MR定量磁化率成像在帕金森病临床诊断中的价值研究

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。

Value of MR quantitative susceptibility mapping in the diagnosis of Parkinson disease

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: F_L=0.661, P_L=0.421; F_R=1.153, P_R=0.290. RN: F_L=0.006, P_L=0.940; F_R=0.109, P_R=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.