磁共振测量帕金森病患者基底节区、黑质体积的研究

目的:探讨MR体积测量技术评价帕金森病(Parkinson’sdiseasePD)患者基底节区(尾状核,壳核,苍白球)、黑质体积改变的价值。方法:采用3·0TMR测量早、晚期PD患者和年龄匹配正常人对照组全脑体积、尾状核、壳核、苍白球、黑质体积。对患者进行PD统一评分量表(UPDRS)第Ⅱ、Ⅲ、Ⅴ部分评分。评分结果与患者基底节区、黑质体积行相关性分析。结果:早、晚期PD患者壳核体积较正常人分别下降12·5%(P=0·004)和26·5%(P<0·001),晚期患者较早期患者下降16·0%(P=0·002)。晚期患者苍白球体积较正常人下降19·2%(P=0·023)。PD患者壳核体积与Hoehn&Yahr分级呈负相关(r=-0·741,P<0·001)。结论:MR体积测量技术是评价PD患者基底节区、黑质体积改变的一种可靠的方法,能为PD辅助诊断提供有效的影像学指标。     

磁共振测量特发性震颤和帕金森病患者基底节区核团体积的研究

目的：利用磁共振体积测量技术评价特发性震颤（ET）,帕金森病（PD）患者基底节区核团体积的变化及互相间的差异。方法：采用1．5T磁共振机测量9例ET患者、5例PD患者和8例年龄匹配正常人全脑体积、尾状核和壳核体积。比较各组之间感兴趣区体积的差异。结果：PD组双侧尾状核标化体积之和、双侧壳核标化体积之和较正常人缩小（P〈0．05）。ET组双侧尾状核标化体积,双侧壳核标化体积与正常对照组无差别。结论：PD患者存在尾状核和壳核体积的缩小,而ET患者无明显尾状核和壳核体积变化。     

磁共振弥散张量成像对基底节区梗死后抑郁状况的评估

目的 利用磁共振弥散张量成像(DTI)技术研究基底节区梗死患者相关解剖结构的异常改变,评估卒中后抑郁( PSD)的状况.方法 选取基底节区梗死患者,依汉密尔顿抑郁量表(HAMD-24)评分分为PSD组(n=7)、对照组(n=19),完成NIHSS评分.后行DTI检测患者双侧尾状核、苍白球、壳核和背侧丘脑的各向异性(FA)值、表观弥散系数( ADC)值、神经纤维数量.结果 PSD组NIHSS评分(6.29±3.45)明显高于对照组(3.95±1.90;t=2.219,P=0.036),各神经核团的DTI数据与对照组比较差异无统计学意义,左侧壳核的FA值(0.37±0.03)明显低于右侧(0.40±0.02;t =2.243,P=0.045).经Spearman相关分析,卒中后患者的HAMD评分与NIHSS评分呈正相关(r=0.464,P=0.017),与左侧苍白球FA值(r=- 0.563,P=0.005)、右侧苍白球FA值(r=-0.416,P=0.035)、左侧壳核FA值(r=- 0.428,P=0.029)呈负相关.结论 严重的神经功能缺损与缺血性PSD的发生有关,而抑郁程度与NIHSS评分增高、双侧苍白球和左侧壳核的FA值下降有关.相关信息有助于我们对基底节区梗死患者PSD的状况进行评估.     

磁共振成像对帕金森病患者黑质致密带的研究

目的：探讨磁共振成像（MRI）辅助诊断帕金森病（PD）的价值。方法：对30例PD患者、28例健康对照者进行MRI检查,通过T2加权成像（T2WI）NI]量黑质致密带（SNc）的宽度,计算分析其与中脑直径的比值和病情的关系;通过灰质抑制成像（GMSI）、白质抑制成像（WMSI）对SNc信号进行观察,在其减影像上进行相对信号值的测量。结果：在T2WI上,PD组SNc的测量宽度（1．173±0．908）mm较对照组（1．722±0．540）mm明显变窄（p=0．027）,PD组SNc宽度与中脑直径比值（0．029±0．023）较对照组（0．044±0．014）下降（P=0．017）,SNc宽度与病情程度间无显著差异（F=1．484,P=0．236）,两者间无明显相关性（r=0.149,P=0．542）;在GMSI、WMSI上,PD患者SNc信号丢失以外侧部明显,在其减影图像上,SNc外侧部信号与内侧部信号比值有显著差异（P=0．0034）。结论：MRI（T2WI、GMSI、WMSI）对辅助诊断PD有应用价值。     

