磁共振测量黑质致密带宽度在帕金森病和血管性帕金森综合征鉴别诊断上的应用

目的　探讨在常规磁共振 (MRI)上测量黑质致密带 (SNc)宽度及其与中脑直径的比值对帕金森病 (PD)和血管性帕金森综合征 (VP)的诊断和鉴别诊断价值。方法　对 6 0例PD患者 (Hoehn Yahr分级为Ⅰ～Ⅱ级 38例、Ⅲ级 14例、Ⅳ级 8例 )、6 0例VP患者 (Hoehn Yahr分级为Ⅰ～Ⅱ级 2 6例、Ⅲ级 2 0例、Ⅳ级 14例 )和6 0名正常老年人对照组进行MRI常规轴位T2 WI上测量SNc宽度和中脑直径以及计算两者的比值 ,并对结果进行比较分析。结果　PD患者比VP患者和正常对照组SNc宽度明显变窄 ,SNc宽度和中脑直径的比值明显降低 (P <0 0 5 ) ,而VP患者与正常对照组相比差异无显著性。并且PD患者在早期 (Ⅰ～Ⅱ级 )其SNc宽度已经变窄 ,SNc宽度与中脑直径的比值已经降低 ,随病情加重其SNc宽度更加变窄 (P <0 0 5 )、SNc宽度与中脑直径的比值更加降低 ;而VP患者在早中期 (Ⅰ～Ⅲ级 )其SNc宽度以及SNc宽度和中脑直径的比值无明显改变 ,仅在后期 (Ⅳ级 )其SNc宽度有轻度变窄、SNc宽度与中脑直径的比值有轻度降低 (P <0 0 5 )。结论　在常规MRI上测量SNc宽度以及SNc宽度与中脑直径的比值对PD和VP的诊断和鉴别诊断具有临床应用价值。     

磁共振测量帕金森病患者基底节区、黑质体积的研究

目的:探讨MR体积测量技术评价帕金森病(Parkinson’sdiseasePD)患者基底节区(尾状核,壳核,苍白球)、黑质体积改变的价值。方法:采用3·0TMR测量早、晚期PD患者和年龄匹配正常人对照组全脑体积、尾状核、壳核、苍白球、黑质体积。对患者进行PD统一评分量表(UPDRS)第Ⅱ、Ⅲ、Ⅴ部分评分。评分结果与患者基底节区、黑质体积行相关性分析。结果:早、晚期PD患者壳核体积较正常人分别下降12·5%(P=0·004)和26·5%(P<0·001),晚期患者较早期患者下降16·0%(P=0·002)。晚期患者苍白球体积较正常人下降19·2%(P=0·023)。PD患者壳核体积与Hoehn&Yahr分级呈负相关(r=-0·741,P<0·001)。结论:MR体积测量技术是评价PD患者基底节区、黑质体积改变的一种可靠的方法,能为PD辅助诊断提供有效的影像学指标。     

磁共振测量基底节区、黑质体积在帕金森病及其相关疾病诊断中的意义

磁共振体积测量是一项能够测量活体组织结构体积的影像学方法。本文对基底节区、黑质磁共振成像及磁共振测量基底节区、黑质体积在帕金森病及其相关疾病诊断中的意义作一综述。     

质子磁共振波谱用于帕金森病黑质代谢研究价值的探讨

目的探讨质子磁共振波谱（^1H MRS）技术在帕金森病（PD）黑质代谢变化研究中的价值。方法PD患者56例和正常对照30例行^1H MRS检查，测定双侧黑质的N-乙酰天门冬氨酸／肌酸（NAA／Cr）、N-乙酰天门冬氨酸／胆碱复合物（NAA／Cho）和胆碱复合物／肌酸（Cho／Cr）比值。结果PD患者和对照组黑质的NAA／Cr、Cho／Cr和NAA／Cho比值无显著性差异。PD患者的^1H MRS结果与UPDRS评分、H＆Y分级和病程均不存在显著相关性。结论目前的^1H MRS技术尚不能精准地反应PD患者黑质的代谢变化。     

