MSA-P患者进行检查,观察患者脑部壳核、齿状核、红核、苍白球在SWI的低信号强度与低信号层数,黑质燕尾征的消失及额颞叶萎缩程度。采用ROC曲线评价其鉴别诊断价值。结果与PD组比较,PSP-P组壳核低信号强度分级显著升高(P=0.007),PSP-P组和MSA-P组红核低信号强度分级显著降低(P=0.000,P=0.000)。与PSP-P组比较,PD组齿状核、苍白球及MSA-P组苍白球低信号层数显著增加(P=0.002,P=0.000,P=0.008)。与正常对照组比较,PD组、PSP-P组和MSA-P组燕尾征消失比率均显著升高(均P<0.008),但PD、PSP-P、MSA-P三组间燕尾征消失比率差异无统计学意义。与PSP-P组比较,PD组和MSA-P组额颞叶萎缩较轻(P=0.000,P=0.001)。壳核低信号强度鉴别PSP-P与PD的最佳截点为0.5,此时敏感度为88.2%,特异性为66.4%,曲线下面积(AUC)为0.70;额颞叶萎缩程度鉴别PD与PSP-P的最佳截点为0.5,在调整为轻度萎缩后,敏感度为88.2%,特异性为45.1%,AUC为0.74。壳核及红核信号强度、齿状核及苍白球层数、额颞叶萎缩程度联合鉴别PSP-P和PD的AUC为0.939,标准误为0.026,P值为0.000。利用燕尾征消失鉴别健康者和PD、PSP-P时,AUC为95.5。结论壳核和红核信号强度分级、齿状核和苍白球层数、额颞叶萎缩程度对PD、PSP-P、MSA-P的鉴别有一定参考价值。

Objective To evaluate the differential diagnosis value of low signal intensity degree and low intensity layers in putamen,dentate nucleus,red nucleus and globus pallidus,absence of substantia nigra swallowtail and degree of frontotemporal atrophy in susceptibility weighted imaging(SWI)sequences for Parkinson’s disease(PD),Parkinsonian variant of progressive supranuclear palsy(PSP-P)and Parkinsonian variant of Multiple system atrophy(MSA-P).Methods Cranial MRI T2WI and SWI sequences were performed on 30 healthy controls,80 PD patients,22 PSP-P patients and 17 MSA-P patients.The low signal intensity degree and low intensity layers in putamen,dentate nucleus,red nucleus and globus pallidus,absence of substantia nigra swallowtail and degree of frontotemporal atrophy were observed.The value of differential diagnosis was evaluated by ROC curve.Results Compared with those in PD group,the low intensity degree of putamen in PSP-P group was significantly increased(P=0.007),and the degree of red nucleus in the PSP-P group and the MSA-P group were significantly lower(P=0.000,P=0.000).Compared with those in PSP-P group,the number of low signal layers in the dentate nucleus,globus pallidus in MSA-P group and PD group significantly increased(P=0.002,P=0.000,P=0.008).Compared with that in healthy control group,the absence rates of swallowtail in PD group,PSP-P group and MSA-P group were significantly increased(all P<0.008),but there was no significant difference between PD,PSP-P,MSA-P groups.Compared with that in PSP-P group,the degree of frontotemporal atrophy in PD group and MSA-P group were significantly lighter(P=0.000,P=0.001).The optimal cut-off point of the low signal intensity degree of putamen in differentiate PSP-P and PD was 0.5.At this time,the sensitivity was 88.2%,the specificity was 66.4%,and the area under the curve(AUC)was 0.70.The optimal cut-off point of the degree of frontotemporal atrophy in differentiate PD and PSP-P was 0.5,and after adjusting to mild atrophy,the sensitivity was 88.2%,the specificity was 45.1%,the AUC was 0.74.The AUC in differentiate PSP-P and PD was 0.939 when combining the signal intensity of putamen and red nuclei,the layer number of dentate nucleus and putamen and the degree of frontotemporal atrophy combined to identify and the standard error was 0.026,the P value was 0.000.When using the absence of swallowtail in differentiate healthy controls and PD,PSP-P,the AUC was 95.5.Conclusion The signal intensity grading of putamen and red nucleus,the number of layers of dentate nucleus and globus pallidus,the degree of frontotemporal lobe atrophy have reference value in the differential diagnosis of PD,PSP-P and MSA-P.