弥散张量成像对帕金森病前驱期的诊断价值

doi:10.3969/j.issn.1006-5725.2023.21.025

Abstract

Abstract:

Objective To explore the value of diffusion-tensor imaging （DTI） of different gray matter nuclei in the diagnosis and assessment of prodromal Parkinson's disease （pPD） under logistic regression model. Methods A total of 20 patients with pPD were collected as case group and 28 healthy people as control group （HC group）. All patients were examined by MRI plain scan and DTI. DSI studio was used to post-process the DTI images of all patients. Parameters （FA, MD, AD, RD） of basal ganglia, midbrain and brainstem of patients with pPD and HC group were automatically extracted and statistically analyzed. Logistic regression analysis was used to draw the Receiver Operating Characteristic （ROC） curve to analyze and compare the diagnostic efficacy of individual diagnosis and combined diagnosis of each parameter. And the correlation between the parameters of each group and MMSE score was analyzed. Results There were statistical differences in basal ganglia, midbrain and brain stem in PPD and HC group （P < 0.05）. Under Logistic regression equation model, when the optimal threshold was 0.63, the AUC of PPD was 0.964. The sensitivity and specificity of differential diagnosis were 85.0% and 100% respectively （P < 0.001）. There was correlation between DTI parameters and MMSE score in locus coeruleus in PPD group （P < 0.05）, and the correlation coefficient of FA value in locus coeruleus （r = -0. 646, P = 0.002） was the highest. Conclusions The lesions of basal ganglia, midbrain and brainstem correlated gray matter nuclei in pPD were extensive and different in degree. AD value of locus coeruleus was valuable for quantitative diagnosis of pPD, FA value of locus coeruleus could be used as a characteristic sensitive index for recognition of the severity of dysfunction in pPD patients. Multi-parameter combined diagnosis of DTI under Logistic regression model could effectively improve the diagnostic efficiency, and provide valuable reference for early diagnosis and intervention of pPD.

Key words: Parkinson's disease prodromal stage, diffusion tensor imaging, gray matter nuclei, MMSE score

CLC Number:

R445

Lei GENG,Rui WANG,Zhaoting ZHANG,Lei XU,Hai HUANG,Yi SUN,Fumeng YANG,Chunfeng. HU. The diagnostic value of diffusion tensor imaging for the prodromal phase of Parkinson′s disease[J]. The Journal of Practical Medicine, 2023, 39(21): 2843-2849.

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References 17

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项目	pPD组	HC组	t/χ²值	P值
年龄（岁）	64.8 ± 8.28	62.1 ± 5.86	1.265	0.215
性别（男/女）	9/11	18/10	1.763	0.184
受教育程度（年）	8.25 ± 4.0	8.25 ± 3.62	< 0.001	1.0
MMSE［M（P₂₅，P₇₅），分］	28（28,30）
病程（年）	5.5 ± 2.40
UPDRS III	8.15 ± 2.81

项目	pPD组	HC组	t值	P值
尾状核	0.41 ± 0.02	0.42 ± 0.03	-1.844	0.072
壳核	0.45 ± 0.03	0.47 ± 0.03	-1.736	0.089
苍白球内侧部	0.48 ± 0.02	0.50 ± 0.03	-1.855	0.066
苍白球外侧部	0.46 ± 0.02	0.48 ± 0.03	-1.847	0.071
丘脑下核	0.40 ± 0.03	0.42 ± 0.03	-1.906	0.063
黑质	0.48 ± 0.02	0.50 ± 0.03	-2.504	0.016
红核	0.46 ± 0.03	0.47 ± 0.03	-1.212	0.232
中缝核	0.40 ± 0.02	0.44 ± 0.07	-2.432	0.02
蓝斑核	0.45 ± 0.05	0.49 ± 0.04	-3.413	0.001
背外侧背盖核	0.46 ± 0.02	0.48 ± 0.04	-2.297	0.026

项目	pPD组	HC组	t值	P值
尾状核	0.96 ± 0.05	0.93 ± 0.04	1.963	0.056
壳核	0.85 ± 0.04	0.83 ± 0.04	1.906	0.063
苍白球内侧部	0.84 ± 0.04	0.82 ± 0.04	1.939	0.059
苍白球外侧部	0.85 ± 0.04	0.82 ± 0.05	1.898	0.064
丘脑下核	0.93 ± 0.06	0.91 ± 0.04	1.839	0.076
黑质	0.86 ± 0.07	0.82 ± 0.05	2.541	0.016
红核	0.93 ± 0.08	0.91 ± 0.06	0.886	0.380
中缝核	1.07 ± 0.10	0.96 ± 0.21	2.032	0.048
蓝斑核	0.95 ± 0.17	0.85 ± 0.07	2.444	0.022
背外侧背盖核	0.79 ± 0.21	0.81 ± 0.05	-0.587	0.564

项目	pPD组	HC组	t值	P值
尾状核	1.37 ± 0.06	1.33 ± 0.06	1.891	0.065
壳核	1.29 ± 0.04	1.26 ± 0.05	2.130	0.039
苍白球内侧部	1.31 ± 0.05	1.28 ± 0.05	1.935	0.059
苍白球外侧部	1.29 ± 0.05	1.26 ± 0.04	2.006	0.051
丘脑下核	1.42 ± 0.09	1.36 ± 0.06	2.602	0.012
黑质	1.34 ± 0.08	1.29 ± 0.06	2.610	0.013
红核	1.39 ± 0.07	1.36 ± 0.06	1.703	0.095
中缝核	1.49 ± 0.10	1.36 ± 0.28	2.047	0.046
蓝斑核	1.47 ± 0.14	1.32 ± 0.09	4.368	< 0.001
背外侧背盖核	1.19 ± 0.32	1.27 ± 0.06	-1.128	0.273

