Jin Jianing, Su Dongning, Zhang Junjiao, Lam Joyce S T, Zhou Junhong, Feng Tao
Center for Movement Disorders, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.
China National Clinical Research Center for Neurological Diseases, Beijing 100070, China.
Chin Med J (Engl). 2025 Mar 20;138(6):678-692. doi: 10.1097/CM9.0000000000003167. Epub 2024 May 28.
Iron deposition plays a crucial role in the pathophysiology of Parkinson's disease (PD), yet the distribution pattern of iron deposition in the subcortical nuclei has been inconsistent across previous studies. We aimed to assess the difference patterns of iron deposition detected by quantitative iron-sensitive magnetic resonance imaging (MRI) between patients with PD and patients with atypical parkinsonian syndromes (APSs), and between patients with PD and healthy controls (HCs).
A systematic literature search was conducted on PubMed, Embase, and Web of Science databases to identify studies investigating the iron content in PD patients using the iron-sensitive MRI techniques (R2 * and quantitative susceptibility mapping [QSM]), up until May 1, 2023. The quality assessment of case-control and cohort studies was performed using the Newcastle-Ottawa Scale, whereas diagnostic studies were assessed using the Quality Assessment of Diagnostic Accuracy Studies-2. Standardized mean differences and summary estimates of sensitivity, specificity, and area under the curve (AUC) were calculated for iron content, using a random effects model. We also conducted the subgroup-analysis based on the MRI sequence and meta-regression.
Seventy-seven studies with 3192 PD, 209 multiple system atrophy (MSA), 174 progressive supranuclear palsy (PSP), and 2447 HCs were included. Elevated iron content in substantia nigra (SN) pars reticulata ( P <0.001) and compacta ( P <0.001), SN ( P <0.001), red nucleus (RN, P <0.001), globus pallidus ( P <0.001), putamen (PUT, P = 0.021), and thalamus ( P = 0.029) were found in PD patients compared with HCs. PD patients showed lower iron content in PUT ( P <0.001), RN ( P = 0.003), SN ( P = 0.017), and caudate nucleus ( P = 0.017) than MSA patients, and lower iron content in RN ( P = 0.001), PUT ( P <0.001), globus pallidus ( P = 0.004), SN ( P = 0.015), and caudate nucleus ( P = 0.001) than PSP patients. The highest diagnostic accuracy distinguishing PD from HCs was observed in SN (AUC: 0.85), and that distinguishing PD from MSA was found in PUT (AUC: 0.90). In addition, the best diagnostic performance was achieved in the RN for distinguishing PD from PSP (AUC: 0.86).
Quantitative iron-sensitive MRI could quantitatively detect the iron content of subcortical nuclei in PD and APSs, while it may be insufficient to accurately diagnose PD. Future studies are needed to explore the role of multimodal MRI in the diagnosis of PD.
PROSPERO (CRD42022344413).
铁沉积在帕金森病（PD）的病理生理学中起着关键作用，但以往研究中皮质下核团中铁沉积的分布模式并不一致。我们旨在评估通过定量铁敏感磁共振成像（MRI）检测到的PD患者与非典型帕金森综合征（APS）患者之间，以及PD患者与健康对照（HC）之间铁沉积的差异模式。
在PubMed、Embase和Web of Science数据库中进行系统文献检索，以识别截至2023年5月1日使用铁敏感MRI技术（R2 *和定量磁化率成像[QSM]）研究PD患者铁含量的研究。使用纽卡斯尔-渥太华量表对病例对照研究和队列研究进行质量评估，而诊断研究则使用诊断准确性研究质量评估-2进行评估。使用随机效应模型计算铁含量的标准化平均差异以及敏感性、特异性和曲线下面积（AUC）的汇总估计值。我们还基于MRI序列进行了亚组分析和meta回归。
纳入了77项研究，其中包括3192例PD患者、209例多系统萎缩（MSA）患者、174例进行性核上性麻痹（PSP）患者和2447例HC。与HC相比，PD患者黑质（SN）网状部（P <0.001）和致密部（P <0.001）、SN（P <0.001）、红核（RN，P <0.001）、苍白球（P <0.001）、壳核（PUT，P = 0.021）和丘脑（P = 0.029）中的铁含量升高。与MSA患者相比，PD患者PUT（P <0.001）、RN（P = 0.003）、SN（P = 0.017）和尾状核（P = 0.017）中的铁含量较低；与PSP患者相比，PD患者RN（P = 0.001）、PUT（P <0.001）、苍白球（P = 0.004）、SN（P = 0.015）和尾状核（P = 0.001）中的铁含量较低。在区分PD与HC方面，SN的诊断准确性最高（AUC：0.85）；在区分PD与MSA方面，PUT的诊断准确性最高（AUC：0.90）。此外，在区分PD与PSP方面，RN的诊断性能最佳（AUC：0.86）。
定量铁敏感MRI可以定量检测PD和APS患者皮质下核团的铁含量，但可能不足以准确诊断PD。未来需要进一步研究探索多模态MRI在PD诊断中的作用。
PROSPERO（CRD42022344413）
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