Department of Neurology, Alpert Medical School of Brown University, Providence, RI, USA; Rhode Island Hospital, Providence, RI, USA.
Rhode Island Hospital, Providence, RI, USA; Department of Diagnostic Imaging, Alpert Medical School of Brown University, Providence, RI, USA.
J Neurol Sci. 2021 Sep 15;428:117581. doi: 10.1016/j.jns.2021.117581. Epub 2021 Jul 14.
Swallow tail sign (STS), which represents nigrosome-1 in the substantia nigra on 3 Tesla (T) susceptibility-weighted imaging (SWI), has attracted attention as a promising magnetic resonance imaging (MRI) biomarker for idiopathic Parkinson's disease (iPD). Some reports have shown high sensitivity and specificity-both above 94%-for distinguishing iPD from healthy controls. However, abnormal STS has been observed in many neurodegenerative parkinsonisms and even in multiple sclerosis.
All patients with parkinsonism who had 3 T MRI were included in a retrospective chart review from a single movement disorders clinic. All subjects were evaluated by a single movement disorder specialist, using Movement Disorders Society diagnostic criteria and American Academy of Neurology consensus guidelines for diagnoses. All MRIs were interpreted by a single neuroradiologist who was blinded to the diagnosis.
Twenty patients were included in the study. Twelve had abnormal STS: iPD (n = 2), probable multiple system atrophy (n = 3), vascular parkinsonism (n = 1), psychogenic gait disorder (n = 1), neuroleptic parkinsonism (n = 2), cervical dystonia (n = 1), static encephalopathy (n = 1) and gait disorder of unknown etiology (n = 1). Eight had normal STS: iPD (n = 1), probable progressive supranuclear palsy (n = 1), vascular parkinsonism (n = 2), transient parkinsonism of unknown etiology (n = 2), valproic acid induced parkinsonism (n = 1), and essential tremor with parkinsonism (n = 1). I-Ioflupane SPECT dopamine transporter (DaT) scan results were available on seven subjects; four subjects had incongruency between DaT and MRI.
Our results suggest that the abnormal STS is not, in isolation, a reliable biomarker of idiopathic Parkinson's disease.
在 3 特斯拉（T）磁化率加权成像（SWI）上，燕尾征（STS）代表黑质中的 nigrosome-1，作为特发性帕金森病（iPD）的有前途的磁共振成像（MRI）生物标志物引起了关注。一些报告显示，其在区分 iPD 与健康对照方面具有很高的敏感性和特异性-均高于 94%-。然而，异常的 STS 已在许多神经退行性帕金森病中观察到，甚至在多发性硬化症中也观察到。
从单一运动障碍诊所的回顾性图表审查中纳入了所有患有帕金森病的 3T MRI 患者。所有患者均由一位运动障碍专家根据运动障碍协会的诊断标准和美国神经病学学会的共识指南进行评估。所有 MRI 均由一位对诊断结果不知情的单一神经放射科医生进行解释。
研究纳入了 20 名患者。12 名患者的 STS 异常：iPD（n=2），可能的多系统萎缩（n=3），血管性帕金森病（n=1），心因性步态障碍（n=1），神经安定性帕金森病（n=2），颈肌张力障碍（n=1），静止性脑病（n=1）和病因不明的步态障碍（n=1）。8 名患者的 STS 正常：iPD（n=1），可能的进行性核上性麻痹（n=1），血管性帕金森病（n=2），原因不明的短暂性帕金森病（n=2），丙戊酸诱导的帕金森病（n=1），和特发性震颤伴帕金森病（n=1）。有 7 名患者可获得 I-Ioflupane SPECT 多巴胺转运蛋白（DaT）扫描结果；4 名患者的 DaT 与 MRI 结果不一致。
我们的结果表明，异常的 STS 孤立存在时，不是特发性帕金森病的可靠生物标志物。
