头部MRI及PET检查对进行性核上性麻痹与帕金森病的诊断价值

目的探讨头部磁共振成像(MRI)及以18F-脱氧葡萄糖(18F-FDG)为示踪剂的正电子发射计算机断层扫描(PET)两种影像学检查对进行性核上性麻痹(PSP)及帕金森病(PD)的诊断价值。方法对2004年8月至2006年11月在首都医科大学附属北京天坛医院神经内科就诊的11例PSP和178例PD患者进行常规头部MRI检查,并对其中5例PSP和48例PD患者进行18F-FDGPET检查。结果(1)MRI检查:11例PSP患者均可见矢状位T1加权像有中脑上缘平坦或者凹陷表现,PD组未见上述表现;正中矢状位T1加权像上计算中脑截面面积,PSP组低于PD组,差异有显著性意义(P<0.01)。(2)18F-FDGPET检查:PSP组主要表现为对称性额叶低代谢,纹状体代谢基本对称。PD组主要表现为顶叶代谢略低于额叶前部,首发症状肢体对侧顶叶代谢降低明显;纹状体呈不对称表现,首发症状肢体同侧纹状体代谢降低,对侧纹状体后部代谢降低;纹状体代谢高于同侧丘脑。结论MRI及18F-FDGPET检查对诊断PSP在中脑形态学改变(中脑萎缩)及脑葡萄糖低代谢方面有特异性,与PD组比较差异有显著性意义。

Value of MRI and PET in diagnosing progressive supranuclear palsy and PD

Objective To investigate the MRI abnormalities and feature of FDG metabolism in the brain of patients with progressive supranuclear palsy.Methods Eleven patients with PSP and 178 patients with PD were prospectively studied with mid-sagittal plain MRI;five patients with PSP and 48 patients with PD were prospectively studied with 18F-FDG PET.Results The atrophy of the midbrain tegmentum and hummingbird sign were demonstrated in all of the PSP patients studied,but were not observed in PD patients.The area of the midbrain on mid-sagittal plain MRI in the patients with PSP was significantly smaller than that in those with PD.The patients with PSP had more prominent decrease of glucose metabolism symmetrically in frontal cortices and lentiform compared with PD.The lentiform in PD showed significant glucose hypermetabolism compared with thalamus.The regional glucose metabolism of PSP was symmetrical while that of PD was asymmetrical in lentiform and thalamus.Conclusion The assessment of the mid-sagittal plain MRI and 18F-FDG PET images may be a useful adjunct to a clinical examination when making a differential diagnosis of PSP with PD.