Pellecchia Maria Teresa, Barone Paolo, Mollica Carmine, Salvatore Elena, Ianniciello Marta, Longo Katia, Varrone Andrea, Vicidomini Caterina, Picillo Marina, De Michele Giuseppe, Filla Alessandro, Salvatore Marco, Pappatà Sabina
Department of Neurological Sciences, University Federico II, Naples, Italy.
Mov Disord. 2009 Apr 15;24(5):689-96. doi: 10.1002/mds.22440.
Multiple system atrophy can be classified into two main types, a Parkinsonian (MSA-P) and a cerebellar (MSA-C) variant based on clinical presentation. We obtained diffusion-weighted magnetic resonance imaging (DWI) in 9 MSA-P and 12 MSA-C patients and 11 controls, and correlated DWI changes with disease duration and severity. We found that Trace (D) values in the entire and anterior putamen were significantly higher in MSA-P than in MSA-C patients and controls, whereas Trace (D) values in the cerebellum and middle cerebellar peduncle (MCP) were significantly higher in MSA-C than in MSA-P patients and controls. Increased disease duration was significantly correlated with increased Trace (D) values in pons of MSA-P patients, and in cerebellum and MCP of MSA-C patients. Both UMSARS and UPDRS motor scores positively correlated with entire and posterior putaminal Trace (D) values in MSA-P patients. The diffusivity changes parallel phenotypical and pathologic differences between MSA-P and MSA-C patients, suggesting that DWI is a feasible tool for in vivo evaluation of neurodegeneration in MSA. Based on our findings, Trace (D) measurements in the putamen and pons in MSA-P patients and in the cerebellum and MCP in MSA-C patients could serve as quantitative markers for microstructural damage in the course of disease.
多系统萎缩可根据临床表现分为两种主要类型，即帕金森型（MSA-P）和小脑型（MSA-C）。我们对9例MSA-P患者、12例MSA-C患者和11名对照者进行了扩散加权磁共振成像（DWI）检查，并将DWI变化与疾病持续时间和严重程度进行关联分析。我们发现，MSA-P患者整个壳核及前壳核的Trace（D）值显著高于MSA-C患者和对照者，而MSA-C患者小脑及小脑中脚（MCP）的Trace（D）值显著高于MSA-P患者和对照者。MSA-P患者脑桥、MSA-C患者小脑和MCP中，疾病持续时间的增加与Trace（D）值的增加显著相关。在MSA-P患者中，统一多系统萎缩评分量表（UMSARS）和帕金森病统一评分量表（UPDRS）运动评分均与整个壳核及后壳核的Trace（D）值呈正相关。扩散率变化与MSA-P和MSA-C患者的表型及病理差异平行，这表明DWI是用于MSA神经退行性变体内评估的可行工具。基于我们的研究结果，MSA-P患者壳核和脑桥、MSA-C患者小脑和MCP的Trace（D）测量值可作为疾病过程中微观结构损伤的定量标志物。
