磁共振弥散张量成像对震颤为主早期帕金森病的诊断价值

Value of MRI diffusion tensor imaging in the diagnosis of Parkinson's disease with early tremor

目的探讨早期震颤为主帕金森病(Parkinson s disease,PD)磁共振弥散张量成像(diffusion tensor imaging,DTI)参数变化及其与临床量表测试值之间的相关性。方法本研究纳入2019年6月—2020年6月收治于同济大学附属东方医院陆家嘴院区神经内科的震颤PD患者31例及同期年龄匹配的正常对照组22例,进行临床量表评估,包括帕金森病量表评分UPDRS的第3部分(运动相关部分)、Hoehn-Yahn分级(H-Y分级);所有被试者行磁共振弥散张量成像检查,应用基于纤维束示踪的空间统计方法(tract-based spatial statistics,TBSS)得到实验组及对照组全脑白质FA、MD、DA、DR值,比较实验组及对照组组间差异区域及分布;提取组间差异脑区DTI参数值与临床量表测试值做相关性分析。结果与对照组相比,实验组UPDRS-Ⅲ评分和H-Y分级差异有统计学意义(P<0.05)。TBSS分析显示实验组FA值减弱区主要位于小脑中脚、内囊前肢、胼胝体、双侧放射冠、扣带回、小脑下脚、外囊。部分感兴趣区FA值与UPDRSⅢ评分和H-Y分级间存在负相关性(P<0.05)。结论DTI技术可以为震颤为主早期PD的诊断及评价提供更完整的认识和有价值的线索。

Objective To assess the value of diffusion tensor imaging(DTI)in the diagnosis of Parkinson's disease(PD)with early tremor.Methods Thirty-one PD patients predominantly with early tremor admitted to the Department of Neurology,Shanghai East Hospital,Tongji University School of Medicine from June 2019 to June 2020 were enrolled in the in the study(PD group)and 22 age-matched healthy subjects were also enrolled as control group.All subjects were evaluated with the third part of the Unified Parkinson Disease Rating Scale(UPDRS)(exercise-related part)and Hoehn-Yahn classification(HY classification);and underwent MRI-DTI examination.The tract-based spatial statistics(TBSS)was used to obtain FA,MD,DA,DR values of whole brain white matter.The differential area and distribution of FA,MD,DA,DR values were compared between the PD group and the control group.The difference in DTI parameter values and clinical scale values of differential brain regions were extracted for correlation analysis.Results There were significant differences in UPDRSⅢscore and H-Y grade between PD group and control group(P<0.05).TBSS analysis showed that the FA value weakened area of the PD group mainly located in the middle cerebellar peduncle,the anterior limb of internal capsule,the corpus callosum,the corona radiata,the cingulate gyrus,the inferior cerebellar peduncle,and the external capsule.There was a negative correlation of the FA value of some of the interest area with the UPDRSIII score and HY grade(P<0.05).Conclusion MRI-DTI can provide more complete information and valuable clues for the diagnosis and evaluation of PD patients predominantly with early tremor.