From the Departments of Radiology (Y.J.B., E.K.), Neurology (J.M.K., K.J.K., J.Y.L., B.J.), Nuclear Medicine (H.S.P., S.Y.K., S.E.K.), and Psychiatry (I.Y.Y.), Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, South Korea; Department of Radiology, National Medical Center, Seoul, South Korea (E.K.); and Department of Transdisciplinary Studies, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea (H.S.P., S.E.K.).
Radiology. 2018 Apr;287(1):285-293. doi: 10.1148/radiol.2017162486. Epub 2017 Dec 12.
Purpose To examine whether the loss of nigral hyperintensity (NH) on 3.0-T susceptibility-weighted (SW) magnetic resonance (MR) images can help identify high synucleinopathy risk in patients with idiopathic rapid eye movement sleep behavior disorder (iRBD). Materials and Methods Between March 2014 and April 2015, 18 consecutively recruited patients with iRBD were evaluated with 3.0-T SW imaging and iodine 123-2β-carbomethoxy-3β-(4-iodophenyl)-N-(3-fluoropropyl)-nortropane (I-FP-CIT) single photon emission computed tomography and compared with 18 healthy subjects and 18 patients with Parkinson disease (PD). Two readers blinded to clinical diagnosis independently assessed the images. I-FP-CIT uptake ratios were compared by using the Kruskal-Wallis test, and intra- and interobserver agreements were assessed with the Cohen κ. The synucleinopathy conversion according to NH status was evaluated in patients with iRBD after follow-up. Results NH was intact in seven patients with iRBD and lost in 11. The I-FP-CIT uptake ratios were comparable between those with intact NH (mean, 3.22 ± 0.47) and healthy subjects (mean, 3.37 ± 0.47) (P = .495). The I-FP-CIT uptake ratios in the 11 patients with iRBD and NH loss (mean, 2.48 ± 0.44) were significantly lower than those in healthy subjects (mean, 3.37 ± 0.47; P < .001) but higher than those in patients with PD (mean, 1.80 ± 0.33; P < .001). The intra- and interobserver agreements were excellent (κ > 0.9). Five patients with iRBD and NH loss developed symptoms of parkinsonism or dementia 18 months after neuroimaging. Conclusion NH loss at 3.0-T SW imaging may be a promising marker for short-term synucleinopathy risk in iRBD. RSNA, 2017 Online supplemental material is available for this article.
目的 探讨 3.0-T 磁敏感加权（SW）磁共振（MR）图像上黑质高信号（NH）的缺失是否有助于识别特发性快速眼动睡眠行为障碍（iRBD）患者的高突触核蛋白病风险。
材料与方法 本研究于 2014 年 3 月至 2015 年 4 月连续纳入 18 例 iRBD 患者，对其进行 3.0-T SW 成像和碘 123-2β- 碳甲氧基-3β-（4-碘苯基）-N-（3-氟丙基）-去甲托烷（I-FP-CIT）单光子发射计算机断层扫描，并与 18 例健康对照者和 18 例帕金森病（PD）患者进行比较。两名对临床诊断不知情的读者独立评估图像。采用 Kruskal-Wallis 检验比较 I-FP-CIT 摄取比值，采用 Cohen κ 评估观察者内和观察者间的一致性。对 iRBD 患者的随访结果根据 NH 状态评估突触核蛋白病的转化。
结果 在 18 例 iRBD 患者中，7 例患者的 NH 完整，11 例患者的 NH 缺失。NH 完整的 iRBD 患者（平均，3.22±0.47）与健康对照者（平均，3.37±0.47）的 I-FP-CIT 摄取比值相当（P=0.495）。11 例 iRBD 患者 NH 缺失（平均，2.48±0.44）的 I-FP-CIT 摄取比值明显低于健康对照者（平均，3.37±0.47；P＜0.001），但高于 PD 患者（平均，1.80±0.33；P＜0.001）。观察者内和观察者间的一致性均极好（κ＞0.9）。神经影像学检查后 18 个月，5 例 iRBD 患者 NH 缺失发展为帕金森病或痴呆症状。
结论 3.0-T SW 成像上的 NH 缺失可能是 iRBD 短期突触核蛋白病风险的一个有前途的标志物。
RSNA，2017 在线补充材料可从本文获得。