帕金森病患者基底节区的磁共振氨基质子转移成像研究

目的 探讨磁共振氨基质子转移成像(APT)技术对于发现帕金森病患者基底节异常改变的可行性.方法 收集27例帕金森病患者和23名年龄及性别相匹配的健康对照者进行头颅APT成像和常规磁共振检查.测量双侧苍白球、壳核和尾状核的酰胺质子不对称磁化转移率(MTRasym),分别采用独立样本t检验和配对样本t检验比较帕金森病患者与健康对照者、帕金森病患者起病侧和对侧各脑结构MTRasym (3.5 ppm)的差异.使用单因素方差分析比较健康对照者和不同严重程度帕金森病患者间各脑结构MTRasym(3.5 ppm)的差异.结果 帕金森病患者苍白球、壳核和尾状核的MTRasym (3.5 ppm)均高于健康对照者[分别为(0.89±0.12)％与(0.57 ±0.16)％,(1.05±0.11)％与(0.82±0.15)％,(1.15±0.13)％与(0.78 ± 0.19)％;t=3.311、2.562和3.277,均P＜0.05].健康对照组、轻度和中重度帕金森病组基底节各脑结构MTRasym(3.5 ppm)的差异具有统计学意义,且轻度帕金森病患者苍白球、壳核和尾状核的MTRasym(3.5 ppm)明显高于健康对照者.帕金森病患者基底节各脑结构起病侧的MTRasym(3.5 ppm)虽均略低于对侧,但差异均无统计学意义.结论 APT成像技术可以敏感地显示早期帕金森病患者和健康对照者基底节各脑结构MTRasym(3.5 ppm)的差异,是一种评价帕金森病患者脑代谢异常的有效工具.     

黑质FA值对早期诊断帕金森病的临床研究

目的 探讨帕金森病(PD)黑质各向异性分数(FA)值的变化特点。方法 对PD患者单侧症状组10例,PD双侧症状组20例和20例健康对照组行常规MRI和DTI扫描,描绘并测量黑质头部(SNr)、黑质体部(SNm)、黑质尾部(SNc)各感兴趣区(ROI)的FA值。结果 PD单侧症状组黑质体部(0.363±177;0.036,0.371±177;0.035)、尾部(0.454±177;0.027,0.464±177;0.038)FA值和PD双侧症状组黑质头部(0.380±177;0.031)、体部(0.352±177;0.031)、尾部(0.431±177;0.033)FA值均较对照组(0.440±177;0.047,0.384±177;0.033,0.481±177;0.042)明显降低(P<0.05)。结论 黑质FA值下降对早期帕金森病的诊断有一定价值。     

红核黑质波谱分析在帕金森病中的应用价值

目的 探讨黑质氢质子磁共振波谱分析（1H-MRS）在帕金森病中的应用价值.方法 采用Philips Achieva 1.5 T双梯度磁共振扫描仪,对29例帕金森病患者（早期11例,晚期18例）和16例健康志愿者行颅脑MRI和黑质1H-MRS检查,观察NAA、Cr、Cho浓度和NAA/（Cho±Cr）、NAA/Cr和NAA/Cho值.分别对帕金森病患者左侧、右侧与正常健康组黑质的NAA/（Cho±Cr）、NAA/Cr和NAA/Cho值进行t检验,分析两者之间有无统计学差异.结果 早、晚期帕金森病患者和健康组左、右侧黑质的NAA/（Cho±Cr）值分别为0.63±0.10、0.51±0.10、0.79±0.07、0.64±0.11、0.50±0.12、0.80±0.06,帕金森病组患侧与正常侧、对照组比较差异有统计学意义（P＜0.05）,而正常侧与对照组比较差异无统计学意义（P＞0.05）.以NAA/（Cho±Cr）值来对早、晚期帕金森病进行分期,灵敏度曲线呈现低→高→低的变化,在0.59时,灵敏度最高.结论 1H-MRS不仅能对早、晚期帕金森病进行分期,而且能对帕金森病进行定侧.     

