中脑和基底节神经核团MR扩散张量成像在帕金森病诊断中的作用

目的探讨中脑和基底节神经核团的磁共振扩散张量成像（DTI）在帕金森病（PD）诊断及病情评估中的应用价值。方法回顾性分析2017年7月~2020年11月在我院就诊的27例PD患者（PD组）及23例正常人群（对照组）的临床及MR资料。对两组进行常规MR平扫及DTI检查，测量各受试者双侧黑质、红核、尾状核头、丘脑、苍白球、壳核的DTI参数，包括各项异性分数（FA）、平均扩散系数（MD）。比较各核团FA和MD值在PD组和对照组间的差异。分析存在组间差异的参数单独及联合应用的诊断效能，以及和病程、Hoehn-Yahr分级及统一帕金森病评定量表运动部分（UPDRS Ⅲ）评分的相关性。结果PD组黑质、尾状核头、丘脑、苍白球及壳核的FA值均低于对照组，尾状核头MD高于对照组（P < 0.05）。受试者工作特征曲线分析示联合应用黑质、尾状核头、丘脑、苍白球及壳核的FA值和尾状核头的MD值诊断PD的曲线下面积（AUC）为0.981，均明显大于各参数单独应用于诊断PD的AUC（P < 0.05）。尾状核头MD值与PD患者UPDRS Ⅲ评分呈正相关（r=0.402, P=0.038），丘脑FA值与PD患者Hoehn-Yahr分级（r=-0.490, P=0.009）、UPDRS Ⅲ评分（r=-0.547, P=0.003）呈负相关。结论中脑、基底节神经核团DTI参数有助于PD的诊断及病情严重程度的评估，联合应用多个核团DTI参数具有较好的诊断效能。

Value of MR diffusion tensor imaging of midbrain and basal ganglia nuclei in the diagnosis and severity assessment of Parkinson's disease

ObjectiveTo investigate the value of MR diffusion tensor imaging (DTI) of midbrain and basal ganglia nuclei in the diagnosis and severity assessment of Parkinson's disease (PD).MethodsThe clinical and MR data of 27 PD patients (PD group) and 23 normal controls (NC group) who visited our hospital from July 2017 to November 2020 were retrospectively analyzed. Routine MR scanning and DTI examination were performed on PD group and NC group. And DTI parameters, including the fractional anisotropy (FA) and mean diffusivity (MD), were measured for bilateral substantia nigra, red nucleus, caudate head, thalamus, globus pallidus and putamen of each subject. The FA and MD values of each nucleus were compared between PD and NC groups. This study analyzed the diagnostic effectiveness of single and combined application of parameters with inter-group differences and their correlation with course of disease, Hoehn-Yahr grade and exercise part of unified Parkinson's disease rating scale (UPDRS Ⅲ) score.ResultsThe FA values of substantia nigra, caudate head, thalamus, globus pallidus and putamen in PD group were all lower than those in NC group, while the MD values of caudate head were higher than that in NC group (all P < 0.05). The receiver operating characteristic curve analysis showed that the area under the curve (AUC) of combined application of FA values of substantia nigra, caudate head, thalamus, globus pallidus and putamen as well as MD value of caudate head for PD diagnosis was 0.981, which was significantly greater than the AUC of each parameter applied alone for PD diagnosis (all P < 0.05). The MD value of caudate head was positively correlated with UPDRS Ⅲ score of PD patients (r=0.402, P=0.038), and the FA value of thalamus was negatively correlated with the Hoehn-Yahr grade (r=-0.490, P=0.009) and UPDRS Ⅲ score (r=-0.547, P=0.003) of PD patients.ConclusionThe DTI parameters of midbrain and basal ganglia nuclei are helpful for the diagnosis and severity assessment of PD. The combined application of DTI parameters of multiple nuclei has better diagnostic efficacy.