帕金森病及帕金森综合征患者脑血流减少的特征性表现：一项 ASL-MRI 研究。
Discriminative pattern of reduced cerebral blood flow in Parkinson's disease and Parkinsonism-Plus syndrome: an ASL-MRI study.
机构信息
Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, China.
Department of Radiology, Guangdong 999 Brain Hospital, Guangzhou, 510510, China.
出版信息
BMC Med Imaging. 2020 Jul 13;20(1):78. doi: 10.1186/s12880-020-00479-y.
BACKGROUND
Accurate identification of Parkinson's disease (PD) and Parkinsonism-Plus syndrome (PPS), especially in the early stage of the disease, is very important. The purpose of this study was to investigate the discriminative spatial pattern of cerebral blood flow (CBF) between patients with PD and PPS.
METHODS
Arterial spin labeling (ASL) perfusion-weighted imaging was performed in 20 patients with PD (mean age 56.35 ± 7.56 years), 16 patients with PPS (mean age 59.62 ± 6.89 years), and 17 healthy controls (HCs, mean age 54.17 ± 6.58 years). Voxel-wise comparison of the CBF was performed among PD, PPS, and HC groups. The receiver operating characteristic (ROC) curve was used to evaluate the performance of CBF in discriminating between PD and PPS. The relationship between CBF and non-motor neuropsychological scores was assessed by correlation analysis.
RESULTS
PD group showed a significantly decreased CBF in the right cerebelum_crus2, the left middle frontal gyrus (MFG), the triangle inferior frontal gyrus (IFG_Tri), the left frontal medial orbital gyrus (FG_Med_Orb) and the left caudate nucleus (CN) compared with the HC group (P < 0.05). Besides the above regions, the left supplementary motor area (SMA), the right thalamus had decreased CBF in the PPS group compared with the HC group (P < 0.05). PPS group had lower CBF value in the left MFG, the left IFG_Tri, the left CN, the left SMA, and the right thalamus compared with the PD group (P < 0.05). CBFs in left IFG_Tri, the left CN, the left SMA, and the right thalamus had moderate to high capacity in discriminating between PD and PPS patients (AUC 0.719-0.831). The CBF was positively correlated with the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores in PD patients, while positively correlated with the MMSE, Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD) scores in PPS patients (P < 0.05).
CONCLUSION
PD and PPS patients have certain discriminative patterns of reduced CBFs, which can be used as a surrogate marker for differential diagnosis.
背景
准确识别帕金森病（PD）和帕金森综合征（PPS），尤其是在疾病早期，非常重要。本研究旨在探讨 PD 和 PPS 患者大脑血流（CBF）的有区别的空间模式。
方法
对 20 例 PD 患者（平均年龄 56.35±7.56 岁）、16 例 PPS 患者（平均年龄 59.62±6.89 岁）和 17 名健康对照者（HCs，平均年龄 54.17±6.58 岁）进行动脉自旋标记（ASL）灌注加权成像。在 PD、PPS 和 HCs 组之间进行 CBF 的体素-wise 比较。采用受试者工作特征（ROC）曲线评价 CBF 鉴别 PD 和 PPS 的性能。采用相关性分析评估 CBF 与非运动性神经心理学评分的关系。
结果
PD 组与 HCs 组相比，右侧小脑 crus2、左侧额中回（MFG）、三角额下回（IFG_Tri）、左侧额眶内侧回（FG_Med_Orb）和左侧尾状核（CN）的 CBF 明显降低（P<0.05）。除上述区域外，PPS 组与 HCs 组相比，左侧辅助运动区（SMA）和右侧丘脑的 CBF 也降低（P<0.05）。与 PD 组相比，PPS 组左侧 MFG、左侧 IFG_Tri、左侧 CN、左侧 SMA 和右侧丘脑的 CBF 值较低（P<0.05）。左侧 IFG_Tri、左侧 CN、左侧 SMA 和右侧丘脑的 CBF 对鉴别 PD 和 PPS 患者具有中高度能力（AUC 0.719-0.831）。PD 患者的 CBF 与简易精神状态检查（MMSE）和蒙特利尔认知评估（MoCA）评分呈正相关，而 PPS 患者的 CBF 与 MMSE、汉密尔顿焦虑量表（HAMA）和汉密尔顿抑郁量表（HAMD）评分呈正相关（P<0.05）。
结论
PD 和 PPS 患者存在一定的 CBF 降低的有区别模式，可作为鉴别诊断的替代标志物。
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