帕金森病的功能磁共振成像研究进展

帕金森病（PD）的主要病理改变是黑质多巴胺能神经元变性坏死并引起多巴胺递质减少,通过神经环路可引起包括脑皮质在内广泛的功能及结构改变.功能磁共振成像（fMRI）作为一项功能影像技术能灵敏地检测出这些变化,进而有可能为PD早期诊断提供依据.本文就PD的fMRI研究进展进行综述.     

帕金森病多模态磁共振成像和基于图论的复杂网络分析法研究进展

帕金森病是临床常见的进行性神经变性病,主要由黑质致密部多巴胺能神经元变性缺失所致,目前已成为继肿瘤、心脑血管病后中老年人群的“第三杀手”.近年来多模态MRI(包括结构性和功能性MRI、扩散张量成像等)的发展和基于图论的复杂网络分析法的引入,为研究帕金森病患者脑结构和功能连接提供新的有效方法.本文对近年来基于多模态MRI和基于图论的复杂网络分析法所构建的结构性和功能性脑网络在帕金森病中的研究进展进行简要概述,以为该病的早期诊断提供新的影像学标记.     

经颅多普勒超声黑质检测对帕金森病的诊断意义

目的 探讨经颅超声(TCS)检查帕金森病患者黑质(SN)回声的变化与临床症状的关系。方法(1)收集2013年6月-2015年3月就诊于本院神经内科接诊的56例帕金森病患者和31名自愿的健康对照者;(2)观察帕金森病患者中脑黑质回声强度及面积;(3)采用Hoehn-Yahr分期评定患者病情严重程度;(4)分析帕金森病患者SN回声的变化与年龄、病程及病情严重程度的关系。结果 帕金森病患者黑质高回声比例明显高于正常人群; 帕金森患者黑质高回声面积与年龄无明确关系,而与病程存在关系; 帕金森病患者中脑黑质回声强度与运动症状严重程度存在关系,而高回声面积与运动症状无明确关系。结论 黑质高回声可能是PD的一个特征性标记,临床上可将经颅黑质超声作为PD患者早期诊断及判断疾病严重程度依据之一。     

Combined R2* and Diffusion Tensor Imaging Changes in the Substantia Nigra in Parkinson's Disease

Recent magnetic resonance imaging studies suggest an increased transverse relaxation rate and reduced diffusion tensor imaging fractional anisotropy values in the substantia nigra in Parkinson's disease. The transverse relaxation rate and fractional anisotropy changes may reflect different aspects of Parkinson's disease‐related pathological processes (ie, tissue iron deposition and microstructure disorganization). This study investigated the combined changes of transverse relaxation rate and fractional anisotropy in the substantia nigra in Parkinson's disease. High‐resolution magnetic resonance imaging (T2‐weighted, T2*, and diffusion tensor imaging) were obtained from 16 Parkinson's disease patients and 16 controls. Bilateral substantia nigras were delineated manually on T2‐weighted images and coregistered to transverse relaxation rate and fractional anisotropy maps. The mean transverse relaxation rate and fractional anisotropy values in each substantia nigra were then calculated and compared between Parkinson's disease subjects and controls. Logistic regression, followed by receiver operating characteristic curve analysis, was employed to investigate the sensitivity and specificity of the combined measures for differentiating Parkinson's disease subjects from controls. Compared with controls, Parkinson's disease subjects demonstrated increased transverse relaxation rate (P < .0001) and reduced fractional anisotropy (P = .0365) in the substantia nigra. There was no significant correlation between transverse relaxation rate and fractional anisotropy values. Logistic regression analyses indicated that the combined use of transverse relaxation rate and fractional anisotropy values provides excellent discrimination between Parkinson's disease subjects and controls (c‐statistic = 0.996) compared with transverse relaxation rate (c‐statistic = 0.930) or fractional anisotropy (c‐statistic = 0.742) alone. This study shows that the combined use of transverse relaxation rate and fractional anisotropy measures in the substantia nigra of Parkinson's disease enhances sensitivity and specificity in differentiating Parkinson's disease from controls. Further studies are warranted to evaluate the pathophysiological correlations of these magnetic resonance imaging measurements and their effectiveness in assisting in diagnosing Parkinson's disease and following its progression. © 2011 Movement Disorder Society     

Multimodal Imaging of Substantia Nigra in Parkinson's Disease with Levodopa-Induced Dyskinesia

Background

Degeneration of the substantia nigra (SN) may contribute to levodopa-induced dyskinesia (LID) in Parkinson's disease (PD), but the exact characteristics of SN in LID remain unclear.

