磁共振弥散张量成像在帕金森病诊断中的临床价值
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摘要
目的探讨磁共振弥散张量成像(diffusion tensor imaging,DTI)技术在帕金森病(Parkinson’s disease,PD)诊断中的临床应用价值。方法筛查入组帕金森研究组27例,其中震颤型12例,强直型15例,筛查对照组22例,均排除抑郁、焦虑及痴呆。分别对研究组与对照组、强直型组与对照组、震颤型组与对照组及强直型组与震颤型组进行感兴趣区DTI对比,感兴趣区为内侧苍白球、外侧苍白球、壳核、尾状核、丘脑底核、黑质、红核、小脑上脚、小脑中脚、小脑蚓部、小脑齿状核、小脑扁桃体。结果与对照组比较,研究组病灶侧壳核、尾状核、黑质、小脑扁桃体、小脑齿状核FA较对照组低,ADC升高。与对照组比较,强直型组尾状核FA值下降。与对照组比较,震颤型组壳核及小脑齿状核FA值下降,ADC值升高。与震颤型组比较,强直组小脑上脚FA值高。结论 DTI技术对PD诊断具有一定临床价值。壳核、尾状核、黑质参与传统STC通路(纹状体-丘脑-皮层通路),小脑齿状核参与了CTC通路(小脑-丘脑-皮质通路),尤其在震颤型患者中作用更大,尾状核在强直型患者中作用突出。
Objective To explore the clinical value of diffusion tensor magnetic resonance imaging( DTI) in the diagnosis of Parkinson's Disease. Methods 27 PD patients were recruited in our study,including 12 patients confirmed as tremor type and 15 confirmed as rigidity type. 22 healthy participants were included in the control group. Participants with depression,anxityor dementia were excluded. The ADC value and FA of regions of interests( ROI) from all participants were collected. The ROI included globus pallidus intermal,globus pallidus external,putamen,caudate nucleus,subthalamic nuclei,substantia nigra,red nucleus,superior cerebellar peduncle,vermis,dentate nucleu,and cerebellar tonsil. Results Compared with the control group,PD patients showed significant decreases in the value of FA and significant increases in the value of ADC in putamen,caudate nucleus,substantia nigra,dentate nucleu and cerebellar tonsil. The FA of caudate nucleus was significantly lower in patients of rigidity type than that in the healthy control group. The FA of the putamen and dentate nucleu were significantly lower in patients of tremor type than that in the control group,while the ADC were significantly increased. PD patients of rigidity type showed significant increases in the value of FA in the superior cerebellar peduncle compared with patients of tremor type. Conclusion the DTI may contribute to the diagnosis of PD. Putamen,dentate nucleu and substantia nigra was involved in STC pathway,while Dentate nucleu was involved in CTC pathway.
Objective To explore the clinical value of diffusion tensor magnetic resonance imaging( DTI) in the diagnosis of Parkinson's Disease. Methods 27 PD patients were recruited in our study,including 12 patients confirmed as tremor type and 15 confirmed as rigidity type. 22 healthy participants were included in the control group. Participants with depression,anxityor dementia were excluded. The ADC value and FA of regions of interests( ROI) from all participants were collected. The ROI included globus pallidus intermal,globus pallidus external,putamen,caudate nucleus,subthalamic nuclei,substantia nigra,red nucleus,superior cerebellar peduncle,vermis,dentate nucleu,and cerebellar tonsil. Results Compared with the control group,PD patients showed significant decreases in the value of FA and significant increases in the value of ADC in putamen,caudate nucleus,substantia nigra,dentate nucleu and cerebellar tonsil. The FA of caudate nucleus was significantly lower in patients of rigidity type than that in the healthy control group. The FA of the putamen and dentate nucleu were significantly lower in patients of tremor type than that in the control group,while the ADC were significantly increased. PD patients of rigidity type showed significant increases in the value of FA in the superior cerebellar peduncle compared with patients of tremor type. Conclusion the DTI may contribute to the diagnosis of PD. Putamen,dentate nucleu and substantia nigra was involved in STC pathway,while Dentate nucleu was involved in CTC pathway.
引文
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[21] MA Y,TANG C,CHALY T,et al. Dopamine cell implantation in Parkinson’s disease:long-term clinical and(18)F-FDOPA PET outcomes[J]. J Nucl Med,2010,51(1):7-15.
[22] KIM W,SHARIM J,TENN S,et al. Diffusion tractography imaging-guided frameless linear accelerator stereotactic radiosurgical thalamotomy for tremor:case report[J]. J Neurosurg,2018,128(1):215-221.
[23] MIYAGI Y. Thalamic Stimulation for Parkinson’s Disease:Clinical Studies on DBS[J]. 2015:103-120.
[24] MAGNIN M,MOREL A,JEANMONOD D. Single-unit analysis of the pallidum,thalamus and subthalamic nucleus in parkinsonian patients[J]. Neuroscience,2000,96(3).
[25] MURE H,HIRANO S,TANG C C,et al. Parkinson’s disease tremor-related metabolic network:Characterization,progression,and treatment effects[J]. Neuro Image,2011,54(2).
[26] HUI-MIN C,ZHI-JIANG W,JIN-PING F,et al. Different patterns of spontaneous brain activity between tremor-dominant and postural instability/gait difficulty subtypes of Parkinson’s disease:a resting-state f MRI study.[J]. CNS neuroscience&therapeutics,2015,21(10).
[27] MA H,CHEN H,FANG J,et al. Resting-state functional connectivity of dentate nucleus is associated with tremor in Parkinson’s disease[J]. J Neurol,2015,262(10):2247-2256.
