From the Departments of Neurology (Y.H.S., Y.N.) and Radiology (E.Y.K.), Gachon University Gil Medical Center, 21 Namdong-daero 774 beon-gil, Namdong-gu, Incheon 21565, South Korea; and Department of Electrical and Computer Engineering, Seoul National University, Seoul, South Korea (J.L.).
Radiology. 2016 Jun;279(3):849-58. doi: 10.1148/radiol.2015151466. Epub 2015 Dec 21.
Purpose To explore the utility of nigrosome 1 with 3-T magnetic resonance (MR) imaging to differentiate idiopathic Parkinson disease (IPD) from drug-induced parkinsonism (DIP). Materials and Methods The institutional review board approved this study, and participants gave informed consent. This study enrolled patients with DIP (n = 20) and IPD (n = 29) who underwent N-3-fluoropropyl-2-β-carbomethoxy-3-β-(4-iodophenyl)nortropane ((18)F-FP-CIT) positron emission tomography (PET) and healthy participants (n = 20). All participants underwent 0.5 × 0.5 × 1.0 mm(3) oblique axial three-dimensional multiecho-data image combination imaging to view the nigrosome 1 with 3-T imaging. Two reviewers independently assessed the nigrosome 1 without clinical information. DIP was diagnosed when no abnormality was seen at (18)F-FP-CIT PET. Diagnostic sensitivity, specificity, and accuracy of the nigrosome 1 imaging were evaluated between the IPD and DIP patients and between the IPD patients and healthy participants. Interrater agreement was assessed with Cohen κ. Results Both reviewers agreed in 63 of 69 participants (91.3%) for the presence of any abnormality on either side of the nigrosome 1 (κ = 0.825). Findings in all 29 IPD patients (100%) and three of 20 DIP patients (15%) were rated as abnormal and in 17 of 20 DIP patients (85%) they were interpreted as normal on the basis of imaging of the nitgrosome 1 (sensitivity, 100% (29 of 29); specificity, 85.0% (17 of 20); accuracy, 93.9% (46 of 49) between IPD and DIP patients). Findings in 3 of 20 healthy participants (15.0%) were interpreted as abnormal on the basis of imaging the nigrosome 1 while in the other 17 of 20 healthy participants (85.0%) they were rated as normal (sensitivity, 100% [29 of 29]; specificity, 85.0% [17 of 20]; accuracy, 93.9% [46 of 49] between IPD patients and healthy participants [κ = 0.831]). Conclusion The imaging of nigrosome 1 with 3-T imaging can differentiate DIP from IPD with high accuracy and may help to screen patients who need dopamine transporter imaging in those suspected of having DIP. (©) RSNA, 2015 Online supplemental material is available for this article.
目的 探讨磁共振成像（MRI）黑质 1 区分特发性帕金森病（IPD）与药物诱导帕金森病（DIP）的应用价值。
材料与方法 本研究经机构审查委员会批准，所有参与者均签署书面知情同意书。本研究纳入 20 例 DIP 患者、29 例 IPD 患者和 20 例健康志愿者，所有患者均接受 N-3-氟丙基-2-β-羧甲基-3-β-（4-碘苯基）-n-降莰烷（（18）F-FP-CIT）正电子发射断层扫描（PET）和 3T 黑质 1 成像检查。所有参与者均接受 0.5×0.5×1.0mm（3）斜轴三维多回波数据图像组合成像，以观察黑质 1 成像。两名观察者独立进行黑质 1 评估，且不参考临床信息。当（18）F-FP-CIT PET 未见异常时，诊断为 DIP。比较 IPD 患者与 DIP 患者、IPD 患者与健康志愿者之间黑质 1 成像的诊断敏感度、特异度和准确度，并采用 Cohen κ 评估观察者间一致性。
结果 对于黑质 1 两侧任何部位存在异常（63/69，91.3%），两名观察者的意见完全一致（κ=0.825）。29 例 IPD 患者（100%）和 20 例 DIP 患者中的 3 例（15%）的结果均被判断为异常，17 例 DIP 患者（85%）的黑质 1 成像结果正常（敏感度，100%[29/29]；特异度，85.0%[17/20]；准确度，93.9%[46/49]）。20 例健康志愿者中，3 例（15.0%）的黑质 1 成像结果异常，而另外 17 例（85.0%）的结果正常（敏感度，100%[29/29]；特异度，85.0%[17/20]；准确度，93.9%[46/49]）。
结论 3T 黑质 1 成像可准确区分 DIP 与 IPD，有助于对疑似 DIP 患者进行多巴胺转运体成像筛查。