Objective

To further understand the pathogenesis of patients with PD with LID (PD-LID), we explored the structural and functional characteristics of SN in PD-LID using multimodal magnetic resonance imaging (MRI).

Methods

Twenty-nine patients with PD-LID, 37 patients with PD without LID (PD-nLID), and 28 healthy control subjects underwent T1-weighted MRI, quantitative susceptibility mapping, neuromelanin-sensitive MRI, multishell diffusion MRI, and resting-state functional MRI. Different measures characterizing the SN were obtained using a region of interest–based approach.

Results

Compared with patients with PD-nLID and healthy control subjects, the quantitative susceptibility mapping values of SN pars compacta (SNpc) were significantly higher (P = 0.049 and P = 0.00002), and the neuromelanin contrast-to-noise ratio values in SNpc were significantly lower (P = 0.012 and P = 0.000002) in PD-LID. The intracellular volume fraction of the posterior SN in PD-LID was significantly higher compared with PD-nLID (P = 0.037). Resting-state fMRI indicated that PD-LID in the medication off state showed higher functional connectivity between the SNpc and putamen compared with PD-nLID (P = 0.031), and the functional connectivity changes in PD-LID were positively correlated with Unified Dyskinesia Rating Scale total scores (R = 0.427, P = 0.042).

Conclusions

Our multimodal imaging findings highlight greater neurodegeneration in SN and the altered nigrostriatal connectivity in PD-LID. These characteristics provide a new perspective into the role of SN in the pathophysiological mechanisms underlying PD-LID. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.     

磁共振测量特发性震颤和帕金森病患者基底节区核团体积的研究

目的：利用磁共振体积测量技术评价特发性震颤（ET）,帕金森病（PD）患者基底节区核团体积的变化及互相间的差异。方法：采用1．5T磁共振机测量9例ET患者、5例PD患者和8例年龄匹配正常人全脑体积、尾状核和壳核体积。比较各组之间感兴趣区体积的差异。结果：PD组双侧尾状核标化体积之和、双侧壳核标化体积之和较正常人缩小（P〈0．05）。ET组双侧尾状核标化体积,双侧壳核标化体积与正常对照组无差别。结论：PD患者存在尾状核和壳核体积的缩小,而ET患者无明显尾状核和壳核体积变化。     

Early‐stage Parkinson's disease: Abnormal nigrosome 1 and 2 revealed by a voxelwise analysis of neuromelanin‐sensitive MRI

Previous pathologic studies evaluated the substantia nigra pars compacta (SNpc) of a limited number of idiopathic Parkinson''s disease (IPD) patients with relatively longer disease durations. Therefore, it remains unknown which region of the SNpc is most significantly affected in early‐stage IPD. We hypothesized that a voxelwise analysis of thin‐section neuromelanin‐sensitive MRI (NM‐MRI) may help determine the significantly affected regions of the SNpc in early‐stage IPD and localize these areas in each nigrosome on high‐spatial‐resolution susceptibility map‐weighted imaging (SMwI). Ninety‐six healthy subjects and 50 early‐stage IPD patients underwent both a 0.8 × 0.8 × 0.8 mm³ NM‐MRI and a 0.5 × 0.5 × 1.0 mm³ multi‐echo gradient‐recalled echo imaging for SMwI. Both NM‐MRI and SMwI templates were created by using image data from the 96 healthy subjects. Permutation‐based nonparametric tests were conducted to investigate spatial differences between the two groups in NM‐MRI, and the results were displayed on both NM‐MRI and SMwI templates. The posterolateral and anteromedial regions of the SNpc in NM‐MRI were significantly different between the two groups, corresponding to the nigrosome 1 and nigrosome 2 regions, respectively, on the SMwI template. There were the areas of significant spatial difference in the hypointense SN on SMwI between early‐stage IPD patients and healthy subjects. These areas on SMwI were slightly greater than those on NM‐MRI, including the areas showing group difference on NM‐MRI. Our voxelwise analysis of NM‐MRI suggests that two regions (nigrosome 1 and nigrosome 2) of the SNpc are separately affected in early‐stage IPD.     

