DTI成像技术评价帕金森病相关认知功能障碍的临床研究

Clinical study of DTI in evaluating cognitive impairment related to Parkinson’s disease

目的 :探讨磁共振扩散张量成像(DTI)技术对帕金森病(PD)相关认知功能障碍诊断的效能。方法 :收集我院于2019年12月—2020年12月诊断为PD相关认知功能障碍的患者80例作为病例组,同时选取健康人群及PD不伴有认知功能障碍患者各60例作为对照组。选用蒙特利尔认知评估量表(MoCA)对3组人群进行认知功能障碍评估。3组人群均接受DTI检测,并测量异性分数值(FA)和平均扩散率(MD)。不同组间的比较采用单因素方差分析方法(one-way ANOVA),进一步的多重比较则采用LSD方法,DTI对于PD相关的认知功能障碍诊断价值采用受试者工作特征(ROC)曲线评估。FA和MD值与认知功能障碍的相关性采用Pearson相关分析。结果:病例组患者丘脑、黑质以及尾状核头FA值显著低于正常健康人群和PD不伴有认知功能障碍患者(P<0.05),其余部位无明显差异(P>0.05);病例组患者所有部位MD值与健康人群和PD不伴有认知功能障碍患者无明显差异(P>0.05);丘脑、黑质以及尾状核头FA值对于PD相关认知功能障碍有一定诊断价值,AUC值分别为0.762、0.834、0.709,且P<0.05;丘脑(r=0.538,P=0.002)、黑质(r=0.624,P<0.001)、尾状核头(r=0.559,P=0.001)的FA值与患者认知功能均存在正相关关系。结论:DTI成像技术对于PD相关的认知功能障碍的诊断有一定的价值,且丘脑、黑质以及尾状核头FA值与认知功能损害程度有相关性。

Objective: To evaluate the diagnostic value of diffusion tensor imaging(DTI) in evaluating cognitive impairment related to Parkinson’s disease(PD). Methods: Eighty patients with PD related cognitive impairment in our hospital from December 2019 to December 2020 were selected as the case group, and 60 healthy people and 60 PD without cognitive impairment were selected as the control group. MoCA was used to evaluate the cognitive impairment of the three groups. DTI was performed in all groups, and fractional anisotropy(FA) and mean diffusivity(MD) were measured. One way ANOVA was used for comparison among different groups, and LSD was used for further multiple comparison. The diagnostic value of DTI for PD related cognitive impairment was evaluated by ROC curve. The correlation between FA, MD and cognitive impairment was analyzed by Pearson correlation. Result: The FA values of thalamus, substantia nigra and head of caudate nucleus in the case group were significantly lower than those in healthy people and PD without cognitive impairment(P<0.05), and there was no significant difference in other parts(P>0.05), the MD values of all parts in the case group were not significantly different from those in healthy people and PD without cognitive impairment(P>0.05), the FA values of thalamus, substantia nigra and head of caudate nucleus had certain diagnostic value for PD related cognitive impairment, and the AUC values were 0.762 and 0.834,and 0.709 respectively. The FA values of thalamus(r=0.538, P=0.002), substantia nigra(r=0.624, P<0.001) and head of caudate nucleus(r=0.559, P=0.001) were positively correlated with cognitive function. Conclusion: DTI has a certain value in the diagnosis of PD related cognitive impairment, and the FA values of thalamus, substantia nigra and head of caudate nucleus are correlated with the degree of cognitive impairment.