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帕金森病(Parkinson disease,PD)是一种中老年人常见的慢性进行性神经系统变性疾病。随着人口老龄化的加剧,其发病率逐年上升。目前对于PD尚无有效的预防方法,但早期诊断和治疗能有效提高患者的生活质量。近些年的研究结果显示,中脑铁沉积与多巴胺能神经元密切相关,而多巴胺能神经元的变性死亡是PD最主要的病理改变,故了解中脑的铁沉积变化情况有助于PD的诊断[1]。MR定量磁化率成像(quantitative susceptibility mapping,QSM)可从梯度回波磁共振相位图上确定脑组织的整体磁化率的空间分布,较磁敏感加权成像(susceptibility weighted imaging,SWI)和T2弛豫时间图成像(T2 Mapping)等更能反映脑内铁含量的变化[2]。目前已有学者对PD患者中脑黑质的铁沉积情况进行研究[1],但关于PD患者中脑红核铁沉积情况及其对PD的诊断价值仍缺少研究。本研究采用QSM技术评估PD患者中脑黑质及红核磁化率的变化情况,明确其对PD诊断、病程、分级及患者临床症状等评估的应用价值。
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PD组与正常对照组在性别、年龄方面的差异无统计学意义(χ2=0.07,P=0.79;t=2.22,P=0.19),早期PD组与中晚期PD组在性别、年龄方面的差异亦无统计学意义(χ2=0.00,P=0.62;t=0.83,P=0.21)。
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QSM图像上正常对照组和PD组的中脑黑质及红核均表现为对称高信号,边界清晰(图1)。由表1可知,PD组的中脑黑质及红核磁化率均较正常对照组显著升高,且差异均有统计学意义(t=−2.125,P=0.043; t=−2.605,P=0.015)。
图 1 正常对照者(女性,47岁)与帕金森病患者(男性,51岁)中脑定量磁化率成像的磁化率分布图
Figure 1. Magnetic susceptibility distribution of the midbrain in quantitative susceptibility mapping in the control (female, 47years old) and Parkinson disease patient(male, 51years old)
组别 例数 黑质 红核 正常对照组 20 0.058±0.028 0.072±0.035 PD组 39 0.073±0.017a 0.094±0.020a 早期PD组 23 0.073±0.019a 0.093±0.021a 中晚期PD组 16 0.072±0.014 0.094±0.020a 注:表中,a:与正常对照组比较,差异均有统计学意义(t=2.014~2.605,均P<0.05)。PD: 帕金森病 表 1 4组患者中脑黑质和红核的磁化率比较(
±s, ×10−3)$\bar x $ Table 1. Mean susceptibility values of substantia nigra and red nucleus in four groups (
±s, ×10−3 )$\bar x $ -
由表1可知,早期PD组的中脑黑质磁化率显著高于正常对照组,且差异有统计学意义(t=2.014, P=0.031);中晚期PD组与早期PD组的中脑黑质磁化率差异无统计学意义(t=0.025, P=0.984);早期PD组及中晚期PD组红核的磁化率均显著高于正常对照组,差异均有统计学意义(t=2.417, P=0.009;t=2.445, P=0.014);早期PD组与中晚期PD组的红核磁化率差异无统计学意义(t=0.117, P=0.927)。
由图2可见,ROC曲线分析结果显示,以中脑黑质磁化率0.069×10−3为最佳阈值诊断PD,AUC为0.710,95% CI为0.567~0.853,灵敏度为51.3%、特异度为85.0%、准确率为62.7%;以红核磁化率0.068×10−3为最佳阈值诊断PD,AUC为0.717、95% CI为0.549~0.886、灵敏度为94.9%、特异度为60.0%、准确率为83.1%。
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PD组的中脑黑质及红核的磁化率与Hoehn-Yahr不同分级均无相关性(r=0.051, P=0.759;r=0.045,P=0.788)。黑质磁化率与病程呈显著正相关(r=0.420,P=0.008),红核磁化率与病程无显著相关性(r=0.241,P=0.130)。PD组的中脑黑质磁化率与红核磁化率呈正相关(r=0.477,P=0.002)。
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单因素分析结果显示,PD组的中脑左侧右侧黑质、红核磁化率的变化与患者发病初期临床肢体运动障碍症状侧的表现无显著相关性(黑质:F左=0.661, P左=0.421;F右=1.153, P右=0.290。红核:F左=0.006, P左=0.940;F右=0.109,P右=0.743)。
MR定量磁化率成像在帕金森病临床诊断中的价值研究
Value of MR quantitative susceptibility mapping in the diagnosis of Parkinson disease
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摘要:
目的 分析帕金森病(PD)患者的中脑黑质及红核的磁化率变化情况,明确MR定量磁化率成像(QSM)技术在PD临床诊断中的价值。 方法 回顾性分析2017年2月至2019年8月于佛山市第一人民医院诊断为PD的患者39例(PD组),其中男性17例、女性22例,年龄47~80(65.44±9.78)岁。根据改良Hoehn-Yahr分级将患者分为早期PD组(23例)及中晚期PD组(16例),另选取20名健康体检者作为正常对照组。所有患者及正常对照者均进行QSM扫描,测量各组中脑左右两侧黑质和红核的磁化率,取平均值。采用独立样本t检验分析PD患者的中脑黑质及红核磁化率的变化特征,并与PD的临床诊断、分级和病程进行Pearson相关性分析;采用单因素分析中脑左右侧黑质及红核的磁化率变化与临床肢体运动障碍症状侧的关系。 结果 PD组的中脑黑质及红核的磁化率较正常对照组显著升高 [(0.073±0.017)×10−3对(0.058±0.028)×10−3,t=−2.125,P=0.043;(0.094±0.020)×10−3对(0.072±0.035)×10−3,t=−2.605,P=0.015]。