Ito Kenji, Ohtsuka Chigumi, Yoshioka Kunihiro, Kameda Hiroyuki, Yokosawa Suguru, Sato Ryota, Terayama Yasuo, Sasaki Makoto
Division of Ultrahigh Field MRI, Institute for Biomedical Sciences, Iwate Medical University, 2-1-1 Nishitokuta, Yahaba, Iwate, 028-3694, Japan.
Department of Neurology and Gerontology, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, Japan.
Neuroradiology. 2017 Aug;59(8):759-769. doi: 10.1007/s00234-017-1870-7. Epub 2017 Jul 8.
We investigated whether diffusion kurtosis imaging (DKI) and quantitative susceptibility mapping (QSM) could detect pathological changes that occur in Parkinson's disease (PD), multiple system atrophy with predominant parkinsonism (MSA-P) or predominant cerebellar ataxia (MSA-C), and progressive supranuclear palsy syndrome (PSPS) and thus be used for differential diagnosis that is often difficult.
Seventy patients (41 with PD, 6 with MSA-P, 7 with MSA-C, 16 with PSPS) and 20 healthy controls were examined using a 3.0 T MRI scanner. From DKI and QSM data, we automatically obtained mean kurtosis (MK), fractional anisotropy (FA), and mean diffusivity (MD) values of the midbrain tegmentum (MBT), pontine crossing tract (PCT), and superior/middle cerebellar peduncles (CPs), which were used to calculate diffusion MBT/PCT ratios (dMPRs) and diffusion superior/middle CP ratios (dCPRs), as well as MS (magnetic susceptibility) values of the anterior/posterior putamen (PUa and PUp) and globus pallidus (GP).
dMPRs of MK were significantly decreased in PSPS and increased in MSA-C compared with the other groups, while dCPRs of MK showed significant differences only between MSA-C and PD, PSPS, or control. MS values were significantly increased in the PUp of MSA-P and in the PUa and GP of PSPS compared with those in PD. The combined use of MK-dMPR and MS-PUp showed sensitivities of 83-100% and specificities of 81-100% for discriminating among the disease groups, respectively.
A quantitative assessment using DKI and QSM analyses, particularly MK-dMPR and MS-PUp values, can readily identify patients with parkinsonism.
我们研究了扩散峰度成像（DKI）和定量磁化率图谱（QSM）是否能够检测帕金森病（PD）、以帕金森综合征为主的多系统萎缩（MSA-P）或以小脑性共济失调为主的多系统萎缩（MSA-C）以及进行性核上性麻痹综合征（PSPS）中发生的病理变化，从而用于通常较为困难的鉴别诊断。
使用3.0 T磁共振成像扫描仪对70例患者（41例PD患者、6例MSA-P患者、7例MSA-C患者、16例PSPS患者）和20名健康对照者进行检查。从DKI和QSM数据中，我们自动获取中脑被盖（MBT）、脑桥交叉束（PCT）以及上/中脑小脑脚（CPs）的平均峰度（MK）、分数各向异性（FA）和平均扩散率（MD）值，这些值用于计算扩散MBT/PCT比值（dMPRs）和扩散上/中CP比值（dCPRs），以及壳核前后部（PUa和PUp）和苍白球（GP）的磁化率（MS）值。
与其他组相比，PSPS组中MK的dMPRs显著降低，MSA-C组中则升高，而MK的dCPRs仅在MSA-C与PD、PSPS或对照组之间存在显著差异。与PD组相比，MSA-P组的PUp以及PSPS组的PUa和GP的MS值显著升高。联合使用MK-dMPR和MS-PUp在区分疾病组时的敏感性分别为83 - 100%，特异性分别为81 - 100%。
使用DKI和QSM分析进行定量评估，尤其是MK-dMPR和MS-PUp值，能够轻松识别帕金森综合征患者。
