DKI对震颤型帕金森患者脑深部核团微结构变化的诊断价值

Diagnostic value of diffusion kurtosis imaging on microstructural changes of deep brain nuclei in patients with tremor-dominant Parkinson's disease

目的:探讨扩散峰度成像(DKI)对震颤型(TD)帕金森病(PD)患者脑微观结构变化的诊断价值。方法:对40例TD型PD患者及34例健康志愿者(对照组)行常规序列及DKI序列MRI检查,对PD患者的运动和认知功能障碍进行评估。MRI原始扫描数据经后处理获得DKI各定量参数图,包括各向异性分数(FA)、平均扩散率(MD)、平均扩散峰度(MK)、横向峰度(Ka)、径向峰度(Kr)、横向扩散率(Da)和径向扩散率(Dr),分别测量双侧红核、黑质致密带、黑质网状带、壳核、尾状核头、苍白球和丘脑的各项参数值,对各项参数值在两组间及患者左、右侧对称区域间的差异进行统计学分析。结果:①FA值:患者组症状侧及对侧红核的FA值与对照组的症状对侧比较,差异有统计学意义(P=0.013、0.036);双侧尾状核头的FA值分别与对照组双侧对应部位比较,差异均有统计学意义(P=0.002、0.012、0.006和0.033)。②MD、Da、Dr、Ka值:双侧红核、壳核、黑质致密带、黑质网状带、苍白球、丘脑和尾状核头的各参数值分别与对照组双侧对应部位比较,差异均有统计学意义(P=0.000~0.030)。③MK值:患者组症状侧的黑质网状带、黑质致密带的MK值与对照组症状对侧之间的差异有统计学意义(P=0.043、0.042);患者组双侧壳核的MK值分别与对照组双侧对应部位两两比较,差异均有统计学意义(P=0.046、0.006、0.008和0.001);PD组中症状侧苍白球的MK值分别与对照组双侧对应部位比较,差异均有统计学意义(P=0.008、0.005))。④Kr值:患者组症状侧尾状核头的Kr值与对照组双侧对应部位比较,差异均有统计学意义(P=0.031、0.006)。结论:DKI在TD型PD患者亚临床期即可敏感的量化分析双侧各灰质核团微观结构的改变。

Objective:The purpose of this study was to explore the value of diffusion kurtosis imaging(DKI)quantifying parameters for evaluating the microstructure changes of deep brain nuclei in patients with tremor-dominant(TD)type Parkinson's disease(PD).Methods:40 TD-type PD patients and 37 healthy controls were recruited in this study.Clinical data was collected,and motor and cognitive symptoms were assessed.Conventional and DKI sequences MRI scan were performed on all subjects.The maps and data of seven DKI parameters including fractional anisotropy(FA),mean diffusivity(MD),axial diffusivity(Da),radial diffusivity(Dr),mean kurtosis(MK),axial kurtosis(Ka)and radial kurtosis(Dr)were obtained by software post-processing,and the values of the seven DKI parameters of seven grey nuclei[red nucleus,putamen,substantia nigra dense zone(SNd),substantia nigra reticulum zone(SNr),pale globule,thalamus,and caudate nucleus]in both hemispheres were measured and compared.Results:①FA values:The FA values of red nucleus on the symptomatic side and the contralateral side in PD group showed statistically significant differences when compared with those on the contra-lateral side in control group(P=0.013 and 0.036);the FA values of the caudate nucleus on the symptomatic side and the contralateral side in PD group were statistically significant different with those at the corresponding location of both sides in control group(P=0.002,0.012,0.006 and 0.033,respectively).②MD,Da,Dr and Ka values:The values of the four DKI parameters in red nucleus,putamen,SNd,SNr,globus pallidus,thalamus,and caudate nucleus on the symptomatic side and the contralateral side in PD group were statistically significant different from those in the control group(P=0.000~0.030).③MK values:The MK values of SNr and SNd on the symptomatic side in PD group were statistically significant different from those on the contralateral side in the control group(P=0.043 and 0.042).The MK values of putamen on the symptomatic side and the contralateral side in PD group were statistically significant when compared with those on the both sides in the control group(P=0.046,0.006,0.008,and 0.001);The MK values of globus pallidus on the symptomatic side in PD group were statistically significant when compared with those on the both sides in the control group(P=0.008 and 0.005);④Kr values:The Kr values of caudate nucleus on the symptomatic side in PD group were statistically significant when compared with those on the both sides in control group(P=0.031 and 0.006).Conclusion:DKI can detect the changes in the microstructure of each gray matter nuclei in the subclinical stage of TD-type PD patients.