Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.
Vita-Salute San Raffaele University, Milan, Italy.
J Neurol. 2021 Sep;268(9):3144-3179. doi: 10.1007/s00415-020-09863-8. Epub 2020 May 6.
The current review summarizes the current knowledge on longitudinal cortical and subcortical grey and white matter MRI findings assessed using T1-weighted and one-tensor diffusion-weighted MRI in Parkinson's disease (PD) patients. Results were reviewed according to disease duration, disease severity and cognitive impairment. The most consistent findings are those showing a progressive cortical atrophy accumulation in caudate, putamen, temporal/hippocampal, frontal and parietal areas in de novo PD cases and in the early/middle phase of the disease, with the achievement of a plateau in the later stage. Analyzing results according to the patient cognitive status, only a few studies used longitudinal MRI metrics to predict mild cognitive impairment or dementia conversion in PD patients, suggesting that atrophy of the hippocampus, fronto-temporal areas, caudate, thalamus and accumbens might play a role in this process. Stratifying patients according to disease severity, findings appear partially controversial, although showing a progressive atrophy of basal ganglia over 1 year of follow up and a widespread cortical thinning over 3-6 years in mild to moderate PD patients. Finally, microstructural damage of the main motor and associative WM tracts seems to be present, and rapidly progress, even in the early phase of PD. The utility of structural MRI metrics as biomarkers of PD progression and their role in improving the accuracy of disease progression prediction is still debated.
目前的综述总结了目前关于帕金森病（PD）患者使用 T1 加权和单张量弥散加权 MRI 评估的纵向皮质和皮质下灰质和白质 MRI 研究结果。结果根据疾病持续时间、疾病严重程度和认知障碍进行了回顾。最一致的发现是在新诊断的 PD 病例和疾病的早期/中期，纹状体、壳核、颞叶/海马、额叶和顶叶区域出现进行性皮质萎缩积累，在后期达到平台期。根据患者的认知状态分析结果，只有少数研究使用纵向 MRI 指标来预测 PD 患者的轻度认知障碍或痴呆转化，表明海马、额颞叶区域、纹状体、丘脑和伏隔核的萎缩可能在这个过程中起作用。根据疾病严重程度对患者进行分层，结果似乎存在部分争议，尽管在轻度至中度 PD 患者中，在 1 年的随访中发现基底节进行性萎缩，在 3 至 6 年内发现广泛的皮质变薄。最后，主要运动和联合 WM 束的微观结构损伤似乎存在，并在 PD 的早期阶段迅速进展。结构 MRI 指标作为 PD 进展的生物标志物的效用及其在提高疾病进展预测准确性中的作用仍存在争议。
