Ballan G, Tison F, Dousset V, Vidailhet M, Agid Y, Henry P
Service de Neurologie, Hôpital Pellegrin, CHU de Bordeaux.
Rev Neurol (Paris). 1998 Apr;154(3):224-7.
Corticobasal degeneration (C.B.D.) is a neurodegenerative disorder characterized mainly by an asymmetrical a kineto-rigid syndrome associated with fronto-parietal cortical signs, particularly apraxia. Conventional imaging even magnetic resonance imaging (M.R.I.) has often been considered as poorly contributive for the diagnosis of C.B.D. We retrospectively studied routinely performed M.R.I. scans of 15 patients presenting a clinical and metabolic (P.E.T/S.P.E.C.T.) syndrome characteristic of probable C.B.D. M.R.I. scans were assessed by 3 investigators, not aware of the clinically most affected side, taking into account M.R.I. technical parameters. We quantified, on each side, the cortical atrophy (frontal, parietal and temporal) and the white matter changes, by using the semi-quantified method of Victoroff et al. (1994). Abnormalities were considered if observed by at least 2 of the 3 investigators. Abnormalities were then correlated with the side initially and most severely affected. The most contributive findings were the asymmetric parietal atrophy (clinically correlated in 93 p. 100 of cases), asymmetric frontal atrophy (clinically correlated in 60 p. 100) and asymmetric dilatation of the lateral ventricles (clinically correlated in 60 p. 100). 80 p. 100 of affected subjects displayed at least 2 of these M.R.I. abnormalities. These results are in accordance with the metabolic and pathologic features of C.B.D. This study demonstrates that M.R.I. evaluation of the cortical atrophy asymmetry may contribute to the diagnosis of C.B.D.
皮质基底节变性(C.B.D.)是一种神经退行性疾病,主要特征为不对称的运动不能-强直综合征,并伴有额顶叶皮质体征,尤其是失用症。传统影像学检查,甚至磁共振成像(M.R.I.),通常被认为对C.B.D.的诊断贡献不大。我们回顾性研究了15例表现出可能为C.B.D.临床和代谢(正电子发射断层扫描/单光子发射计算机断层扫描,即P.E.T/S.P.E.C.T.)综合征的患者的常规M.R.I.扫描结果。3名不了解临床最受累侧的研究人员在考虑M.R.I.技术参数的情况下对M.R.I.扫描进行了评估。我们采用Victoroff等人(1994年)的半定量方法,对每一侧的皮质萎缩(额叶、顶叶和颞叶)和白质变化进行了量化。如果3名研究人员中至少有2人观察到异常,则认为存在异常。然后将异常情况与最初和最严重受累的一侧进行关联。最具诊断价值的发现是不对称的顶叶萎缩(93%的病例与临床相关)、不对称的额叶萎缩(60%与临床相关)以及侧脑室不对称扩张(60%与临床相关)。80%的受累受试者至少表现出上述两种M.R.I.异常。这些结果与C.B.D.的代谢和病理特征相符。本研究表明,M.R.I.对皮质萎缩不对称性的评估可能有助于C.B.D.的诊断。