帕金森病的功能磁共振成像研究进展

帕金森病（PD）的主要病理改变是黑质多巴胺能神经元变性坏死并引起多巴胺递质减少,通过神经环路可引起包括脑皮质在内广泛的功能及结构改变.功能磁共振成像（fMRI）作为一项功能影像技术能灵敏地检测出这些变化,进而有可能为PD早期诊断提供依据.本文就PD的fMRI研究进展进行综述.     

磁共振测量基底节区、黑质体积在帕金森病及其相关疾病诊断中的意义

磁共振体积测量是一项能够测量活体组织结构体积的影像学方法。本文对基底节区、黑质磁共振成像及磁共振测量基底节区、黑质体积在帕金森病及其相关疾病诊断中的意义作一综述。     

帕金森病多模态磁共振成像和基于图论的复杂网络分析法研究进展

帕金森病是临床常见的进行性神经变性病,主要由黑质致密部多巴胺能神经元变性缺失所致,目前已成为继肿瘤、心脑血管病后中老年人群的“第三杀手”.近年来多模态MRI(包括结构性和功能性MRI、扩散张量成像等)的发展和基于图论的复杂网络分析法的引入,为研究帕金森病患者脑结构和功能连接提供新的有效方法.本文对近年来基于多模态MRI和基于图论的复杂网络分析法所构建的结构性和功能性脑网络在帕金森病中的研究进展进行简要概述,以为该病的早期诊断提供新的影像学标记.     

帕金森病定向术磁共振靶点定位

目的　探讨帕金森病立体定向术核磁共振靶点定位最佳扫描方式。方法　 72例帕金森病患者行磁共振导向结合微电极记录定位 ,丘脑腹中间核 (Vim)毁损术。分为两组 ,采用中反转恢复序列 (IR)扫描直视定位和常规自旋回波 (SE)扫描解剖间接定位。以术中微电极记录和射频刺激验证确定的毁损靶点为标准 ,观察毁损靶点与影像定位靶点坐标的一致性 ,统计两种MRI定位方式下预定靶点与毁损靶点坐标符合率 ,结合疗效分析评价两种定位法。结果　 34例行IR扫描直视定位术中靶点符合率为 88.2 % ,38例行SE扫描间接定位术中靶点符合率为 31.6 %。两种定位法存在显著差异 (P <0 .0 5 )。MRI直视定位较解剖间接定位电生理靶点符合率高。结论　IR序列是MRI帕金森病立体定向靶点影像定位的优选扫描方式。其个体化直视定位靶点对提高疗效、减少并发症发生具有重要意义     

帕金森病患者风险决策能力研究

目的 探讨帕金森病( Parkinson' disease,PD)患者在风险概率明确条件下的决策能力是否改变,进一步研究基底节与决策的关系.方法 采用风险概率明确的骰子博弈测试( Game of Dice Test,GDT)对25例PD患者(PD组)和25名健康被试者(HC组)进行风险决策能力研究.结果 与HC组(5.72±3.69)相比,PD组(10.88±5.58)更倾向于选择风险选项(t=3.86,P＜0.01).PD组(-3748.00±3923.87)的最后总资产通常是负值,而HC组(684.00±1764.62)都有盈利,两者的差异有统计学意义(t=-5.15,P＜0.01).PD组选择最多的是风险最大的选项即1个数字,而HC组选择最多的是3个数字的联合(1个数字:PD组:6.48±5.81;HC组:1.00±1.44;t=4.58,P＜0.01；3个数字:PD组:2.64±2.14;HC组:7.04±2.54；t=-6.62,P＜0.01),差异有统计学意义.此外,选择风险选项的次数与负反馈利用率(r=-0.59,P=0.003)和Stroop结果(r=0.55,P=0.004)的相关性显著.结论 研究表明PD患者在风险概率明确条件下存在明显的决策能力改变,并与执行功能和负反馈利用率相关.     