PD组的中脑黑质及红核的磁化率与Hoehn-Yahr分级无显著相关性(r=0.051,P=0.759;r=0.045,P=0.788);黑质的磁化率与病程呈显著正相关(r=0.420,P=0.008),红核的磁化率与病程无相关性(r=0.241,P=0.130)。PD组的中脑左右侧黑质、红核的磁化率变化与患者临床发病时肢体运动障碍症状的表现无显著相关性(黑质:F左=0.661,P左=0.421;F右=1.153,P右=0.290。红核:F左=0.006,P左=0.940;F右=0.109,P右=0.743)。 结论 QSM技术能够测量中脑黑质及红核的磁化率,并间接反映脑内铁沉积情况,对PD诊断及病程评估具有临床价值。 Abstract:Objective To analysis the changes in the magnetic susceptibility of substantia nigra(SN) and red nucleus(RN) in midbrain in Parkinson disease (PD), and determine the value of MR quantitative susceptibility mapping (QSM) in the clinical diagnosis of PD. Methods A total of 39 PD patients (PD group) who were hospitalized in the First People's Hospital of Foshan from February 2017 to August 2019, including 17 males and 22 females, aged 47−80 (65.44±9.78) years old, were divided into early PD group (n=23) and progress PD group (n=16) according to improved Hoehn-Yahr classification. And 20 normal controls were selected. All were scanned by QSM technique, and the magnetic susceptibility of SN and RN were measured. The independent sample t test was used to analyze the change of magnetic susceptibility of SN and RN in PD patients, which were analysis with the clinical diagnosis, grading and course of PD perform with Pearson correlation analysis. Univariate analysis was used to analyze the relationship between the magnetic susceptibility of bilateral SN and RN with the symptom of physical movement disorder. Results The magnetic susceptibility value of the SN and RN in the PD group are significantly increase compared with control group ((0.073±0.017) ×10−3 vs. (0.058±0.028) ×10−3; (0.094±0.020) ×10−3 vs. (0.072±0.035) ×10−3), the difference is statistically significant (t=−2.125, P=0043; t=−2.605, P=0.015). No significant correlation among the magnetic susceptibility of SN and RN and the Hoehn-Yahr classification (r=0.051, P=0.759; r=0.045, P=0.788), but the magnetic susceptibility of SN was positively correlated with the course of the disease (r=0.420, P=0.008), while not the RN (r=0.241, P=0.130). There was no significant difference among the magnetic susceptibility of SN and RN on the left or right sides of the midbrain in the PD group, and the symptoms of limb movement disorder during clinical onset (SN: FL=0.661, PL=0.421; FR=1.153, PR=0.290. RN: FL=0.006, PL=0.940; FR=0.109, PR=0.743). Conclusions QSM technology can indirectly reflect the iron deposition in the brain by measure the magnetic susceptibility of SN and RN in midbrain. It is valuable for the diagnosis and assessing the course of PD. -
表 1 4组患者中脑黑质和红核的磁化率比较(
±s, ×10−3)$\bar x $ Table 1. Mean susceptibility values of substantia nigra and red nucleus in four groups (
±s, ×10−3 )$\bar x $ 组别 例数 黑质 红核 正常对照组 20 0.058±0.028 0.072±0.035 PD组 39 0.073±0.017a 0.094±0.020a 早期PD组 23 0.073±0.019a 0.093±0.021a 中晚期PD组 16 0.072±0.014 0.094±0.020a 注:表中,a:与正常对照组比较,差异均有统计学意义(t=2.014~2.605,均P<0.05)。PD: 帕金森病 -
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