帕金森病淋巴系统与运动症状及左旋多巴反应性的不同影像学评估表现
Different Imaging Evaluating Performances Between Glymphatic System and Motor Symptoms and Levodopa Responsiveness of Parkinson Disease.
作者信息
Deng Jin-Huan, Zhang Han-Wen, Lan Xin-Xin, Liu Yu-Feng, Liu Xiao-Lei, Deng Hua-Zhen, Luo Si-Ping, Yao Gui-Zhi, Wu He-Lv, Huang Biao, Lin Fan
机构信息
Department of Radiology, the First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen.
Department of Radiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangdong, China.
出版信息
J Comput Assist Tomogr. 2025 Jan 27. doi: 10.1097/RCT.0000000000001720.
BACKGROUND AND PURPOSE
Parkinson disease (PD) is defined by its unique motor symptoms, where responsiveness to levodopa (L-DOPA) is fundamental for management. Recent research has highlighted a significant relationship between PD symptoms and glymphatic dysfunction. This study endeavors to clarify the connection between glymphatic system functionality and initial motor symptoms in PD, utilizing imaging biomarkers to determine its predictive capacity for L-DOPA responsiveness (LR).
MATERIALS AND METHODS
Retrospective study of 86 PD patients with 3.0-T MRI scans (July 2019 to March 2021), assessing the diffusion tensor image analysis along the perivascular space (DTI-ALPS) methods, enlarged perivascular spaces (ePVSs) load, and choroid plexus volume (CPV). Analyzed metrics versus the third part of the Unified Parkinson Disease Rating Scale (UPDRSIII) scores and %LR using linear regression, creating a %LR prediction model for the L-DOPA challenge. Explored relationships with age, sex, Hoehn and Yahr stage, Montreal Cognitive Assessment scores, and Mini-Mental State Examination score. Examined DTI-ALPS index, ePVSs, and CPV interrelations.
RESULTS
Pre-L-DOPA, UPDRSIII inversely correlated with DTI-ALPS index (P=0.049), positively with bilateral basal ganglia ePVSs (P<0.001). Age-adjusted BG-ePVSs-UPDRSIII link (P<0.001). Post-L-DOPA, UPDRSIII correlated similarly and CPV was positive. %LR positively linked to DTI-ALPS index (P<0.001), negatively to BG-ePVSs (P=0.04), CPV (P<0.001). Adjusted %LR-DTI-ALPS index positive (P=0.005), %LR-CPV negative (P=0.04). DTI-ALPS index, CPV predicted LCT outcomes (%LR ≥33%) with area under the curves 0.78, 0.79; accuracies 86.01%, 81.4%. The combined model area under the curve is 0.82, with an accuracy of 87.2%. Significant linear correlations were observed (CPV-DTI-ALPS, CPV-ePVSs, DTI-ALPS-ePVSs).
CONCLUSIONS
A study affirms the link between glymphatic impairment, motor symptoms, and L-DOPA responses in PD. As glymphatic function declines, symptoms worsen, and L-DOPA effectiveness diminishes. The DTI-ALPS index and CPV emerge as potential predictors of PD patient LCT outcomes.
背景与目的
帕金森病（PD）由其独特的运动症状定义，对左旋多巴（L-DOPA）的反应性是治疗的基础。最近的研究强调了PD症状与类淋巴系统功能障碍之间的重要关系。本研究旨在阐明类淋巴系统功能与PD初始运动症状之间的联系，利用成像生物标志物来确定其对L-DOPA反应性（LR）的预测能力。
材料与方法
对86例接受3.0-T MRI扫描的PD患者进行回顾性研究（2019年7月至2021年3月），评估沿血管周围间隙的扩散张量图像分析（DTI-ALPS）方法、扩大的血管周围间隙（ePVSs）负荷和脉络丛体积（CPV）。使用线性回归分析各项指标与统一帕金森病评定量表（UPDRSIII）第三部分评分及LR百分比的关系，建立L-DOPA激发试验的LR百分比预测模型。探讨与年龄、性别、Hoehn和Yahr分期、蒙特利尔认知评估评分及简易精神状态检查评分的关系。研究DTI-ALPS指数、ePVSs和CPV之间的相互关系。
结果
左旋多巴治疗前，UPDRSIII与DTI-ALPS指数呈负相关（P = 0.049），与双侧基底节ePVSs呈正相关（P < 0.001）。年龄校正后的基底节ePVSs与UPDRSIII的关联（P < 0.001）。左旋多巴治疗后，UPDRSIII的相关性相似，且与CPV呈正相关。LR百分比与DTI-ALPS指数呈正相关（P < 0.001），与基底节ePVSs呈负相关（P = 0.04），与CPV呈负相关（P < 0.001）。校正后的LR百分比与DTI-ALPS指数呈正相关（P = 0.005），与CPV呈负相关（P = 0.04）。DTI-ALPS指数、CPV预测LCT结果（LR百分比≥33%）的曲线下面积分别为0.78、0.79；准确率分别为86.01%、81.4%。联合模型的曲线下面积为0.82，准确率为87.2%。观察到显著的线性相关性（CPV与DTI-ALPS、CPV与ePVSs、DTI-ALPS与ePVSs）。
结论
一项研究证实了PD中类淋巴系统损伤、运动症状和L-DOPA反应之间的联系。随着类淋巴系统功能下降，症状加重，L-DOPA疗效降低。DTI-ALPS指数和CPV成为PD患者LCT结果的潜在预测指标。
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