Reimão Sofia, Pita Lobo Patrícia, Neutel Dulce, Guedes Leonor Correia, Coelho Miguel, Rosa Mário M, Azevedo Pedro, Ferreira Joana, Abreu Daisy, Gonçalves Nilza, Nunes Rita G, Campos Jorge, Ferreira Joaquim J
Neurological Imaging Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Portugal.
Clinical Pharmacology Unit, Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Portugal.
Mov Disord. 2015 Jun;30(7):953-9. doi: 10.1002/mds.26182. Epub 2015 Mar 11.
Essential tremor (ET) is a very common movement disorder that has no diagnostic markers. Differentiation with Parkinson's disease (PD) can be clinically challenging in some cases, with a high rate of misdiagnosis. Magnetic resonance imaging (MRI) studies have been able to identify neuromelanin changes in the substantia nigra (SN) of PD patients, but they have thus far not been investigated in ET. In this study, we aimed to characterize neuromelanin-MR signal changes in ET and evaluate its diagnostic accuracy in the differential diagnosis with PD.
The inclusion criteria were patients with ET and untreated "de novo" PD patients; in addition, age-matched controls were enrolled. These were studied with a high-resolution T1-weighted MRI sequence at 3.0 Tesla to visualize neuromelanin. The primary outcomes were the area and width of the SN region with high signal.
A total of 15 ET patients and 12 "de novo" PD patients were evaluated. The area and width of the T1 high signal in the SN region were markedly decreased in the PD group compared with the ET and age-matched controls, and a greater decrease was seen in the ventrolateral segment. The neuromelanin measures in the ET group, although slightly lower, were not significantly different from the healthy control group. We obtained a sensitivity of 66.7% and a specificity of 93.3% in discriminating ET from early-stage PD.
Neuromelanin-sensitive MRI techniques can discriminate ET from early-stage tremor-dominant PD and can be a useful clinical tool in the evaluation of tremor disorders. © 2015 International Parkinson and Movement Disorder Society.
特发性震颤（ET）是一种非常常见的运动障碍，目前尚无诊断标志物。在某些情况下，与帕金森病（PD）进行鉴别在临床上具有挑战性，误诊率较高。磁共振成像（MRI）研究能够识别帕金森病患者黑质（SN）中的神经黑色素变化，但迄今为止尚未在特发性震颤中进行研究。在本研究中，我们旨在描述特发性震颤中神经黑色素-MR信号变化的特征，并评估其在与帕金森病鉴别诊断中的诊断准确性。
纳入标准为特发性震颤患者和未经治疗的“初发”帕金森病患者；此外，还纳入了年龄匹配的对照组。使用3.0特斯拉的高分辨率T1加权MRI序列对这些对象进行研究，以观察神经黑色素。主要观察指标为黑质区域高信号的面积和宽度。
共评估了15例特发性震颤患者和12例“初发”帕金森病患者。与特发性震颤组和年龄匹配的对照组相比，帕金森病组黑质区域T1高信号的面积和宽度明显减小，腹外侧段减小更为明显。特发性震颤组的神经黑色素测量值虽然略低，但与健康对照组无显著差异。在鉴别早期帕金森病和特发性震颤时，我们获得的敏感度为66.7%，特异度为93.3%。
神经黑色素敏感的MRI技术可以鉴别特发性震颤和早期以震颤为主的帕金森病，并且可以成为评估震颤性疾病的一种有用的临床工具。© 2015国际帕金森和运动障碍协会。
