Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Mov Disord. 2012 Mar;27(3):421-7. doi: 10.1002/mds.24926. Epub 2012 Jan 30.
It can be difficult to clinically distinguish between classical Parkinson's disease (PD) and progressive supranuclear palsy. Previously, there have been no biomarkers that reliably allow this distinction to be made. We report that an abnormal brain iron accumulation is a marker for ongoing neurodegeneration in both conditions, but the conditions differ with respect to the anatomical distribution of these accumulations. We analyzed quantitative T2' maps as markers of regional brain iron content from PD and progressive supranuclear palsy patients and compared them to age-matched control subjects. T2-weighted and T2*-weighted images were acquired in 30 PD patients, 12 progressive supranuclear palsy patients, and 24 control subjects at 1.5 Tesla. Mean T2' values were determined in regions-of-interest in the basal ganglia, thalamus, and white matter within each hemisphere. The main findings were shortened T2' values in the caudate nucleus, globus pallidus, and putamen in progressive supranuclear palsy compared to PD patients and controls. A stepwise linear discriminant analysis allowed progressive supranuclear palsy patients to be distinguished from PD patients and the healthy controls. All progressive supranuclear palsy patients were correctly classified. No progressive supranuclear palsy patient was classified as a healthy control, no healthy controls were incorrectly classified as having progressive supranuclear palsy, and only 6.7% of the PD patients were incorrectly classified as progressive supranuclear palsy. Regional decreases of T2' relaxation times in parts of the basal ganglia reflecting increased brain iron load in these areas are characteristic for progressive supranuclear palsy but not PD patients.
临床上区分经典帕金森病 (PD) 和进行性核上性麻痹 (PSP) 可能具有一定难度。此前，尚无可靠的生物标志物可以明确区分这两种疾病。我们报告称，异常的脑铁积累是这两种疾病持续神经退行性变的标志物，但就这些异常铁积累的解剖分布而言，这两种疾病存在差异。我们分析了 PD 和 PSP 患者的定量 T2' 图谱作为区域性脑铁含量的标志物，并将其与年龄匹配的对照组进行了比较。在 1.5T 磁共振扫描仪上对 30 名 PD 患者、12 名 PSP 患者和 24 名对照组进行了 T2 加权和 T2*-加权成像。在每个半球的基底节、丘脑和白质中确定了感兴趣区域的平均 T2' 值。主要发现是 PSP 患者的尾状核、苍白球和壳核的 T2' 值较 PD 患者和对照组缩短。逐步线性判别分析允许将 PSP 患者与 PD 患者和健康对照组区分开来。所有 PSP 患者均被正确分类。没有 PSP 患者被错误地归类为健康对照组，没有健康对照组被错误地归类为 PSP，只有 6.7%的 PD 患者被错误地归类为 PSP。反映这些区域脑铁负荷增加的基底节部分的 T2' 弛豫时间的区域减少是 PSP 的特征，但不是 PD 患者的特征。
