MR精神影像用于精神疾病初筛及分型的诊断效能研究

The diagnostic performance of MR psychoradiology in identifying patients with mental disorders

目的探讨MR精神影像用于精神疾病初筛及分型的诊断效能,拟阐明其在临床应用中的价值。方法回顾性分析2018年9月至2020年7月于四川大学华西医院行MR精神影像检查,且基于《国际疾病与相关健康问题统计分类》第10版(ICD-10)做出临床诊断的144例患者的临床及影像资料。根据前期研究基础,分别构建抑郁症、焦虑症、双相情感障碍、精神分裂症这4类精神疾病基于灰质体积的结构影像诊断模型。对于临床怀疑精神疾病的120例患者,对比影像结果及影像诊断模型中涉及的灰质体积改变脑区,计算相似度,选取相似度最高且大于50%的对应疾病作为患者的影像诊断,若无相似度大于50%的对应疾病,则认为其未见典型精神障碍脑改变模式;以临床诊断为金标准,分别评价MR精神影像用于这4类精神疾病初筛及分型的诊断效能。对于临床诊断为痴呆疾病的24例患者,分别统计常规MRI及MR精神影像检测到典型脑萎缩的患者所占比例。结果MR精神影像用于初筛这4类精神疾病的灵敏度、特异度、约登指数、准确度分别为86.6%(84/97)、69.6%(16/23)、0.56、83.3%(100/120);用于检测抑郁症、精神分裂症、双相情感障碍、焦虑症的灵敏度、特异度、约登指数、准确度分别为77.8%(28/36)、69.0%(58/84)、0.47、71.7%(86/120),58.8%(10/17)、91.3%(94/103)、0.50、86.7%(104/120),42.1%(8/19)、96.0%(97/101)、0.38、87.5%(105/120)和24.0%(6/25)、100%(95/95)、0.24、84.2%(101/120)。临床诊断为痴呆疾病的患者中,常规MRI及MR精神影像检测到典型脑萎缩的患者所占比例分别为58.3%(14/24)、91.7%(22/24)。结论MR精神影像实现了精神疾病脑灰质结构改变的可视化和可量化,尽管尚不能作为单独的生物标志物用于诊断,但在提高精神、认知疾病诊断的时效性及客观性方面有重要意义。

Objective To explore the efficiency of MR psychoradiology examination in screening and classification of psychiatric disorders as well as its potential clinical application.Methods Retrospective study was conducted for 144 patients with MR psychoradiology examination,who were diagnosed mental disorders based on International Statistical Classification of Diseases and Related Health Problems Tenth Revision(ICD-10)from September 2018 to July 2020 in West China Hospital of Sichuan University.As our previous studies,imaging diagnostic models were constructed based on gray matter volume(GMV)analysis for four kinds of psychiatric disorders,including depression,anxiety disorder,bipolar disorder and schizophrenia.For 120 patients with psychiatric disorders,the GMV change pattern of brain regions was detected and subtyped by MR psychoradiology examination with 50%similarity threshold of the above imaging diagnostic models.The diagnostic efficiency of MR psychoradiology examination was evaluated with references of clinical diagnose.For 24 patients with dementia,brain atrophy was additionally measured by conventional MR examination and MR psychoradiology examination respectively.Results The sensitivity,specificity,Youden index and accuracy of MR psychoradiology in identifying the four psychiatric disorders were 86.6%(84/97),69.6%(16/23),0.56 and 83.3%(100/120),including depression[77.8%(28/36),69.0%(58/84),0.47,71.7%(86/120)],schizophrenia[58.8%(10/17),91.3%(94/103),0.50,86.7%(104/120)],bipolar disorder[42.1%(8/19),96.0%(97/101),0.38,87.5%(105/120)]and anxiety disorder[24.0%(6/25),100%(95/95),0.24,84.2%(101/120)].As for 24 patients with dementia,58.3%(14/24)were detected with brain atrophy by conventional MR examination,while 91.7%(22/24)were detected by MR psychoradiology examination.Conclusions MR psychoradiology can detect the subtle brain structural abnormalities of patients with mental disorders.Although it can′t be used as an independent biomarker for disease diagnosis till now,it is of great help in improving the accuracy and objectivity of diagnosis.