经颅超声成像、磁敏感加权成像和磁共振成像对鉴别进行性核上性麻痹和帕金森病的价值

The value of TCS、SWI and MRI in identifying progressive supranuclear palsy and Parkinson’s disease

目的探讨经颅超声成像(TCS)、磁敏感加权成像(SWI)、磁共振成像(MRI)3种辅助检查鉴别进行性核上性麻痹(PSP)和帕金森病(PD)的价值。方法选取临床确诊的22例PSP患者、33例PD患者和30例对照组行TCS、SWI、MRI检查且病历资料全面。采用ROC曲线对TCS、SWI、MRI结果进行分析,探讨3种辅助检查对鉴别PSP和PD的价值。结果PSP组豆状核高回声比例、第三脑室最小直径>10 mm比例、P/M、MCP/SCP、MRPI、壳核低信号强度、红核低信号强度高于PD组和对照组(P<0.01)。PD组黑质高回声面积、S/M高于PSP组和对照组(P<0.01)。RQC曲线显示,在两者鉴别诊断方面,TCS中黑质高回声面积敏感度高(84.8%);SWI中壳核低信号强度特异性高(85%);两种指标联合对其鉴别时,敏感度为93.9%,特异度为81.8%,AUC为0.938,鉴别诊断价值高。MRI中MRPI及P/M值鉴别两者的敏感性和特异性达100%。结论TCS、SWI、MRI对鉴别PSP和PD的价值各不相同,TCS联合SWI对两者的鉴别诊断价值较高,为其鉴别诊断提供了一种新思路,MRI的整体鉴别诊断价值优于TCS和SWI。

Objective To explore the value of the three auxiliary examinations of transcranial ultrasound imaging,magnetic sensitivity weighted imaging,and magnetic resonance imaging in the identification of progressive supranuclear palsy and Parkinson’s disease.Methods Twenty-two clinically diagnosed patients with PSP,33 patients with PD were selected,and 30 cases in the control group underwent TCS,SWI,and MRI examinations and medical records were comprehensive.ROC curve was used to compare and analyze the results of TCS,SWI and MRI.The value of three auxiliary examinations in the identification of progressive supranuclear palsy and Parkinson’s disease was discussed.Results Compared with the PD group and the control group,the ratio of hyperechoic lenticular nucleus,the ratio of the minimum diameter of the third ventricle more than 10mm,the midbrain area/pontine area,the ratio of midbrain/pontine diameter,magnetic resonance Parkinson’s index,low signal strength of the putamen,and low signal strength of the red nucleus in the PSP group were higher(P<0.01).Compared with the PSP group and the control group,the substantia nigra hyperechoic area,the ratio of total substantia nigra hyperechoic area to total midbrain area in the PD group were higher(P<0.01).According to the ROC curve,it can be observed that the sensitivity of substantia nigra hyperechoic area in TCS was high while the specificity of low signal intensity of putamen in SWI was high as well;When TCS and SWI jointly identified the PD group and PSP group,the sensitivity was 93.9%,the specificity was 81.8%,the area under the curve(AUC)was 0.938,and the value of identification diagnosis was high.The sensitivity and specificity of the MRPI and P/M values in the identification of the PSP group and PD group reached 100%.Conclusion The value of TCS,SWI,and MRI in the identification of PSP and PD is different.TCS combined with SWI is of higher diagnosis value in the identification of PD group and PSP group,which provides a new method for the identification diagnosis of PSP.The overall value of differential diagnosis of MRI is better than TCS and SWI.