Centre for Neuroscience, Department of Medicine, Imperial College London, UK.
Parkinsonism Relat Disord. 2012 Jan;18 Suppl 1:S31-3. doi: 10.1016/S1353-8020(11)70012-8.
In established PD the Queen Square Brain Bank criteria applied by experts show 90% sensitivity and specificity for the presence of midbrain Lewy bodies. However, in early disease clinical diagnosis is less straightforward. PD diagnosis made in the community by non-experts is associated with a 25% error rate. Nigral abnormalities can now be detected in vivo with 7 tesla MRI and diffusion tensor MRI. Magnetisation transfer can demonstrate melanin loss in the substantia nigra. Transcranial sonography (TCS) detects midbrain hyperechogenicity in both sporadic and genetic PD. PET and SPECT ligands can demonstrate the presence of dopamine terminal dysfunction in early and preclinical disease and an abnormal covariance pattern between levels of resting brain blood flow metabolism in cortical and subcortical regions. In the atypical parkinsonian syndrome multiple system atrophy (MSA) T2-weighted MRI can reveal characteristic changes including reduced putmen signal due to iron deposition and the pontine 'hot cross bun' sign as transverse fibres become visible. Progressive supranuclear palsy (PSP) is associated with midbrain atrophy and 3(rd) ventricular widening. In both these conditions diffusion weighted MRI shows increased striatal water diffusivity but the middle cerebellar peduncle is targeted in MSA and the superior peduncle in PSP. In this review the role of structural and functional imaging for supporting the differential diagnosis of the various degenerative parkinsonian syndromes will be discussed.
在已确立的帕金森病中，专家应用的 Queen Square 脑库标准显示，存在中脑路易体的敏感性和特异性为 90%。然而，在早期疾病中，临床诊断就不那么简单了。由非专家在社区中做出的帕金森病诊断的错误率为 25%。现在可以使用 7 特斯拉 MRI 和弥散张量 MRI 活体检测黑质异常。磁化传递可以显示黑色素在黑质中的丢失。经颅超声（TCS）可检测到散发性和遗传性帕金森病患者的中脑回声过高。正电子发射断层扫描（PET）和单光子发射计算机断层扫描（SPECT）配体能显示多巴胺终末功能障碍在早期和临床前疾病中的存在，以及皮质和皮质下区域静息脑血流代谢水平之间的异常协方差模式。在非典型帕金森综合征中，多系统萎缩（MSA）的 T2 加权 MRI 可以揭示特征性变化，包括由于铁沉积导致的壳核信号降低和桥脑“热十字面包”征，因为横向纤维变得可见。进行性核上性麻痹（PSP）与中脑萎缩和第三脑室扩大有关。在这两种情况下，弥散加权 MRI 显示纹状体水弥散度增加，但 MSA 中靶向的是小脑中脑脚，PSP 中靶向的是上脑脚。在这篇综述中，将讨论结构和功能成像在支持各种退行性帕金森综合征的鉴别诊断中的作用。