Substantia Nigra Pars Reticulata Projections to the Pedunculopontine Nucleus Modulate Dyskinesia

Background

Long-term use of levodopa for Parkinson's disease (PD) treatment is often hindered by development of motor complications, including levodopa-induced dyskinesia (LID). The substantia nigra pars reticulata (SNr) and globus pallidus internal segment (GPi) are the output nuclei of the basal ganglia. Dysregulation of SNr and GPi activity contributes to PD pathophysiology and LID.

Objective

The objective of this study was to determine whether direct modulation of SNr GABAergic neurons and SNr projections to the pedunculopontine nucleus (PPN) regulates PD symptoms and LID in a mouse model.

Methods

We expressed Cre-recombinase activated channelrhodopsin-2 (ChR2) or halorhodopsin adeno-associated virus-2 (AAV2) vectors selectively in SNr GABAergic neurons of Vgat-IRES-Cre mice in a 6-hydroxydopamine model of PD to investigate whether direct optogenetic modulation of SNr neurons or their projections to the PPN regulates PD symptoms and LID expression. The forepaw stepping task, mouse LID rating scale, and open-field locomotion were used to assess akinesia and LID to test the effect of SNr modulation.

Results

Akinesia was improved by suppressing SNr neuron activity with halorhodopsin. LID was significantly reduced by increasing SNr neuronal activity with ChR2, which did not interfere with the antiakinetic effect of levodopa. Optical stimulation of ChR2 in SNr projections to the PPN recapitulated direct SNr stimulation.

Conclusions

Modulation of SNr GABAergic neurons alters akinesia and LID expression in a manner consistent with the rate model of basal ganglia circuitry. Moreover, the projections from SNr to PPN likely mediate the antidyskinetic effect of increasing SNr neuronal activity, identifying a potential novel role for the PPN in LID. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.     

Differential involvement of nigral subregions in idiopathic parkinson's disease

In this study, the prevalence of abnormality in putative nigrosome 1 and nigrosome 4 (N1 and N4, respectively) was investigated in early versus late‐stage idiopathic Parkinson's disease (IPD) patients. A total of 128 IPD patients (early stage[n = 89]; late stage[n = 39]) and 15 healthy subjects were scanned for high‐resolution (0.5 × 0.5 × 1.0 mm³) multiecho gradient‐recalled echo MRI and dopamine transporter PET imaging. The MRI data were processed for susceptibility map‐weighted imaging (SMWI) to improve a contrast‐to‐noise ratio, and the images were resliced at 0.5 mm to define N1 and N4. When each side of N1 and N4 was assessed separately for the loss of hyperintensity by two independent reviewers, the consensus review results showed that in early‐stage IPD (178 substantia nigras [SNs]), the loss of hyperintensity was observed more often in only the N1 region (65.2%) when compared to in both N1 and N4 regions (34.8%). In late‐stage IPD (78 SNs), on the other hand, the loss in only the N1 region (25.6%) was less prevalent than in both N1 and N4 (74.4%) (P < 0.0001). Additionally, intact SNs (both in N1 and N4) were observed 17 SNs (9.6%) of the early‐stage IPD patients, whereas it was not found in any SNs of the late‐stage IPD patients (P = 0.005). Moreover, involvement of both N1 and N4 on both sides was found in 19.1% of the early‐stage IPD patients, whereas its incidence was higher (61.5%) in the late‐stage IPD patients (P < 0.0001), suggesting that the loss of hyperintensity in IPD progresses from N1 to N4 as the disease advances. Hum Brain Mapp 39:542–553, 2018. © 2017 Wiley Periodicals, Inc.