Department of Clinical Neuroscience, K8, CMM L8:01, Karolinska University Hospital, 171 76 Stockholm, Sweden; Department of Neurology, R54, Karolinska University Hospital, 141 86 Stockholm, Sweden.
Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Radiology, C1-46, Karolinska University Hospital, 141 86 Stockholm, Sweden.
Parkinsonism Relat Disord. 2017 Nov;44:51-57. doi: 10.1016/j.parkreldis.2017.08.029. Epub 2017 Sep 1.
It is often challenging to clinically distinguish between Parkinson's disease (PD), multiple system atrophy (MSA) and progressive supranuclear palsy (PSP). Quantitative susceptibility mapping (QSM) is an accurate indirect method for estimating brain iron levels in vivo. This method has yet to be applied in atypical parkinsonism. We aimed to investigate differences in brain iron accumulation parkinsonian disorders and healthy controls using QSM.
15 patients with PSP, 11 patients with MSA, 62 patients with PD and 14 healthy controls were included in the study and their phase and magnitude data from susceptibility-weighted magnetic resonance imaging were retrospectively analyzed with an in-house pipeline to create susceptibility maps. Two-way ANCOVA were used to assess group differences. Pairwise comparisons within the ANCOVA were corrected for multiple comparisons.
Red nucleus susceptibility was higher in PSP compared with PD (p < 0.001), MSA (p < 0.001) and controls (p < 0.001), which separated PSP from these groups with areas under receiver operating characteristic curve of 0.97, 0.75 and 0.98 respectively. PSP showed higher globus pallidus susceptibility compared with PD (p < 0.001), MSA (p = 0.006) and controls (p < 0.001). Putamen susceptibility was higher in MSA than in PD (p = 0.022) and controls (p = 0.026). Substantia nigra susceptibility was increased in PD compared to controls (p = 0.030).
We show that all studied parkinsonian disorders have increased susceptibility subcortically, reflecting distinct topographical patterns of abnormal brain iron accumulation. QSM, particularly of the red nucleus, is a promising biomarker in differentiating parkinsonian disorders, and would be interesting to study longitudinally for monitoring disease progression and treatment effects.
临床上常难以区分帕金森病（PD）、多系统萎缩（MSA）和进行性核上性麻痹（PSP）。定量磁化率映射（QSM）是一种准确的间接方法，可用于估计体内脑铁水平。该方法尚未应用于非典型帕金森病。我们旨在使用 QSM 研究帕金森病患者脑铁积累的差异。
本研究纳入 15 例 PSP 患者、11 例 MSA 患者、62 例 PD 患者和 14 例健康对照者，回顾性分析他们的磁共振磁敏感加权成像相位和幅度数据，使用内部流水线创建磁化率图。采用双因素方差分析评估组间差异。ANCOVA 中的两两比较均经多重比较校正。
与 PD、MSA 和对照组相比，PSP 的红核磁化率更高（p<0.001），这将 PSP 与这些组区分开来，其受试者工作特征曲线下面积分别为 0.97、0.75 和 0.98。PSP 的苍白球磁化率高于 PD（p<0.001）、MSA（p=0.006）和对照组（p<0.001）。MSA 的壳核磁化率高于 PD（p=0.022）和对照组（p=0.026）。与对照组相比，PD 的黑质磁化率增加（p=0.030）。
我们表明，所有研究的帕金森病都存在皮质下磁化率升高，反映了异常脑铁积累的不同拓扑模式。QSM，特别是红核 QSM，是一种有前途的生物标志物，可用于区分帕金森病，并且对监测疾病进展和治疗效果具有重要意义。
