Department of Neurology, Cardiovascular and Cerebrovascular Disease Hospital, General Hospital of Ningxia Medical University; School of Clinical Medicine, Ningxia Medical University, Yinchuan, China.
Department of Neural Electrophysiology, Cardiovascular and Cerebrovascular Disease Hospital, General Hospital of Ningxia Medical University, Yinchuan, China.
Neurol India. 2023 Jul-Aug;71(4):716-724. doi: 10.4103/0028-3886.383826.
We sought to evaluate whether the neuromelanin-sensitive magnetic resonance imaging (NM-MRI) features of the substantia nigra (SN) have utility in the differential diagnosis of Parkinson's disease (PD) and essential tremor (ET). This study enrolled 23 patients with PD, 20 patients with ET, and 18 healthy participants. All subjects underwent clinical examination, motor and cognitive assessments, and NM-MRI scans. The area and contrast-to-noise ratio (CNR) values of SN were defined according to NM-MRI images. Then, receiver operating characteristic (ROC) analysis was conducted to characterize the diagnostic power of the SN area and CNR values of SN. Compared with ET and control groups, the PD group showed a significant reduction of the area of SN (P = 0.003, PD vs. ET; P = 0.001, PD vs. control) and in the SN to midbrain area ratio in the same layer (P = 0.006, PD vs. ET; P = 0.005, PD vs. control). The SN area had a sensitivity of 65% and a specificity of 87% for distinguishing ET from PD, with an area under the curve (AUC) of 0.7630 and a Youden index of 0.5200, whereas the ratio of the SN area to midbrain area in the same layer had a sensitivity of 60% and a specificity of 87% for distinguishing ET from PD, with an AUC of 0.7478 and a Youden index of 0.4700. Compared with the ET group, the mean CNR value of the SN and the respective CNR values of the three subregions were all weakened in the PD group, and only the CNR in the middle part was significantly different from the control group (P = 0.006). The sensitivity of the CNR value of the middle part of the SN for differentiating ET from PD was 65%, the specificity was 87%, the AUC was 0.7500, and the Youden index was 0.5200.Based on our findings, we conclude that NM-MRI can improve diagnostic accuracy in PD and can be used as a specific and sensitive potential diagnostic biomarker for PD.
我们旨在评估黑质（SN）神经黑色素敏感磁共振成像（NM-MRI）特征在帕金森病（PD）和特发性震颤（ET）鉴别诊断中的应用价值。本研究纳入 23 例 PD 患者、20 例 ET 患者和 18 名健康受试者。所有受试者均接受临床检查、运动和认知评估以及 NM-MRI 扫描。根据 NM-MRI 图像定义 SN 的面积和对比噪声比（CNR）值。然后，进行受试者工作特征（ROC）分析，以描述 SN 面积和 CNR 值的诊断能力。与 ET 和对照组相比，PD 组 SN 面积显著减小（P = 0.003，PD 与 ET 比较；P = 0.001，PD 与对照组比较），同一层面 SN 与中脑面积比值也减小（P = 0.006，PD 与 ET 比较；P = 0.005，PD 与对照组比较）。SN 面积用于区分 ET 和 PD 的敏感性为 65%，特异性为 87%，曲线下面积（AUC）为 0.7630，Youden 指数为 0.5200；而同一层面 SN 面积与中脑面积的比值用于区分 ET 和 PD 的敏感性为 60%，特异性为 87%，AUC 为 0.7478，Youden 指数为 0.4700。与 ET 组相比，PD 组 SN 的平均 CNR 值以及三个亚区的相应 CNR 值均减弱，只有中部 CNR 值与对照组有显著差异（P = 0.006）。SN 中部 CNR 值用于区分 ET 和 PD 的敏感性为 65%，特异性为 87%，AUC 为 0.7500，Youden 指数为 0.5200。基于我们的发现，我们得出结论，NM-MRI 可提高 PD 的诊断准确性，可作为 PD 特定且敏感的潜在诊断生物标志物。
