From the Institut du Cerveau et de la Moelle épinière (N.P., B.M., M.M., L.Y.-C., R.V., D.A., M.V., S.L.), Centre de NeuroImagerie de Recherche, Paris, France
UMR S 1127, CNRS UMR 7225 (N.P., B.M., M.M., L.Y.-C., M.V., S.L.), Sorbonne University, Paris, France.
AJNR Am J Neuroradiol. 2018 Aug;39(8):1460-1467. doi: 10.3174/ajnr.A5702. Epub 2018 Jun 28.
Several new MR imaging techniques have shown promising results in patients with Parkinson disease; however, the comparative diagnostic values of these measures at the individual level remain unclear. Our aim was to compare the diagnostic value of MR imaging biomarkers of substantia nigra damage for distinguishing patients with Parkinson disease from healthy volunteers.
Thirty-six patients and 20 healthy volunteers were prospectively included. The MR imaging protocol at 3T included 3D T2-weighted and T1-weighted neuromelanin-sensitive images, diffusion tensor images, and R2* mapping. T2* high-resolution images were also acquired at 7T to evaluate the dorsal nigral hyperintensity sign. Quantitative analysis was performed using ROIs in the substantia nigra drawn manually around the area of high signal intensity on neuromelanin-sensitive images and T2-weighted images. Visual analysis of the substantia nigra neuromelanin-sensitive signal intensity and the dorsolateral nigral hyperintensity on T2* images was performed.
There was a significant decrease in the neuromelanin-sensitive volume and signal intensity in patients with Parkinson disease. There was also a significant decrease in fractional anisotropy and an increase in mean, axial, and radial diffusivity in the neuromelanin-sensitive substantia nigra at 3T and a decrease in substantia nigra volume on T2* images. The combination of substantia nigra volume, signal intensity, and fractional anisotropy in the neuromelanin-sensitive substantia nigra allowed excellent diagnostic accuracy (0.93). Visual assessment of both substantia nigra dorsolateral hyperintensity and neuromelanin-sensitive images had good diagnostic accuracy (0.91 and 0.86, respectively).
The combination of neuromelanin signal and volume changes with fractional anisotropy measurements in the substantia nigra showed excellent diagnostic accuracy. Moreover, the high diagnostic accuracy of visual assessment of substantia nigra changes using dorsolateral hyperintensity analysis or neuromelanin-sensitive signal changes indicates that these techniques are promising for clinical practice.
几项新的磁共振成像技术已显示出在帕金森病患者中具有良好的效果，但这些测量指标在个体水平上的比较诊断价值尚不清楚。我们的目的是比较黑质损害的磁共振成像生物标志物在区分帕金森病患者与健康志愿者方面的诊断价值。
本研究前瞻性纳入了 36 名患者和 20 名健康志愿者。3T 磁共振成像方案包括 3D T2 加权和 T1 加权神经黑色素敏感图像、弥散张量图像和 R2* 映射。还在 7T 上采集 T2高分辨率图像以评估背侧黑质高信号征象。使用手动在神经黑色素敏感图像和 T2 加权图像上的高信号区域周围绘制的黑质 ROI 进行定量分析。对神经黑色素敏感信号强度和 T2图像上背外侧黑质高信号进行视觉分析。
帕金森病患者的神经黑色素敏感体积和信号强度显著降低。3T 时，神经黑色素敏感黑质中的各向异性分数显著降低，平均、轴向和径向弥散度显著增加，T2*图像上黑质体积减少。神经黑色素敏感黑质中黑质体积、信号强度和各向异性分数的组合具有出色的诊断准确性（0.93）。背外侧黑质高信号和神经黑色素敏感图像的视觉评估具有良好的诊断准确性（分别为 0.91 和 0.86）。
黑质神经黑色素信号和体积变化与各向异性分数测量相结合显示出出色的诊断准确性。此外，背外侧高信号分析或神经黑色素敏感信号变化的黑质变化的视觉评估具有很高的诊断准确性，表明这些技术具有良好的临床应用前景。