磁共振成像评估帕金森病脑铁的临床应用研究

帕金森病（Parkinson disease,PD）又称震颤麻痹,是中老年常见的慢性中枢神经退行性疾病.脑铁与PD病理学改变之间存在密切关系,黑质（substantia nigra,SN）脑铁增加可诱导自由基参与多巴胺（dopamine,DA）能神经元变性.本研究拟通过磁共振成像（MRI）的双回波（duel-echo,DE）的自旋回波序列（spin echo,SE）中的T2加权成像（T2WI）评估PD脑铁变化造成的横向弛豫时间（transverserelaxation time,T2RT）的改变,探讨MRI对PD脑铁病理性改变的诊断价值.     

Motor phenotype and magnetic resonance measures of basal ganglia iron levels in Parkinson's disease

BackgroundIn Parkinson's disease the degree of motor impairment can be classified with respect to tremor dominant and akinetic rigid features. While tremor dominance and akinetic rigidity might represent two ends of a continuum rather than discrete entities, it would be important to have non-invasive markers of any biological differences between them in vivo, to assess disease trajectories and response to treatment, as well as providing insights into the underlying mechanisms contributing to heterogeneity within the Parkinson's disease population.MethodsHere, we used magnetic resonance imaging to examine whether Parkinson's disease patients exhibit structural changes within the basal ganglia that might relate to motor phenotype. Specifically, we examined volumes of basal ganglia regions, as well as transverse relaxation rate (a putative marker of iron load) and magnetization transfer saturation (considered to index structural integrity) within these regions in 40 individuals.ResultsWe found decreased volume and reduced magnetization transfer within the substantia nigra in Parkinson's disease patients compared to healthy controls. Importantly, there was a positive correlation between tremulous motor phenotype and transverse relaxation rate (reflecting iron load) within the putamen, caudate and thalamus.ConclusionsOur findings suggest that akinetic rigid and tremor dominant symptoms of Parkinson's disease might be differentiated on the basis of the transverse relaxation rate within specific basal ganglia structures. Moreover, they suggest that iron load within the basal ganglia makes an important contribution to motor phenotype, a key prognostic indicator of disease progression in Parkinson's disease.     

Excessive synchronization of basal ganglia neurons at 20 Hz slows movement in Parkinson's disease

Excessive synchronization of neuronal activity at around 20 Hz is a common finding in the basal ganglia of patients with untreated Parkinson's disease (PD). Correlative evidence suggests, but does not prove, that this spontaneous activity may contribute to slowness of movement in this condition. Here we investigate whether externally imposed synchronization through direct stimulation of the region of the subthalamic nucleus at 20 Hz can slow motor performance in a simple unimanual tapping task and whether this effect is frequency selective. Tapping rates were recorded on 42 sides in 22 patients with PD after overnight withdrawal of medication. Tapping was performed without stimulation and during bilateral stimulation at 20 Hz, 50 Hz and 130 Hz. We found that tapping rates were slowed by 8.2+/-3.2% (p=0.014) during 20-Hz stimulation in subjects with relatively preserved baseline function in the task. This effect was frequency selective. The current data provide proof of the principle that excessive beta synchrony within the basal ganglia-cortical loop may contribute to the slowing of movements in Parkinson's disease.     

Quantitative proton magnetic resonance spectroscopy of the basal ganglia in patients with affective disorders

Proton magnetic resonance spectra were recorded from a subcortical region containing the basal ganglia in 40 patients with affective disorders (18 with bipolar disorder and 22 with major depression) and in 20 normal controls. The absolute concentration of the choline-containing compounds (Cho) in the patients with bipolar disorder in the depressive state was significantly higher than that in the normal controls. The patients with bipolar disorder had significantly higher levels of the Cho/creatine + phosphocreatine (Cr) and Cho/N-acetly-l-aspartate (NAA) peak ratio compared with the normal controls in both the depressive and euthymic states, with a tendency to higher levels in the depressive state. The Cho/NAA peak ratio was also significantly higher in the patients with major depression compared with the normal controls. These results suggest that the membrane phospholipid metabolism in the basal ganglia is altered in affective disorders. Received: 26 June 1997 / Accepted: 5 August 1997     

