肝豆状核变性磁共振神经突起方向离散度和密度成像与临床症状相关性

Magnetic resonance neurite orientation dispersion and density imaging in Wilson disease correlation with clinical symptoms

目的应用磁共振神经突起方向离散度与密度成像(neurite orientation dispersion and density imaging,NODDI)定量分析肝豆状核变性(Wilson disease)基底核及丘脑核团微结构改变,并评估各核团NODDI改变与WD神经精神症状的相关性.方法收集24例定期排铜的WD患者(WD组)和年龄性别相匹配的25名正常对照(正常对照组)的双侧尾状核、壳核、苍白球和丘脑的NODDI数据,主要参数包括神经突内体积分数(intraneurite volume fraction,Vic)、神经突方向离散度(orientation dispersion index,ODI)和脑脊液体积分数(isotropic volume fraction,Viso),比较各核团三项参数与正常对照组差异.分析WD患者改良Young量表与WD患者的NODDI参数的相关性.利用受试者工作特征曲线ROC分析NODDI各参数诊断WD患者的诊断效能.结果WD组与正常对照组相比,双侧尾状核、壳核、苍白球Vic值和ODI值均减少,而Viso值增加(均P<0.05);双侧丘脑Vic值降低,Viso值增加(均P<0.05),ODI不具有统计学差异(P>0.05).WD组分型之间各核团NODDI参数比较无统计学差异(均P>0.05).WD组肢体肌张力严重程度和左侧苍白球Vic值负相关(r=-0.425,P=0.038);震颤严重程度与左侧苍白球(r=-0.437,P=0.033)、左侧壳核(r=-0.541,P=0.006)、左右侧丘脑(r=-0.556,P=0.005;r=-0.493,P=0.014)的Vic值呈负相关;舞蹈样症状严重程度和左侧尾状核(r=-0.461,P=0.024)、左侧壳核(r=-0.489,P=0.015)Vic值呈负相关;高级神经功能评分和左侧苍白球(r=-0.562,P=0.004)、壳核(r=-0.570,P=0.004)、右侧苍白球(r=-0.679,P<0.001)、右侧丘脑(r=-0.490,P=0.015)的Vic值,左侧苍白球ODI值(r=-0.440,P=0.031)呈负相关.ROC曲线分析得到右侧丘脑Vic值、左侧尾状核ODI值、右侧尾状核Viso值对WD患者具有最佳诊断效能.结论不同临床症状表现WD患者核团NODDI改变不同,不同核团NODDI参数改变与临床症状具有一定相关性.

Objective To apply magnetic resonance neurite orientation dispersion and density imaging(Neurite Orientation Dispersion and Density Imaging,NODDI)to quantitatively analyze the microstructural changes of the basal nucleus and thalamic nucleus in Wilson disease,and to evaluate each nucleus The change of NODDI is correlated with the neuropsychiatric symptoms of WD.Methods The NODDI data of the bilateral caudate nucleus,putamen,globus pallidus,and thalamus of 24 WD patients who regularly drained copper(WD group)and 25 normal controls(normal control group)matched with their age and sex were collected.Parameters include intraneurite volume fraction(Vic),neurite direction dispersion(ODI)and cerebrospinal fluid integration(Viso).Compare the three parameters of each nucleus with the normal control group.The correlation between the modified Young scale of WD patients and the NODDI parameters of WD patients was analyzed.The receiver operating characteristic curve ROC was used to analyze the diagnostic efficacy of NODDI parameters in diagnosing WD patients.Results Compared with the normal control group,the Vic value and ODI value of the bilateral caudate nucleus,putamen,and globus pallidus in the WD group decreased,while the Viso value increased P<0.05;the bilateral thalamus Vic value decreased,and the Viso value increased(P<0.05),ODI is not statistically significant P>0.05.The NODDI parameters of each nucleus were not statistically significant between the WD group types(all P>0.05).The severity of limb muscle tension in the WD group was negatively correlated with the Vic value of the left globus pallidus(r=-0.425,P=0.038);the severity of tremor was negatively correlated with the Vic value of the left globus pallidus,left putamen,and left and right thalamus(r=-0.437,-0.541,-0.556,-0.493,P=0.033,0.006,0.005,0.014);the severity of chorea-like symptoms is negatively correlated with the Vic value of the left caudate nucleus and left putamen(r=-0.461,-0.489,P=0.024,0.015);advanced neurological function scores are negatively correlated with the Vic value of left globus pallidus,putamen,right globus pallidus,and right thalamus,and the ODI value of left globus pallidus(r=-0.562,-0.570,-0.679,-0.490,-0.440,P=0.004,0.004,0.000,0.015,0.031);ROC curve analysis obtains the right thalamus Vic value,the left caudate nucleus ODI value,and the right caudate nucleus Viso The value has the best diagnostic performance for WD patients.Conclusion The alterations in gray matter structures in NODDI imaging are different in different clinical symptoms in WD.The clinical symptoms are correlated with alterations in gray matter structures to some degree.