神经黑色素敏感磁共振成像对诊断帕金森病的应用价值

The Value of Neuromelanin-Sensitive Magnetic Resonance Imaging in the Diagnosis of Parkinson’s Disease

目的探究神经黑色素敏感磁共振成像(NM-MRI)技术对帕金森病患者的诊断及鉴别运动分型的价值。方法搜集65例帕金森病患者(帕金森组)和55例无神经系统疾病的患者(正常对照组)作为研究对象,行NM-MRI扫描,分别观察黑质致密部(SNc)的面积、SNc面积与同层中脑面积的比值在帕金森组和正常对照组中的差异,分别绘制SNc面积、SNc面积与同层中脑面积比值的受试者工作特征(ROC)曲线并计算曲线下面积(AUC),确定诊断帕金森病的最佳临界值;此外,将帕金森病患者分为震颤(TD)组20例和姿势不稳-步态障碍(PIGD)组13例,比较SNc的面积、SNc面积与同层中脑面积的比值在两种运动亚型中的差异。结果与正常对照组相比,帕金森病组中的SNc的面积、SNc面积与同层中脑面积的比值均显著减小(P<0.05)。SNc面积诊断帕金森病的AUC为0.958(0.923~0.992),最佳临界值为27.11 mm^(2),其灵敏度为90.9%,特异度为92.3%;SNc面积与同层中脑面积的比值诊断帕金森病的AUC为0.919(0.872~0.967),最佳临界值为0.047,其灵敏度为89.1%,特异度为81.5%。然而,SNc的面积、SNc面积与同层中脑面积的比值在TD组和PIGD组之间无显著差异(P>0.05)。结论 NM-MRI技术在区分帕金森病患者和正常对照组方面有较好的价值,有助于更好地理解帕金森病的病理改变,而在区分帕金森病的运动亚型方面,需要做出进一步的研究分析。

Objective To investigate the value of neuromelanin-sensitive magnetic resonance imaging(NM-MRI) in the diagnosis of Parkinson’s Disease(PD) and differentiation of motor subtypes. Methods Sixty-five PD patients(PD group) and fifty-five patients without nervous system diseases(normal control group) were collected and scanned by NM-MRI.Observing the difference of the area of the substantia nigra pars compacta(SNc) and the ratio of the area of the SNc to the area of the midbrain in the same layer between the PD group and the normal control group.Receiveroperating characteristic(ROC) curves of the area of the SNc and the ratio of the area of the SNc to the area of the midbrain were plotted respectively to determine the area under the curve(AUC) and the best cut-off value of the diagnosis of PD.In addition, the PD patients were divided into the tremor dominant(TD) group(n=20) and the postural instability gait difficulty(PIGD) group(n=13).Observing the difference of the area of the SNc and the ratio of the area of the SNc to the area of the midbrain in the same layer in the two motor subtypes. Results The area of the SNc and the ratio of the area of the SNc to the area of the midbrain were markedly decreased in the PD group compared with the normal control group(P<0.05).TheAUCmeasured by the area of the SNc was 0.958(0.923-0.992),the best cut-off value of the indicator was 27.11 mm^(2),sensitivity 90.9% and specificity 92.3%. The AUCmeasured by the ratio of the area of the SNc to the area of the midbrain was 0.919(0.872-0.967),the best cut-off value of the indicator was 0.047,sensitivity 89.1% and specificity 81.5%.However, there was no significant difference of the area of the SNc and the ratio of the area of the SNc to the area of the midbrain between TD group and PIGD group(P>0.05). Conclusion NM-MRI technology has a good value in distinguishing patients with Parkinson’s disease from the control group, which helps to better understand the pathological changes of Parkinson’s disease.However, further research and analysis are needed to distinguish the motor subtypes of PD.