SCA3/MJD与SPG4的弥散加权成像对比研究

Diffusion weighted imaging of SCA3/MJD and SPG4

目的:探讨弥散加权成像(diffusion weighted imaging,DWI)在遗传性脊髓小脑型共济失调3型/马查多-约瑟夫病(hereditary spinocerebellar ataxia 3 and the Machado Joseph disease,SCA3/MJD)及遗传性痉挛性截瘫4型(hereditary spastic paraplegia 4,SPG4)的诊断及鉴别诊断中的价值。方法:对13例SPG4患者,30例SCA3/MJD及27名年龄匹配的健康志愿者进行DWI检查,经数据后处理获得了表观扩散系数(apparent diffusion coefficient,ADC)值。将以上数据分组进行对比研究。结果:SCA3/MJD起病患者的ADC值在中央前回、内囊后肢、大脑脚、桥脑、小脑皮层及小脑白质区域较正常对照组升高。SCA3/MJD未起病患者的ADC值仅在小脑齿状核位置较正常对照组增高。SCA3/MJD起病患者仅在小脑皮层较SCA3/MJD未起病患者ADC值明显升高;SCA3/MJD起病患者的ADC值在内囊后肢、小脑皮层、小脑白质及桥脑较SPG4患者明显增高。在中央前回,SPG4患者的ADC值较正常对照组明显增高。结论:DWI对于SCA3/MJD与SPG4的鉴别诊断有一定的应用前景。

Objective: To determine the value of diffusion weighted imaging(DWI) in the diagnosis of hereditary spinocerebellar ataxia 3 and the Machado Joseph disease(SCA3/MJD) and hereditary spastic paraplegia 4(SPG4).Methods: We scanned 13 patients with SPG4, 30 patients with SCA3/MJD(21 onset patients and 9 with only genetic abnormalities), and 27 healthy volunteers with DWI. The processing data were apparent diffusion coefficient(ADC). The above data were grouped for comparative study. Results: In the precentral gyrus, posterior limb of the internal capsule, cerebral peduncle, pons, cerebellar cortex and cerebellar white matter, the ADC of onset SCA3/MJD patients increased compared with the control group. The ADC of non-onset SCA3/MJD patients increased only in the cerebellar dentate nucleus compared with the control group. In the cerebellar cortex, the ADC of onset SCA3/MJD patients was significantly higher than the non-onset SCA3/MJD. The ADC of onset SCA3/MJD patients was significantly higher in the posterior limb of the internal capsule,cerebellar cortex, cerebellar white matter and pons than that of SPG4 patients. In the precentral gyrus, the ADC of SPG4 was significantly higher than control.Conclusion: DWI is useful in the diagnosis of SCA3/MJD and SPG4.