Institute of Neurological Sciences, National Research Council, Piano-Lago, Mangone, Italy.
Parkinsonism Relat Disord. 2011 Mar;17(3):172-6. doi: 10.1016/j.parkreldis.2010.12.010. Epub 2011 Jan 13.
Quantitative analysis of brain atrophy may be useful in differentiating Parkinson's Disease (PD) from Progressive Supranuclear Palsy (PSP) and parkinsonian variant of Multiple System Atrophy (MSA-P); the aim of this study was to identify the volumetric differences of subcortical structures in patients with PD, PSP and MSA-P using a novel and validated fully-automated whole brain segmentation method.
Volumetric MRIs were obtained in 72 patients with PD, 32 patients with PSP, 15 patients with MSA-P, and in 46 control subjects. Subcortical volume was measured automatically by FreeSurfer. Multivariate analysis of covariance, adjusted for intracranial volume (ICV), sex and age, was used to explore group differences.
No volumetric differences were found between PD and controls group; otherwise the volumes of the cerebellum, the thalamus, the putamen, the pallidum, the hippocampus, and the brainstem were significantly reduced in PSP and MSA-P compared to patients with PD and control subjects. PSP and MSA-P patients only differed in thalamus volume which was smaller in PSP group (p < 0.001). Moreover, patients with PSP and MSA-P showed a ventricular system (including lateral, third and fourth ventricles) larger than that detected in PD and controls (p < 0.001).
Volumetric data obtained with automated segmentation of cerebral regions show a significant atrophy of different brain structures in parkinsonisms rather than in PD. Our study also demonstrates that the atrophy of the thalamus only occurs in PSP while the enlargement of the whole ventricular system characterizes both PSP and MSA-P.
脑萎缩的定量分析可能有助于区分帕金森病（PD）与进行性核上性麻痹（PSP）和多系统萎缩的帕金森型（MSA-P）；本研究旨在使用一种新的、经过验证的全自动全脑分割方法，确定 PD、PSP 和 MSA-P 患者的皮质下结构体积差异。
对 72 例 PD 患者、32 例 PSP 患者、15 例 MSA-P 患者和 46 例对照者进行了容积 MRI 检查。皮质下体积通过 FreeSurfer 自动测量。采用多元协方差分析，调整了脑容量（ICV）、性别和年龄，以探讨组间差异。
PD 与对照组之间未发现体积差异；否则，与 PD 患者和对照组相比，PSP 和 MSA-P 患者的小脑、丘脑、壳核、苍白球、海马和脑干体积明显减小。PSP 和 MSA-P 患者仅在丘脑体积上存在差异，PSP 组的丘脑体积较小（p < 0.001）。此外，与 PD 和对照组相比，PSP 和 MSA-P 患者的脑室系统（包括侧脑室、第三脑室和第四脑室）较大（p < 0.001）。
使用大脑区域的自动分割获得的容积数据显示，不同帕金森病患者的不同脑结构存在明显萎缩，而不仅仅是 PD。我们的研究还表明，只有 PSP 患者的丘脑萎缩，而整个脑室系统的增大则是 PSP 和 MSA-P 的特征。
