From the Department of Radiology (S.I., Y.M., K.F., K.A., Y.Y., S.F., J.T., T.A.), School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
From the Department of Radiology (S.I., Y.M., K.F., K.A., Y.Y., S.F., J.T., T.A.), School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
AJNR Am J Neuroradiol. 2024 Aug 9;45(8):1141-1152. doi: 10.3174/ajnr.A8275.
Parkinson disease is a prevalent disease, with olfactory dysfunction recognized as an early nonmotor manifestation. It is sometimes difficult to differentiate Parkinson disease from atypical parkinsonism using conventional MR imaging and motor symptoms. It is also known that olfactory loss occurs to a lesser extent or is absent in atypical parkinsonism. To the best of our knowledge, no study has examined olfactory bulb changes to differentiate Parkinson disease from atypical parkinsonism, even in an early diagnosis, and its association with conventional MR imaging findings. Hence, we aimed to assess the utility of olfactory bulb measurements in differentiating Parkinson disease from atypical parkinsonism even in the early stage.
In this retrospective study, we enrolled 108 patients with Parkinson disease, 13 with corticobasal syndrome, 15 with multiple system atrophy, and 17 with progressive supranuclear palsy who developed parkinsonism. Thirty-nine age-matched healthy subjects served as controls. All subjects underwent conventional MR imaging and 3D FIESTA for olfactory bulb measurements using manual ROI quantification of the cross-sectional olfactory bulb area using the coronal plane. Bilateral olfactory bulb measurements were averaged. For group comparisons, we used the Welch test, and we assessed diagnostic accuracy using receiver operating characteristic analysis.
Patients with Parkinson disease had a mean olfactory bulb area of 4.2 (SD, 1.0 mm), significantly smaller than in age-matched healthy subjects (6.6 [SD, 1.7 mm], < .001), and those with corticobasal syndrome (5.4 [SD, 1.2 mm], < .001), multiple system atrophy (6.5 [SD, 1.2 mm], < .001), and progressive supranuclear palsy (5.4 [SD, 1.2 mm], < .001). The receiver operating characteristic analysis for the olfactory bulb area measurements showed good diagnostic performance in differentiating Parkinson disease from atypical parkinsonism, with an area under the curve of 0.87, an optimal cutoff value of 5.1 mm, and a false-positive rate of 18%. When we compared within 2 years of symptom onset, the olfactory bulb in Parkinson disease (4.2 [SD, 1.1 mm]) remained significantly smaller than in atypical parkinsonism (versus corticobasal syndrome (6.1 [SD, 0.7 mm]), < .001; multiple system atrophy (6.3 [SD, 1.4 mm]), < .001; and progressive supranuclear palsy (5.2 [1.3 mm], = .003, respectively).
3D FIESTA-based olfactory bulb measurement holds promise for distinguishing Parkinson disease from atypical parkinsonism, especially in the early stage.
帕金森病是一种常见疾病，其嗅觉功能障碍被认为是一种早期的非运动表现。使用常规磁共振成像（MR）和运动症状有时难以将帕金森病与非典型帕金森综合征区分开来。众所周知，在非典型帕金森综合征中，嗅觉丧失的程度较轻或不存在。据我们所知，即使在早期诊断中，也没有研究检查嗅球变化以将帕金森病与非典型帕金森综合征区分开来，以及其与常规 MR 成像结果的关联。因此，我们旨在评估嗅球测量在区分帕金森病与非典型帕金森综合征中的作用，即使在早期也是如此。
在这项回顾性研究中，我们纳入了 108 例帕金森病患者、13 例皮质基底节综合征患者、15 例多系统萎缩症患者和 17 例进行性核上性麻痹患者，这些患者均出现帕金森病。39 名年龄匹配的健康受试者作为对照组。所有受试者均接受常规 MR 成像和 3D FIESTA 检查，使用冠状面手动 ROI 量化嗅球的横截面积来测量嗅球。双侧嗅球测量值取平均值。对于组间比较，我们使用 Welch 检验，使用受试者工作特征（ROC）分析评估诊断准确性。
帕金森病患者的嗅球面积平均值为 4.2（标准差 [SD]，1.0mm），明显小于年龄匹配的健康受试者（6.6 [SD，1.7mm]，<0.001），也明显小于皮质基底节综合征患者（5.4 [SD，1.2mm]，<0.001）、多系统萎缩症患者（6.5 [SD，1.2mm]，<0.001）和进行性核上性麻痹患者（5.4 [SD，1.2mm]，<0.001）。嗅球面积测量的 ROC 分析显示，在区分帕金森病与非典型帕金森综合征方面具有良好的诊断性能，曲线下面积为 0.87，最佳截断值为 5.1mm，假阳性率为 18%。当我们比较症状出现后 2 年内的情况时，帕金森病患者的嗅球（4.2 [SD，1.1mm]）仍明显小于非典型帕金森综合征患者（皮质基底节综合征患者，6.1 [SD，0.7mm]，<0.001；多系统萎缩症患者，6.3 [SD，1.4mm]，<0.001；进行性核上性麻痹患者，5.2 [1.3mm]，=0.003）。
基于 3D FIESTA 的嗅球测量有望区分帕金森病与非典型帕金森综合征，尤其是在早期。
