Department of Radiology, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka, 807-8555, Japan.
Department of Pathology, Brain Research Institute, Niigata University, Niigata, Japan.
Neuroradiology. 2019 Nov;61(11):1251-1259. doi: 10.1007/s00234-019-02253-6. Epub 2019 Jul 2.
The typical MRI findings in corticobasal degeneration (CBD), which have been described in previous reports, may be non-specific. We evaluated cerebral gyri (CG) using quantitative susceptibility mapping (QSM) images of patients with CBD, progressive supranuclear palsy (PSP), and Parkinson's disease (PD) to determine the possibility of discriminating them on an individual basis.
After reviewing the normal appearances on QSM on 16 healthy subjects, two radiologists assessed abnormal findings from 12 CBD, 14 PSP, and 30 PD patients. For conventional MRI, two radiologists independently reviewed typical CBD findings that have been previously reported. We also investigated three autopsy cases including one each of CBD, PSP, and PD to reveal the histopathological basis of MRI findings.
CBD-specific findings included three layers; a higher susceptibility layer in superficial GM, a lower susceptibility layer, and a higher susceptibility layer in corticomedullary junction, with frequencies of 83% (10/12) in CBD, 21% (3/14) in PSP, and 0% (0/30) in PD patients. The typical CBD findings on conventional MRI were observed in only 42% (5/12) of CBD patients. Ferritin-positive microglia accumulated in the superficial gray matter (third cortical layer) and corticomedullary junction in CBD patients.
The CG findings on QSM images may be more useful than those on conventional MRI for discriminating CBD from PD on an individual basis. Based on postmortem pathological data, cortical QSM hyperintensity might be an expression of ferritin-positive microglia.
皮质基底节变性（CBD）的典型 MRI 表现以前已有报道，可能不具有特异性。我们通过对 CBD、进行性核上性麻痹（PSP）和帕金森病（PD）患者的定量磁化率（QSM）图像进行脑回（CG）评估，来确定在个体基础上对其进行区分的可能性。
在对 16 名健康受试者的 QSM 正常表现进行回顾后，两名放射科医生对 12 名 CBD、14 名 PSP 和 30 名 PD 患者的异常表现进行了评估。对于常规 MRI，两名放射科医生独立评估了以前报道的 CBD 的典型表现。我们还研究了三个尸检病例，包括一个 CBD、一个 PSP 和一个 PD，以揭示 MRI 表现的组织病理学基础。
CBD 特异性表现包括三层；在浅层 GM 中存在更高的磁化率层，在皮质-髓质交界处存在更低的磁化率层和更高的磁化率层，在 CBD 患者中出现频率为 83%（10/12），在 PSP 患者中为 21%（3/14），在 PD 患者中为 0%（0/30）。在 CBD 患者中，仅在 42%（5/12）的 CBD 患者中观察到典型的 CBD 常规 MRI 表现。在 CBD 患者中，铁蛋白阳性小胶质细胞在浅层灰质（第三皮质层）和皮质-髓质交界处聚集。
与常规 MRI 相比，QSM 图像上的 CG 表现可能更有助于 CBD 与 PD 在个体基础上的区分。基于尸检病理数据，皮质 QSM 高信号可能是铁蛋白阳性小胶质细胞的一种表达。
