用于区分进行性核上性麻痹与帕金森病及多系统萎缩帕金森变异型的磁共振成像指标。

MR imaging index for differentiation of progressive supranuclear palsy from Parkinson disease and the Parkinson variant of multiple system atrophy.

作者信息

Quattrone Aldo, Nicoletti Giuseppe, Messina Demetrio, Fera Francesco, Condino Francesca, Pugliese Pierfrancesco, Lanza Pierluigi, Barone Paolo, Morgante Letterio, Zappia Mario, Aguglia Umberto, Gallo Olivier

机构信息

Institute of Neurology, Magna Graecia University of Catanzaro, Catanzaro, Calabria, Italy.

出版信息

Radiology. 2008 Jan;246(1):214-21. doi: 10.1148/radiol.2453061703. Epub 2007 Nov 8.

DOI:10.1148/radiol.2453061703

PMID:17991785

Abstract

PURPOSE

To prospectively assess sensitivity and specificity of magnetic resonance (MR) imaging measurements of midbrain, pons, middle cerebellar peduncles (MCPs), and superior cerebellar peduncles (SCPs) for differentiating progressive supranuclear palsy (PSP) from Parkinson disease (PD) and Parkinson variant of multiple system atrophy (MSA-P), with established consensus criteria as reference standard.

MATERIALS AND METHODS

All study participants provided informed consent; study was approved by the institutional review board. Pons area, midbrain area, MCP width, and SCP width were measured in 33 consecutive patients with PSP (16 possible, 17 probable), 108 consecutive patients with PD, 19 consecutive patients with MSA-P, and 50 healthy control participants on T1-weighted MR images. The pons area-midbrain area ratio (P/M) and MCP width-SCP width ratio (MCP/SCP) were also used, and an index termed MR parkinsonism index was calculated [(P/M).(MCP/SCP)]. Differences in MR imaging measurements among groups were evaluated with Kruskal-Wallis test, Mann-Whitney U test, and Bonferroni correction.

RESULTS

Midbrain area and SCP width in patients with PSP (23 men, 10 women; mean age, 69.3 years) were significantly (P < .001) smaller than in patients with PD (62 men, 46 women; mean age, 65.8 years), patients with MSA-P (five men, 14 women; mean age, 64.0 years), and control participants (25 men, 25 women; mean age, 66.6 years). P/M and MCP/SCP were significantly larger in patients with PSP than in patients in other groups and control participants. All measurements showed some overlap of values between patients with PSP and patients from other groups and control participants. MR parkinsonism index value was significantly larger in patients with PSP (median, 19.42) than in patients with PD (median, 9.40; P < .001), patients with MSA-P (median, 6.53; P < .001), and control participants (median, 9.21; P < .001), without overlap of values among groups. No patient with PSP received a misdiagnosis when the index was used (sensitivity and specificity, 100%).

CONCLUSION

The MR parkinsonism index can help distinguish patients with PSP from those with PD and MSA-P on an individual basis.

摘要

目的

以前瞻性评估中脑、脑桥、小脑中脚（MCP）和小脑上脚（SCP）的磁共振（MR）成像测量对于区分进行性核上性麻痹（PSP）与帕金森病（PD）及多系统萎缩帕金森型（MSA-P）的敏感性和特异性，以既定的共识标准作为参考标准。

材料与方法

所有研究参与者均提供了知情同意书；研究获得机构审查委员会的批准。在T1加权MR图像上，对33例连续的PSP患者（16例可能型，17例很可能型）、108例连续的PD患者、19例连续的MSA-P患者以及50名健康对照参与者测量脑桥面积、中脑面积、MCP宽度和SCP宽度。还使用了脑桥面积与中脑面积之比（P/M）以及MCP宽度与SCP宽度之比（MCP/SCP），并计算了一个称为MR帕金森指数的指标[（P/M）·（MCP/SCP）]。采用Kruskal-Wallis检验、Mann-Whitney U检验和Bonferroni校正评估各组之间MR成像测量值的差异。

结果

PSP患者（23例男性，10例女性；平均年龄69.3岁）的中脑面积和SCP宽度显著（P <.001）小于PD患者（62例男性，46例女性；平均年龄65.8岁）、MSA-P患者（5例男性，14例女性；平均年龄64.0岁）和对照参与者（25例男性，25例女性；平均年龄66.6岁）。PSP患者的P/M和MCP/SCP显著大于其他组患者和对照参与者。所有测量值在PSP患者与其他组患者及对照参与者之间均存在一定程度的重叠。PSP患者的MR帕金森指数值（中位数为19.4）显著大于PD患者（中位数为9.40；P <.001）、MSA-P患者（中位数为6.53；P <.001）和对照参与者（中位数为9.21；P <.001），各组之间的值无重叠。当使用该指数时，没有PSP患者被误诊（敏感性和特异性均为100%）。