[2]马凌燕,冯涛.帕金森病脑网络研究及神经调控治疗的研究进展[J].中华医学杂志,2018,98(29).
[3] REITER E,MUELLER C,PINTER B,et al. Dorsolateral nigral hyperintensity on 3. 0T susceptibility‐weighted imaging in neurodegenerative Parkinsonism[J]. Mov Disord,2015,30(8):1068-1076.
[4] WU Z,CHENG F,LI J,et al. SDTNBI:an integrated network and chemoinformatics tool for systematic prediction of drug-target interactions and drug repositioning[J]. Brief Bioinform,2017,18(2):333-347.
[5] HARMS R L,ROEBROECK A. Robust and Fast Markov Chain Monte Carlo Sampling of Diffusion MRI Microstructure Models[J]. Front Neuroinform,2018,12:97.
[6]舒红格,胡军武,朱元清,等.原发性单侧症状帕金森病患者脑黑质DTI和SWI的特点及其预后评估价值[J].华中科技大学学报(医学版),2015(3):344-348.
[7] JASON L,DANIEL E H,MICHAEL M,et al. Diffusion tensor imaging of the substantia nigra in Parkinson’s disease revisited.[J]. Human brain mapping,2016,37(7).
[8]郑奎宏,戚晓昆,马林.多系统萎缩与帕金森病的鉴别诊断[J].转化医学杂志,2017(2):116-121.
[9]陈慧敏,冯涛.帕金森病步态异常的脑网络和神经环路研究进展[J].中华神经科杂志,2017,50(3):238-240.
[10] GEORGIOPOULOS C,WARNTJES M,DIZDAR N,et al. Olfactory Impairment in Parkinson’s Disease Studied with Diffusion Tensor and Magnetization Transfer Imaging[J]. Journal of Parkinsons Disease,2017,7(2):301-311.
[11] LI C,HUANG B,ZHANG R,et al. Impaired topological architecture of brain structural networks in idiopathic Parkinson’s disease:a DTI study.[J]. Brain Imaging&Behavior,2017,11(1):113-128.
[12] ARGYELAN M,HERZALLAH M,SAKO W,et al. Dopamine modulates striatal response to reward and punishment in patients with Parkinson’s disease:a pharmacological challenge f MRI study[J]. Neuroreport,2018:1.
[13] TAYLOR K I,SAMBATARO F,BOESS F,et al. Progressive Decline in Gray and White Matter Integrity in de novo Parkinson’s Disease:An Analysis of Longitudinal Parkinson Progression Markers Initiative Diffusion Tensor Imaging Data[J]. Front Aging Neurosci,2018,10:318.
[14] GUIMARAES R P,CAMPOS B M,DE REZENDE T J,et al. Is Diffusion Tensor Imaging a Good Biomarker for Early Parkinson’s Disease[J]. Front Neurol,2018,9:626.
[15] SATO E,ISOBE T,YAMAMOTO T,et al. Basic Principle and Image Analysis in the Diffusion Tensor Image[J]. Igaku Butsuri,2016,36(2):97-102.
[16]王耀炜,王惠芳,程旭东. OSAHS合并认知障碍患者肺泡巨噬细胞表达TREM2的研究[J].实用医学杂志,2018,34(7):1171-1173,1178.
[17] TUITE P. Brain Magnetic Resonance Imaging(MRI)as a Potential Biomarker for Parkinson’s Disease(PD)[J]. Brain Sciences,2017,7(6):68.
[18] DELLI P S,BELLOMO R G,CARMIGNANO S M,et al. Rehabilitation program based on sensorimotor recovery improves the static and dynamic balance and modifies the basal ganglia neurochemistry:A pilot 1H-MRS study on Parkinson’s disease patients[J]. Medicine(Baltimore),2017,96(50):e8732.
[19]余健敏,潘小平,彭蔚,等.针刺治疗对帕金森病抑郁患者额叶-纹状体通路的影响[J].广东医学,2016,37(22):3460-3462.
[20]韩雨,孙成凤,王习,等.扩散张量成像评价子宫肌瘤高强度聚集超声刀治疗前后的临床价值[J].实用医学杂志,2017,33(15):2486-2488.
[21] MA Y,TANG C,CHALY T,et al. Dopamine cell implantation in Parkinson’s disease:long-term clinical and(18)F-FDOPA PET outcomes[J]. J Nucl Med,2010,51(1):7-15.
[22] KIM W,SHARIM J,TENN S,et al. Diffusion tractography imaging-guided frameless linear accelerator stereotactic radiosurgical thalamotomy for tremor:case report[J]. J Neurosurg,2018,128(1):215-221.
[23] MIYAGI Y. Thalamic Stimulation for Parkinson’s Disease:Clinical Studies on DBS[J]. 2015:103-120.
[24] MAGNIN M,MOREL A,JEANMONOD D. Single-unit analysis of the pallidum,thalamus and subthalamic nucleus in parkinsonian patients[J]. Neuroscience,2000,96(3).
[25] MURE H,HIRANO S,TANG C C,et al. Parkinson’s disease tremor-related metabolic network:Characterization,progression,and treatment effects[J]. Neuro Image,2011,54(2).
[26] HUI-MIN C,ZHI-JIANG W,JIN-PING F,et al. Different patterns of spontaneous brain activity between tremor-dominant and postural instability/gait difficulty subtypes of Parkinson’s disease:a resting-state f MRI study.[J]. CNS neuroscience&therapeutics,2015,21(10).
[27] MA H,CHEN H,FANG J,et al. Resting-state functional connectivity of dentate nucleus is associated with tremor in Parkinson’s disease[J]. J Neurol,2015,262(10):2247-2256.