Chung Seok Jong, Cho Kyoo Ho, Lee Yang Hyun, Yoo Han Soo, Baik KyoungWon, Jung Jin Ho, Ye Byoung Seok, Sohn Young H, Cha Jungho, Lee Phil Hyu
Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.
Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea.
J Neurosci Res. 2021 Nov;99(11):2922-2931. doi: 10.1002/jnr.24926. Epub 2021 Sep 14.
The pons is one of the earliest affected regions in patients with synucleinopathies. We aimed to investigate the diagnostic value of measuring pontine damage using diffusion tensor imaging (DTI) in these patients. We enrolled 49 patients with Parkinson's disease (PD), 16 patients with idiopathic rapid eye movement sleep behavior disorder (iRBD), 23 patients with multiple system atrophy (MSA), and 39 healthy controls in this study. All the participants underwent high-resolution T1-weighted imaging and DTI. Mean diffusivity (MD) and fraction anisotropy (FA) values in the pons were calculated to characterize structural damage. The discriminatory power of pontine MD and FA values to differentiate patients with synucleinopathies from healthy controls was examined using receiver operating characteristics (ROC) analyses. Compared to healthy controls, patients with PD, iRBD, and MSA had increased MD values and decreased FA values in the pons, although no correlation was observed between these DTI measures and disease severity. The ROC analyses showed that MD values in the pons had a fair discriminatory power to differentiate healthy controls from patients with PD (area under the curve [AUC], 0.813), iRBD (AUC, 0.779), and MSA (AUC, 0.951). The AUC for pontine FA values was smaller than that for pontine MD values when differentiating healthy controls from patients with PD (AUC, 0.713; p = 0.054) and iRBD (AUC, 0.686; p = 0.045). Our results suggest that MD values in the pons may be a useful marker of brain stem neurodegeneration in patients with synucleinopathies.
脑桥是突触核蛋白病患者最早受影响的区域之一。我们旨在研究使用扩散张量成像（DTI）测量脑桥损伤在这些患者中的诊断价值。本研究纳入了49例帕金森病（PD）患者、16例特发性快速眼动睡眠行为障碍（iRBD）患者、23例多系统萎缩（MSA）患者和39名健康对照者。所有参与者均接受了高分辨率T1加权成像和DTI检查。计算脑桥中的平均扩散率（MD）和各向异性分数（FA）值以表征结构损伤。使用受试者工作特征（ROC）分析检查脑桥MD和FA值区分突触核蛋白病患者与健康对照者的鉴别能力。与健康对照者相比，PD、iRBD和MSA患者脑桥中的MD值升高，FA值降低，尽管这些DTI测量值与疾病严重程度之间未观察到相关性。ROC分析表明，脑桥中的MD值在区分健康对照者与PD患者（曲线下面积[AUC]，0.813）、iRBD患者（AUC，0.779）和MSA患者（AUC，0.951）方面具有较好的鉴别能力。在区分健康对照者与PD患者（AUC，0.713；p = 0.054）和iRBD患者（AUC，0.686；p = 0.045）时，脑桥FA值的AUC小于脑桥MD值的AUC。我们的结果表明，脑桥中的MD值可能是突触核蛋白病患者脑干神经变性的有用标志物。