项目	pPD组	HC组	t值	P值
尾状核	0.75 ± 0.05	0.73 ± 0.04	1.842	0.074
壳核	0.63 ± 0.05	0.60 ± 0.04	1.949	0.057
苍白球内侧部	0.61 ± 0.04	0.59 ± 0.05	1.261	0.214
苍白球外侧部	0.62 ± 0.04	0.60 ± 0.04	1.997	0.052
丘脑下核	0.68 ± 0.06	0.68 ± 0.03	0.170	0.866
黑质	0.63 ± 0.06	0.60 ± 0.05	1.880	0.069
红核	0.69 ± 0.08	0.69 ± 0.06	0.174	0.862
中缝核	0.84 ± 0.07	0.75 ± 0.16	2.684	0.011
蓝斑核	0.70 ± 0.21	0.60 ± 0.07	2.033	0.054
背外侧背盖核	0.59 ± 0.13	0.59 ± 0.05	0.226	0.823

The diagnostic value of diffusion tensor imaging for the prodromal phase of Parkinson′s disease

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参数	AUC	95%CI	最佳界值	敏感度（%）	特异度（%）	P值
黑质FA	0.686	0.537 ~ 0.835	0.50	95.0	42.9	0.03
中缝核FA	0.668	0.513 ~ 0.823	0.41	70.0	54.3	0.049
蓝斑核FA	0.808	0.676 ~ 0.940	0.48	95.0	67.9	< 0.001
背外侧背盖核FA	0.721	0.577 ~ 0.866	0.45	50.0	85.7	0.01
黑质MD（× 10^-3mm²/s）	0.696	0.544 ~ 0.849	0.81	85.0	46.4	0.021
中缝核MD（× 10^-3mm²/s）	0.641	0.484 ~ 0.798	1.00	80.0	53.6	0.099
蓝斑核MD（× 10^-3mm²/s）	0.800	0.667 ~ 0.933	0.95	60.0	92.9	< 0.001
壳核AD（× 10^-3mm²/s）	0.704	0.554 ~ 0.853	1.28	65.0	75.0	0.017
丘脑下核AD（× 10^-3mm²/s）	0.695	0.530 ~ 0.859	1.44	50.0	89.3	0.023
黑质AD（× 10^-3mm²/s）	0.696	0.544 ~ 0.849	1.31	55.0	78.6	0.021
中缝核AD（× 10^-3mm²/s）	0.659	0.501 ~ 0.817	1.42	80.0	50.0	0.063
蓝斑核AD（× 10^-3mm²/s）	0.846	0.739 ~ 0.952	1.34	80.0	75.0	< 0.001
中缝核RD（× 10^-3mm²/s）	0.687	0.537 ~ 0.838	0.81	85.0	60.7	0.028

自变量	偏回归系数	标准误	Wald值	P值	OR值	95%CI
黑质FA	38.634	56.561	0.467	0.495	6.0×10¹⁶	< 0.001～8.38 × 10⁶⁴
中缝核FA	-177.688	89.339	3.956	0.047	< 0.001	< 0.001～0.075
蓝斑核FA	-49.062	43.683	1.261	0.261	< 0.001	< 0.001～7.51 × 10¹⁵
背外侧背盖核FA	-30.201	37.300	0.656	0.418	< 0.001	< 0.000～4.30 × 10¹⁸
黑质MD	-38.391	32.605	1.386	0.239	< 0.001	< 0.001～1.20 × 10¹¹
中缝核MD	-20.819	13.547	2.362	0.124	< 0.001	< 0.001～308.910
蓝斑核MD	-19.010	14.274	1.774	0.183	< 0.001	< 0.001～7842.231
壳核AD	62.361	38.820	2.581	0.108	1.21 × 10²⁷	< 0.001～1.34 × 10⁶⁰
丘脑下核AD	45.056	24.670	3.335	0.068	3.69 × 10¹⁹	0.037～3.69 × 10⁴⁰
黑质AD	31.500	18.063	3.041	0.081	4.79 × 10¹³	0.020～1.14 × 10²⁹
中缝核AD	-17.234	23.708	0.528	0.467	< 0.001	< 0.001～4.96 × 10¹²
蓝斑核AD	23.292	10.731	4.711	0.030	1.31 × 10¹³	9.583～1.78 × 10¹⁹
中缝核RD	81.648	40.927	3.980	0.046	2.88 × 10³⁵	4.190～1.98 × 10⁷⁰
常数项	-94.550	61.278	2.381	0.123	< 0.001	-

参数		尾状核	壳核	苍白球内侧部	苍白球外侧部	丘脑下核	黑质	红核	中缝核	蓝斑核	背外侧背盖核
FA	r值	-0.095	-0.306	0.230	0.230	0.188	0.068	0.071	-0.091	0.648	0.099
FA	P值	0.691	0.190	0.330	0.330	0.427	0.775	0.768	0.702	0.002	0.676
MD	r值	-0.075	0.074	-0.059	-0.009	-0.384	-0.032	0.038	-0.265	-0.479	0.219
MD	P值	0.753	0.755	0.806	0.971	0.095	0.893	0.872	0.259	0.033	0.355
AD	r值	-0.220	0.026	-0.111	-0.024	-0.197	-0.081	0.117	-0.232	-0.457	0.147
AD	P值	0.351	0.914	0.641	0.919	0.404	0.735	0.624	0.3254	0.043	0.535
RD	r值	0.000	0.179	-0.045	-0.085	-0.159	0.035	0.061	-0.351	-0.507	-0.004
RD	P值	1.000	0.449	0.849	0.720	0.502	0.883	0.798	0.129	0.023	0.987

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