Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, Canada; Department of Medical Imaging, Toronto Western Hospital, the Joint Department of Medical Imaging, and The University of Toronto, Canada.
Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, Canada; Department of Medicine (Neurology), University of Toronto, Canada.
Parkinsonism Relat Disord. 2014 Feb;20(2):222-5. doi: 10.1016/j.parkreldis.2013.10.002. Epub 2013 Oct 12.
MRI has been used in parkinsonism to assess atrophy, tissue water diffusivity, and mineral deposition but usually at a single time-point. However, multiple system atrophy (MSA) and progressive supranuclear palsy (PSP) are progressive diseases. This study assessed the value of longitudinal MRI in characterizing the time course of the degenerative process.
Two serial MRIs (mean 23 months apart) were retrospectively analyzed in 12 MSA, 6 PSP, and 18 age and sex matched controls. Assessment included selected cross-sectional areas, regional apparent diffusion coefficient (ADC) and gradient echo (GRE) intensity ratios of the lateral ventricles, caudate, putamen, middle cerebellar peduncle, pons and midbrain.
On follow-up imaging, there was a larger ADC increase in the putamen in PSP over time compared to controls (p = 0.02). In MSA there was greater volume loss in the pons over time compared to controls (p = 0.002). In MSA the changes in middle cerebellar peduncle ADC were correlated with motor symptom severity according to the Unified Parkinson's Disease Rating Scale Part III (p = 0.005).
Evidence of progressive neurodegeneration can be observed on MRI in MSA and PSP within two years consisting of increasing putaminal ADC in PSP and pontine atrophy in MSA.
磁共振成像（MRI）已被用于帕金森病患者的评估，包括萎缩、组织水扩散和矿物质沉积，但通常仅在一个时间点进行。然而，多系统萎缩（MSA）和进行性核上性麻痹（PSP）是进展性疾病。本研究评估了纵向 MRI 在描述退行性过程时间进程中的价值。
回顾性分析了 12 例 MSA、6 例 PSP 和 18 例年龄和性别匹配的对照组的 2 次连续 MRI（平均间隔 23 个月）。评估包括选择的横截面积、侧脑室、尾状核、壳核、小脑上脚、脑桥和中脑的区域表观扩散系数（ADC）和梯度回波（GRE）强度比。
在随访影像学中，与对照组相比，PSP 患者的壳核 ADC 随时间推移而逐渐增加（p = 0.02）。与对照组相比，MSA 患者的脑桥体积随时间推移而逐渐减小（p = 0.002）。在 MSA 中，小脑上脚 ADC 的变化与根据统一帕金森病评定量表第三部分（UPDRS III）评估的运动症状严重程度相关（p = 0.005）。
在 2 年内，MSA 和 PSP 患者的 MRI 上可观察到进行性神经退行性变的证据，包括 PSP 患者的壳核 ADC 增加和 MSA 患者的脑桥萎缩。
