Hwang I, Sohn C-H, Kang K M, Jeon B S, Kim H-J, Choi S H, Yun T J, Kim J-H
From the Departments of Radiology (I.H., C.-H.S., K.M.K, S.H.C., T.J.Y., J.-h.K.).
From the Departments of Radiology (I.H., C.-H.S., K.M.K, S.H.C., T.J.Y., J.-h.K.) Department of Radiology (C.-H.S.), Seoul National University College of Medicine, Seoul, Korea Institute of Radiation Medicine (C.-H.S.), Seoul National University Medical Research Center, Seoul, Korea.
AJNR Am J Neuroradiol. 2015 Dec;36(12):2227-34. doi: 10.3174/ajnr.A4442. Epub 2015 Sep 3.
Asymmetric presentation of clinical feature in parkinsonism is common, but correlatable radiologic feature is not clearly defined. Our aim was to evaluate 3T susceptibility-weighted imaging findings for differentiating parkinsonism-predominant multiple system atrophy from idiopathic Parkinson disease, focusing on putaminal changes and lesion asymmetry.
This retrospective cohort study included 27 patients with parkinsonism-predominant multiple system atrophy and 50 patients with idiopathic Parkinson disease diagnosed clinically. Twenty-seven age-matched subjects without evidence of movement disorders who underwent SWI were included as the control group. A consensus was reached by 2 radiologists who visually assessed SWI for the presence of putaminal atrophy and marked signal hypointensity on each side of the posterolateral putamen. We also quantitatively measured putaminal width and phase-shift values.
The mean disease duration was 4.7 years for the patients with parkinsonism-predominant multiple system atrophy and 7.8 years for the patients with idiopathic Parkinson disease. In the patients with parkinsonism-predominant multiple system atrophy, putaminal atrophy was frequently observed (14/27, 51.9%) and was most commonly found in the unilateral putamen (13/14). Marked signal hypointensity was observed in 12 patients with parkinsonism-predominant multiple system atrophy (44.4%). No patients with idiopathic Parkinson disease or healthy controls showed putaminal atrophy or marked signal hypointensity. Quantitatively measured putaminal width, phase-shift values, and the ratio of mean phase-shift values for the dominant and nondominant sides were significantly different between the parkinsonism-predominant multiple system atrophy group and the idiopathic Parkinson disease and healthy control groups (P < .001).
3T SWI can visualize putaminal atrophy and marked signal hypointensity in patients with parkinsonism-predominant multiple system atrophy with high specificity. Furthermore, it clearly demonstrates the dominant side of putaminal changes, which correlate with the contralateral symptomatic side of patients.
帕金森综合征临床特征的不对称表现很常见，但相关的影像学特征尚未明确界定。我们的目的是评估3T磁敏感加权成像（SWI）表现，以鉴别以帕金森综合征为主的多系统萎缩与特发性帕金森病，重点关注壳核变化和病变不对称性。
这项回顾性队列研究纳入了27例临床诊断为以帕金森综合征为主的多系统萎缩患者和50例特发性帕金森病患者。27例年龄匹配、无运动障碍证据且接受了SWI检查的受试者作为对照组。由2名放射科医生达成共识，他们通过视觉评估SWI，观察壳核萎缩情况以及壳核后外侧每一侧是否存在明显信号减低。我们还定量测量了壳核宽度和相位偏移值。
以帕金森综合征为主的多系统萎缩患者的平均病程为4.7年，特发性帕金森病患者为7.8年。在以帕金森综合征为主的多系统萎缩患者中，经常观察到壳核萎缩（14/27，51.9%），最常见于单侧壳核（13/14）。12例以帕金森综合征为主的多系统萎缩患者（44.4%）观察到明显信号减低。特发性帕金森病患者或健康对照组中均未出现壳核萎缩或明显信号减低。以帕金森综合征为主的多系统萎缩组与特发性帕金森病组及健康对照组之间，定量测量的壳核宽度、相位偏移值以及优势侧与非优势侧平均相位偏移值之比存在显著差异（P <.001）。
3T SWI能够以高特异性显示以帕金森综合征为主的多系统萎缩患者的壳核萎缩和明显信号减低。此外，它清楚地显示了壳核变化的优势侧，这与患者对侧的症状侧相关。
