Ito Mizuki, Watanabe Hirohisa, Kawai Yoshinari, Atsuta Naoki, Tanaka Fumiaki, Naganawa Shinji, Fukatsu Hiroshi, Sobue Gen
Department of Neurology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho Showa-ku, Nagoya 466-8550, Japan.
J Neurol Neurosurg Psychiatry. 2007 Jul;78(7):722-8. doi: 10.1136/jnnp.2006.104075. Epub 2007 Mar 12.
To determine whether apparent diffusion coefficient (ADC) values and fractional anisotropy (FA) values can detect early pathological involvement in multiple system atrophy (MSA), and be used to differentiate MSA-P (multiple system atrophy if parkinsonian features predominate) from Parkinson's disease (PD).
We compared ADC and FA values in the pons, cerebellum and putamen of 61 subjects (20 probable MSA patients, 21 age matched PD patients and 20 age matched healthy controls) using a 3.0 T magnetic resonance system.
ADC values in the pons, cerebellum and putamen were significantly higher, and FA values lower in MSA than in PD or controls. These differences were prominent in MSA lacking dorsolateral putaminal hyperintensity (DPH) or hot cross bun (HCB) sign. In differentiating MSA-P from PD using FA and ADC values, we obtained equal sensitivity (70%) and higher specificity (100%) in the pons than in the putamen and cerebellum. In addition, all patients that had both significant low FA and high ADC values in each of these three areas were MSA-P cases, and those that had both normal FA and ADC values in the pons were all PD cases. Our diagnostic algorithm based on these results accurately diagnosed 90% of patients with MSA-P.
FA and ADC values detected early pathological involvement prior to magnetic resonance signal changes in MSA. In particular, low FA values in the pons showed high specificity in discriminating MSA-P from PD. In addition, combined analysis of both FA and ADC values in all three areas was more useful than only one.
确定表观扩散系数（ADC）值和分数各向异性（FA）值能否检测多系统萎缩（MSA）早期的病理改变，并用于鉴别帕金森综合征型多系统萎缩（MSA-P，以帕金森症状为主的多系统萎缩）和帕金森病（PD）。
我们使用3.0 T磁共振系统比较了61名受试者（20名疑似MSA患者、21名年龄匹配的PD患者和20名年龄匹配的健康对照）脑桥、小脑和壳核的ADC值和FA值。
MSA患者脑桥、小脑和壳核的ADC值显著高于PD患者或对照组，FA值则低于PD患者或对照组。这些差异在缺乏壳核背外侧高信号（DPH）或“热交叉面包”（HCB）征的MSA患者中尤为明显。在使用FA值和ADC值鉴别MSA-P和PD时，我们发现在脑桥鉴别时具有相同的敏感性（70%）和比壳核及小脑更高的特异性（100%）。此外，在这三个区域中FA值均显著降低且ADC值均显著升高的患者均为MSA-P病例，而脑桥FA值和ADC值均正常的患者均为PD病例。基于这些结果的诊断算法准确诊断了90%的MSA-P患者。
FA值和ADC值在MSA患者出现磁共振信号改变之前就能检测到早期病理改变。特别是脑桥低FA值在鉴别MSA-P和PD时具有较高的特异性。此外，对所有三个区域的FA值和ADC值进行联合分析比仅分析其中一个更有用。
