Paviour Dominic C, Thornton John S, Lees Andrew J, Jäger H Rolf
Sara Koe PSP Research Centre, Institute of Neurology, University College London, London, United Kingdom.
Mov Disord. 2007 Jan;22(1):68-74. doi: 10.1002/mds.21204.
Progressive supranuclear palsy (PSP) and the parkinsonian variant of multiple-system atrophy (MSA-P) may present with a similar phenotype. Magnetic resonance diffusion-weighted imaging (DWI) has been shown to be a sensitive discriminator of MSA-P from Parkinson's disease (PD). We studied 20 PSP, 11 MSA-P, 12 PD patients and 7 healthy controls in order to investigate whether regional apparent diffusion coefficients (rADCs) help distinguish PSP and MSA-P; whether rADCs are correlated with clinical disease severity scores; and the relationship between brainstem and cerebellar volumes and rADCs in PSP and MSA-P. The Unified Parkinson's Disease Rating Scale, Hoehn and Yahr score, Mini Mental State Examination, and frontal assessment battery were recorded in all patients. Regional ADCs were measured in the middle cerebellar peduncle (MCP), caudal and rostral pons, midbrain, decussating fibers of the superior cerebellar peduncle, thalamus, putamen, globus pallidus, caudate nucleus, corpus callosum, frontal and parietal white matter, as well as the centrum semiovale. In MSA-P, rADCs in the MCP and rostral pons were significantly greater than in PSP (P < 0.001 and 0.009) and PD (P < 0.001 and = 0.002). Stepwise logistic regression revealed that the MCP rADC distinguishes MSA-P from PSP with a sensitivity of 91% and a specificity of 84%. Increased brainstem rADCs were associated with motor deficit in MSA-P and PSP. Increased rADCs in the pons and MCP were associated with smaller pontine and cerebellar volumes in MSA-P. rADCs distinguish MSA-P from PSP. These have a clinical correlate and are associated with reduced brainstem and cerebellar volumes.
进行性核上性麻痹（PSP）和多系统萎缩的帕金森变异型（MSA-P）可能具有相似的表型。磁共振扩散加权成像（DWI）已被证明是鉴别MSA-P与帕金森病（PD）的敏感方法。我们研究了20例PSP患者、11例MSA-P患者、12例PD患者和7名健康对照者，以调查局部表观扩散系数（rADC）是否有助于区分PSP和MSA-P；rADC是否与临床疾病严重程度评分相关；以及PSP和MSA-P中脑干和小脑体积与rADC之间的关系。记录了所有患者的统一帕金森病评定量表、霍恩和雅尔分级、简易精神状态检查表和额叶评估量表。在小脑中脚（MCP）、脑桥尾侧和头侧、中脑、小脑上脚交叉纤维、丘脑、壳核、苍白球、尾状核、胼胝体、额叶和顶叶白质以及半卵圆中心测量局部ADC。在MSA-P中，MCP和脑桥头侧的rADC显著高于PSP（P<0.001和0.009）和PD（P<0.001和=0.002）。逐步逻辑回归显示，MCP的rADC区分MSA-P与PSP的灵敏度为91%，特异度为84%。脑干rADC增加与MSA-P和PSP中的运动功能障碍相关。脑桥和MCP中rADC增加与MSA-P中脑桥和小脑体积较小相关。rADC可区分MSA-P与PSP。这些具有临床相关性，并与脑干和小脑体积减小有关。
