Filip Pavel, Vojtíšek Lubomír, Baláž Marek, Mangia Silvia, Michaeli Shalom, Šumec Rastislav, Bareš Martin
Department of Neurology, Charles University, First Faculty of Medicine and General University Hospital, Prague, Czech Republic; First Department of Neurology, Faculty of Medicine, Masaryk University and University Hospital of St. Anne, Brno, Czech Republic; International Clinical Research Center (ICRC), University Hospital of St. Anne, Brno, Czech Republic; Center for Magnetic Resonance Research (CMRR), University of Minnesota, Minneapolis, MN, USA.
Central European Institute of Technology (CEITEC) Masaryk University, Neuroscience Centre, Brno, Czech Republic.
Parkinsonism Relat Disord. 2020 Dec;81:190-193. doi: 10.1016/j.parkreldis.2020.10.048. Epub 2020 Nov 4.
Differential diagnosis of the most common tremor syndromes - essential tremor (ET) and Parkinson's disease (PD) is burdened with high error rate. However, diagnostic MRI biomarkers applicable in this clinically highly relevant scenario remain an unfulfilled objective. The presented study was designed in search for possible candidate MRI protocols relevant for differential diagnostic process in tremor syndromes.10 non-advanced tremor-dominant PD patients meeting diagnostic criteria for clinically established PD, 12 isolated ET patients and 16 healthy controls were enrolled into this study. The study focused on relaxation MRI protocols - T1, T2, adiabatic T1ρ and adiabatic T2ρ due to their relatively low post-processing requirements enabling implementation into routine clinical practice. Compared to ET, PD patients had significantly longer T2 relaxation times in striata with dominant findings in the putamen contralateral to the clinically more affected body side. This difference was driven by alterations in the PD group as confirmed in the complementary comparison with healthy controls. According to the receiver operating characteristic analysis, this region provided a reasonable sensitivity of 0.91 and specificity of 0.89 in the differential diagnosis of PD and ET. In PD patients, we further found prolonged T1ρ in the substantia nigra compared to ET and healthy controls, and shorter T2 and T2ρ in the cerebellum compared to healthy controls. T2 relaxation time in the putamen contralateral to the clinically more affected body side is a plausible candidate diagnostic marker for the differentiation of PD and ET.
最常见震颤综合征——特发性震颤（ET）和帕金森病（PD）的鉴别诊断存在较高的误诊率。然而，适用于这种临床高度相关情况的诊断性MRI生物标志物仍是一个未实现的目标。本研究旨在寻找与震颤综合征鉴别诊断过程相关的可能的候选MRI方案。10例符合临床确诊PD诊断标准的非晚期以震颤为主的PD患者、12例孤立性ET患者和16例健康对照者纳入本研究。该研究聚焦于弛豫MRI方案——T1、T2、绝热T1ρ和绝热T2ρ，因为它们的后处理要求相对较低，能够应用于常规临床实践。与ET相比，PD患者纹状体的T2弛豫时间显著延长，在临床受累更严重身体侧对侧的壳核中表现更为明显。与健康对照的补充比较证实，这种差异是由PD组的改变驱动的。根据受试者工作特征分析，该区域在PD和ET的鉴别诊断中提供了合理的灵敏度0.91和特异度0.89。在PD患者中，我们进一步发现与ET和健康对照相比，黑质的T1ρ延长，与健康对照相比，小脑的T2和T2ρ缩短。临床受累更严重身体侧对侧壳核的T2弛豫时间是鉴别PD和ET的一个合理的候选诊断标志物。