缝隙连接蛋白36表达变化对帕金森病模型大鼠基底节环路功能的影响

目的 观察缝隙连接蛋白36(Cx36)在帕金森病模型大鼠纹状体和运动皮质区的表达变化,并探讨缝隙连接功能异常与帕金森病基底节环路功能紊乱间的关系。方法 采用6羟多巴胺注射法建立帕金森病动物模型,免疫组织化学染色及Westernblotting法检测纹状体及运动皮质区Cx36表达变化,免疫荧光双标染色进一步分析纹状体脑啡肽阳性传出神经元及Parvalbumin阳性中间神经元Cx36表达变化。结果 (1)免疫组织化学染色显示,帕金森病组大鼠右侧纹状体及运动皮质区Cx36表达水平高于正常对照组(均P<0.05)。(2)免疫荧光双标染色显示,纹状体脑啡肽阳性神经元数目和Cx36表达水平高于正常对照组(均P<0.05),而Parvalbumin阳性神经元数目和Cx36表达水平低于正常对照组(均P<0.05)。(3)Westernblotting法检测显示,帕金森病组大鼠右侧纹状体[(119.31±8.92)%]及运动皮质区[(138.20±17.88)%]Cx36表达水平高于正常对照组[(104.05±3.82)和(105.27±2.82)%,均P<0.05]。结论 帕金森病大鼠右侧纹状体及运动皮质区Cx36表达水平升高,纹状体脑啡肽阳性传出神经元Cx36表达上调,Parvalbumin阳性中间神经元Cx36表达下调。提示缝隙连接异常可能参与帕金森病皮质基底节皮质环路功能紊乱的发生机制。     

偏侧帕金森病大鼠基底神经节亚区氨基酸递质及GABAA受体亚单位mRNA的表达

目的 研究偏侧帕金森病(PD)大鼠基底神经节亚区新纹状体、内侧苍白球、外侧苍白球和丘脑底核氨基酸递质含量以及GABA A型受体(GABAA)mRNA表达变化.方法 6-羟基多巴胺(6-OHDA)脑内立体定位注射制成偏侧PD大鼠模型,采用高效液相色谱分析仪(HPLC)测定新纹状体、内侧苍白球、外侧苍白球和丘脑底核内氨基酸递质的含量;Northern ELISA法测定GABAA受体α1、α2、β2/3、γ2亚单位mRNA表达.结果 偏侧PD大鼠损毁侧新纹状体、内侧苍白球、外侧苍白球和丘脑底核内的GABA,新纹状体、外侧苍白球和丘脑底核内的谷氨酸,以及丘脑底核内的天冬氨酸、甘氨酸与未损毁侧相同解剖部位相比含量明显增加,差异均有统计学意义.偏侧PD大鼠新纹状体:损毁侧GABAA受体α1(105.3 ±24.5)、β2/3(113.7±15.3)亚单位与未损毁侧(186.7±37.2、157.4±32.4)比较,其mRNA表达水平显著下降(t=5.16、3.45,P<0.01);偏侧PD大鼠内侧苍白球:损毁侧GABAA受体α1、α2、β2/3亚单位与未损毁侧比较其mRNA表达水平显著升高(其中α1 P<0.05,α2、β2/3 P<0.01);偏侧PD大鼠外侧苍白球:损毁侧GABAA受体α2(179.1±26.8)、β2/3(154.7 ±37.8)亚单位与未损毁侧(219.3 ±19.7、231.1±55.8)比较,其mRNA表达水平显著下降(t=3.42、3.21,P<0.01);偏侧PD大鼠丘脑底核:损毁侧GABAA受体α1、α2、β2/3、γ2:亚单位与未损毁侧比较其mRNA表达水平均显著下降(其中α1、α2、β2/3P<0.01,γ2 P<0.05).结论 偏侧PD大鼠基底神经节亚区氨基酸递质含量以及GABAA受体亚单位mRNA表达水平的改变可能参与了PD的发病.     

