Grossauer Anna, Müller Christoph, Hussl Anna, Krismer Florian, Schocke Michael, Gizewski Elke, Mahlknecht Philipp, Scherfler Christoph, Wenning Gregor K, Poewe Werner, Seppi Klaus, Heim Beatrice
Department of Neurology Medical University of Innsbruck Innsbruck Austria.
Department of Radiology Medical University of Innsbruck Innsbruck Austria.
Mov Disord Clin Pract. 2023 Apr 14;10(6):914-921. doi: 10.1002/mdc3.13736. eCollection 2023 Jun.
An absent dorsolateral nigral hyperintensity (DNH) is a common finding in patients with neurodegenerative parkinsonism at high or ultra-high field susceptibility-weighted magnetic resonance imaging (SWI).
Despite increasing use of high field magnetic resonance imaging (MRI) in specialized centers, these scanners are still frequently unavailable in primary care or outpatient facilities and underdeveloped or emerging countries. Therefore, the aim of the present study was to evaluate the diagnostic utility of DNH assessment at 1.5 versus 3 T MRI to distinguish patients with neurodegenerative parkinsonism, including Parkinson's disease (PD), multiple system atrophy (MSA) and progressive supranuclear palsy (PSP), from healthy controls (HC).
Absence of DNH was assessed on visual inspection of anonymized 1.5 T and 3.0 T SWI scans in a case-control study including 86 patients with neurodegenerative parkinsonism and 33 healthy controls (HC). All study participants were consecutively recruited to undergo 1.5 and 3 T MRI.
Overall correct classification was 81.7% (95% CI, 72.6-88.4%) for 1.5 T and 95.7% (95% CI, 89.1-98.7%) for 3 T MRI in discriminating neurodegenerative parkinsonism from controls. However, while DNH was bilaterally present in all but one of the HC at 3 T MRI, it was rated as abnormal (at least unilateral absence) in 15 of 22 HC at 1.5 T MRI, resulting in a specificity of 31.8%.
The results of the present study demonstrate an insufficient specificity of visual assessment of DNH at 1.5 T MRI for the diagnosis of neurodegenerative parkinsonism.
在神经退行性帕金森综合征患者的高场或超高场 susceptibility-weighted 磁共振成像（SWI）中，背外侧黑质高信号缺失（DNH）是常见表现。
尽管高场磁共振成像（MRI）在专科中心的使用日益增加，但在基层医疗、门诊设施以及不发达或新兴国家，这些扫描仪仍常常无法使用。因此，本研究的目的是评估 1.5T 与 3T MRI 下 DNH 评估在区分神经退行性帕金森综合征患者（包括帕金森病（PD）、多系统萎缩（MSA）和进行性核上性麻痹（PSP））与健康对照（HC）方面的诊断效用。
在一项病例对照研究中，对 86 例神经退行性帕金森综合征患者和 33 例健康对照（HC）的匿名 1.5T 和 3.0T SWI 扫描图像进行视觉检查，评估 DNH 是否缺失。所有研究参与者均连续接受 1.5T 和 3T MRI 检查。
在区分神经退行性帕金森综合征与对照方面，1.5T MRI 的总体正确分类率为 81.7%（95%CI，72.6 - 88.4%），3T MRI 为 95.7%（95%CI，89.1 - 98.7%）。然而，在 3T MRI 时，除 1 例健康对照外，其余所有健康对照双侧均存在 DNH，而在 1.5T MRI 时，22 例健康对照中有 15 例被评定为异常（至少单侧缺失），导致特异性为 31.8%。
本研究结果表明，1.5T MRI 下对 DNH 进行视觉评估用于神经退行性帕金森综合征诊断时特异性不足。
