磁敏感加权成像黑质“燕尾征”在帕金森病中的诊断价值

Diagnostic value of "swallow tail" appearance in the substantia nigra using susceptibility weighted imaging in Parkinson's disease

摘要:

目的： 探讨3.0 T磁敏感加权成像（susceptibility weighted imaging，SWI）中“燕尾征”缺失在帕金森病（Parkinson's disease，PD）的诊断价值并分析黑质小体-1（nigrosome-1）可视化与PD患者临床资料的相关性。 方法： 收集2017年9月至2019年11月于重庆医科大学附属第一医院神经内科住院的50例PD患者及年龄、性别与之匹配的57例非PD患者。所有受试者均接受3.0 T头颅SWI检查。在获得的SWI图像上，由2名临床医师采用盲法独立对双侧“燕尾征”进行评估。一侧“燕尾征”缺失即判定为PD。计算“燕尾征”缺失诊断PD的灵敏度、特异度、预测值和准确度，并分析nigrosome-1可视化与PD患者临床资料的相关性。 结果： 以临床诊断作为金标准，45例PD患者判断正确，评估者之间的一致性很高（k=0.963，P=0.000）。“燕尾征”缺失诊断PD的灵敏度为90.0%，特异度为91.2%，阳性预测值为90.0%，阴性预测值为91.2%，准确度为90.7%。44例PD患者临床症状不对称，其中32例患者nigrosome-1可视化不对称。PD患者nigrosome-1可视化偏侧和临床症状偏侧比较差异无统计学意义（χ²=5.756，P=0.056）。11例PD患者双侧nigrosome-1全部缺失，纳入全部缺失组，其余PD患者为非全部缺失组。全部缺失组和非全部缺失组患者的汉密尔顿抑郁量表评分差异有统计学意义（U=126.500，P=0.038），而病程、帕金森病统一评定量表第Ⅲ部分、改良Hoehn-Yahr（H-Y）分级、简易智能状态量表和蒙特利尔认知评估量表评分差异均无统计学意义（P=0.768、0.140、0.839、0.054、0.067）。 结论： “燕尾征”缺失诊断PD的准确率较高，缺失程度可能与PD患者的抑郁程度有关，对PD的诊断有一定参考价值。

Abstract:

Objective: To explore the diagnostic value of the absence of "swallow tail" appearance at 3.0 T susceptibility weighted imaging (SWI) in Parkinson's disease (PD) and analyze the correlation between visualization of nigrosome-1 and clinical data of PD patients. Methods: We enrolled 50 PD patients and 57 sex-and age-matched non-PD patients from the Department of Neurology, The First Affiliated Hospital of Chongqing Medical University from September 2017 to November 2019.All subjects underwent 3.0 T SWI. Bilateral "swallow tail" appearance on the SWI images were evaluated by two clinicians blinded to the clinical data and diagnosis. The absence of "swallow tail" on one side was diagnosed as PD. Then, the sensitivity, specificity, accuracy and predictive values of the absence of "swallow tail" appearance in the diagnosis of PD were calculated. The correlation between visualization of nigrosome-1 and clinical data was also assessed. Results: Taking clinical diagnosis as the gold standard, and the absence of "swallow tail" on one side as the image diagnosis standard for PD, 45 patients were diagnosed correctly. Inter-rater agreement was excellent (k=0.963, P=0.000). The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of discriminating PD patients from non-PD patients with the absence of "swallow tail" appearance were 90.0%, 91.2%, 90.7%, 90.0% and 91.2%, respectively. The clinical symptoms of 44 PD patients were asymmetrical, among which 32 cases of nigrosome-1 visualization were asymmetrical. There was no significant difference between poorly visualized nigrosome-1 and clinical symptoms in PD patients (χ²=5.756, P=0.056). Bilateral nigrosome-1 absence occurred in 11 PD patients, which were "total absence group", and the rest of PD patients were "non-total absence group". There was a significant difference in the hamilton depression rating Scale score between "total absence group" and "non-total absence group" (U=126.500, P=0.038), while, there were no significant differences in the duration, modified Hoehn-Yahr stage, the Unified Parkinson's disease rating scale part Ⅲ score, the mini mental state examination score and the Montreal cognitive assessment score between two groups (P=0.768, P=0.140, P=0.839, P=0.054, P=0.067). Conclusion: The absence of "swallow tail" appearance at 3.0 T SWI has a high accuracy in the diagnosis of PD and the degree of absence may be related to the depression degree of PD patients, and has certain reference value for the diagnosis of PD.