The role of the basal ganglia in implicit contextual learning: A study of Parkinson's disease

Implicit contextual learning refers to the ability to memorize contextual information from our environment. This contextual information can then be used to guide our attention to a specific location. Although the medial temporal lobe is important for this type of learning, the basal ganglia might also be involved considering its role in many implicit learning processes. In order to understand the role of the basal ganglia in this top-down process, a group of non-demented early-stage Parkinson's patients were tested with a contextual cueing task. In this visual search task, subjects have to quickly locate a target among a number of distractors. To test implicit contextual learning, some of the configurations are repeated during the experiment, resulting in faster responses. A significant interaction effect was found between Group and Configuration, indicating that the control subjects responded faster when the spatial context was repeated, whereas Parkinson's patients failed to do so. These results, showing that the contextual cueing effect was significantly different for the patients than for the controls, suggest an important role for the basal ganglia in implicit contextual learning, thus extending previous findings of medial temporal lobe involvement. The basal ganglia are therefore not only involved in implicit motor learning, but may also have a role in purely visual implicit learning.     

Structural findings in the basal ganglia in genetically determined and idiopathic Parkinson's disease

A bilateral compensatory increase of basal ganglia (BG) gray matter value (GMV) was recently demonstrated in asymptomatic Parkin mutation carriers, who likely have an increased risk to develop Parkinson's disease (PD). We hypothesized BG morphological changes in symptomatic Parkin mutation carriers (sPARKIN-MC) and idiopathic PD patients (iPD) after the occurrence of PD symptoms, reflecting the breakdown of compensatory mechanisms. Nine sPARKIN-MC, 14 iPD, and 24 controls were studied clinically and with voxel-based morphometry. Analysis of variance revealed mainly BG decrease of GMV in sPARKIN-MC and to a lesser extent in iPD. However, a slight increase in GMV was also found in the right globus pallidus externus in sPARKIN-MC and in the right putamen in iPD. This may reflect a structural correlate of functional compensation that can only partially be maintained when nigrostriatal neurodegeneration becomes manifest. Simple regression analyses with the UPDRS-III and disease duration score revealed a distinct more bilateral linear decrease of BG GMV in sPARKIN-MC than in iPD that may correspond to previous findings showing a symmetric reduction in putaminal (18)F-DOPA-uptake and bilateral manifestation of symptoms in sPARKIN-MC. In symptomatic PD, BG are subject to a progressive atrophy, which gradually increases with disease severity and duration.     

A diffusion tensor MRI study of basal ganglia from patients with ADEM

Using diffusion tensor (DT) MRI and histogram analysis, we measured mean diffusivity ((-)D) of basal ganglia grey matter (GM) from eight patients with acute disseminated encephalomyelitis (ADEM), 10 patients with multiple sclerosis (MS), and 10 healthy controls. Patients with ADEM had higher average (-)D (p=0.02) and lower (-)D histogram peak height (p=0.008) of the basal ganglia GM than patients with MS. Microscopic tissue damage occurs in the basal ganglia of ADEM patients, but not in MS patients with a similar burden of MRI-visible brain lesions.     

Calcification of the basal ganglia in Down's syndrome and Alzheimer's disease

Summary The prevalance and severity of calcification in the basal ganglia (BGC) has been examined histopathologically in 194 patients divided into ten diagnostic categories. The prevalence and severity of BGC was greater (for age) in Down's syndrome and in patients under 75 years of age with Alzheimer's disease. The severity, but not the prevalance, of BGC was greater in Down's syndrome than in patients of similar age with Alzheimer's disease. Both the prevalence and the severity of BGC in patients over 75 years of age with Alzheimer's disease were as expected for age alone. The increased prevalence and severity of BGC in Down's syndrome and in younger patients with Alzheimer's disease appeared not to be related to the presence of dementia or degenerative disease per se, nor was it affected by the presence of cerebral infarction. BGC may result from an age-related disturbance of the structure of arteries within the globus pallidus, which is accelerated (or occurs prematurely) in Down's syndrome and in younger patients with Alzheimer's disease, but probably does not form part of that spectrum of changes that constitutes the pathological basis of Alzheimer's disease.