Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
NeuroImaging Network (NIN), Universal Scientific Education and Research Network (USERN), Tehran, Iran.
Cerebellum. 2022 Aug;21(4):545-571. doi: 10.1007/s12311-021-01355-3. Epub 2022 Jan 10.
Diffusion tensor imaging (DTI) is now having a strong momentum in research to evaluate the neural fibers of the CNS. This technique can study white matter (WM) microstructure in neurodegenerative disorders, including Parkinson's disease (PD). Previous neuroimaging studies have suggested cerebellar involvement in the pathogenesis of PD, and these cerebellum alterations can correlate with PD symptoms and stages. Using the PRISMA 2020 framework, PubMed and EMBASE were searched to retrieve relevant articles. Our search revealed 472 articles. After screening titles and abstracts, and full-text review, and implementing the inclusion criteria, 68 papers were selected for synthesis. Reviewing the selected studies revealed that the patterns of reduction in cerebellum WM integrity, assessed by fractional anisotropy, mean diffusivity, radial diffusivity, and axial diffusivity measures can differ symptoms and stages of PD. Cerebellar diffusion tensor imaging (DTI) changes in PD patients with "postural instability and gait difficulty" are significantly different from "tremor dominant" PD patients. Freezing of the gate is strongly related to cerebellar involvement depicted by DTI. The "reduced cognition," "visual disturbances," "sleep disorders," "depression," and "olfactory dysfunction" are not related to cerebellum microstructural changes on DTI, while "impulsive-compulsive behavior" can be linked to cerebellar WM alteration. Finally, higher PD stages and longer disease duration are associated with cerebellum white matter alteration depicted by DTI. Depiction of cerebellar white matter involvement in PD is feasible by DTI. There is an association with disease duration and severity and several clinical presentations with DTI findings. This clinical-imaging association may eventually improve disease management.
弥散张量成像(DTI)在评估中枢神经系统神经纤维方面的研究中势头强劲。该技术可研究神经退行性疾病(包括帕金森病(PD))中的白质(WM)微观结构。先前的神经影像学研究表明小脑参与了 PD 的发病机制,这些小脑改变可以与 PD 症状和阶段相关。使用 PRISMA 2020 框架,在 PubMed 和 EMBASE 上搜索相关文章。我们的搜索共发现 472 篇文章。经过筛选标题和摘要、全文审查,并实施纳入标准后,有 68 篇文章被选入进行综合分析。对选定研究的回顾表明,通过各向异性分数、平均弥散系数、径向弥散系数和轴向弥散系数评估的小脑 WM 完整性降低的模式可能因 PD 的症状和阶段而异。患有“姿势不稳和步态困难”的 PD 患者的小脑弥散张量成像(DTI)变化与“震颤主导”的 PD 患者明显不同。冻结步态与 DTI 显示的小脑受累有很强的关系。“认知障碍”、“视觉障碍”、“睡眠障碍”、“抑郁”和“嗅觉功能障碍”与 DTI 小脑微观结构变化无关,而“冲动强迫行为”可能与小脑 WM 改变有关。最后,更高的 PD 阶段和更长的疾病持续时间与 DTI 所示的小脑白质改变相关。DTI 可对 PD 小脑白质受累进行描述。与疾病持续时间和严重程度以及 DTI 发现的几种临床表现存在关联。这种临床影像学关联可能最终会改善疾病的管理。
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