探讨MRI检查在帕金森病与帕金森综合征鉴别诊断中的应用价值

The value of MRI in the differential diagnosis of Parkinson's disease and Parkinsonism syndrome

目的探讨MRI检查在帕金森病与帕金森综合征鉴别诊断中的应用价值。方法选择2018年1月—2020年1月于本院就诊的帕金森病(PD)患者45例、帕金森综合征(VP)患者52例作为研究对象,另选取同期健康体检50名作为对照组。所有研究对象均接受头部MRI扫描,对比两组患者影像学表现与参数方面(中脑直径、WPCSN)的差异。结果PD组患者黑质致密带宽度(WPCSN)值以及WPCSN值/中脑直径指标明显低于VP组(P<0.05),并且PD组、VP组WPCSN值明显低于对照组(P<0.05),PD组WPCSN值/中脑直径明显低于对照组(P<0.05),但三组中脑直径比较无显著差异(P>0.05);PD组颅脑无异常率明显高于VP组(P<0.05),并且PD组与VP组患者基底节区病变率、脑萎缩发生率、皮层下白质病变率比较存在显著差异(P<0.05),但两组丘脑、脑干损害发生率比较无显著差异(P>0.05)。结论MRI检查在帕金森病与帕金森综合征鉴别诊断中具有一定的临床应用价值,PD患者MRI影响多无特殊改变或呈现出正常老化状态,而VP患者则出现明显的基底节区以及皮层下的异常信号,可根据影像学表现特点初步鉴别诊断PD与VP,具有应用及推广价值。

Objective To explore the value of MRI in the differential diagnosis of Parkinson's disease and Parkinsonism syndrome.Methods From January 2018 to January 2020,45 patients with Parkinson's disease(PD)and 52 patients with Parkinson's syndrome(VP)were selected as the study subjects,and 50 healthy people were selected as the control group.All subjects received MRI scan on the head,and compared the differences of imaging performance and parameters(Midbrain diameter,WPCSN)between the two groups.Results Width of pars compacta of substantia nigra(WPCSN)and WPCSN/midbrain diameter of PD group were significantly lower than those of VP group(P<0.05),and WPCSN value of PD group and VP group were significantly lower than those of control group(P<0.05).WPCSN/midbrain diameter of PD group was significantly lower than that of control group(P<0.05).There was no significant difference in the midbrain diameter among the three groups(P>0.05).The rate of craniocerebral non-abnormality in PD group was significantly higher than that in VP group(P<0.05).There were significant differences in the incidence of basal ganglia lesions,cerebral atrophy and subcortical white matter lesions between the two groups(P<0.05),but there was no significant difference in the incidence of thalamus and brainstem lesions between the two groups(P>0.05).Conclusions MRI has a certain clinical application value in the differential diagnosis of Parkinson's disease and Parkinsonism syndrome.The MRI images of PD patients showed no special changes or presents normal aging status.In VP patients,there were obvious abnormal signals in Basal Ganglia and subcortical areas.Initial differential diagnosis of PD and VP could be made according to characteristics of imaging performance.It is worth of applying and popularizing.