弥散张量成像在血管性帕金森综合征诊断中的应用

摘要

Objective To study the pathogenesis of lower limb motor disorder in vascular parkinsonism(VP)using diffusion tensor image(DTI). Methods A case⁃control study was performed in a cohort of 16 VP patients and 32 PD patients. Patients were all recruited from the first affiliated hospital of China Medical University from Dec. 2011 to Dec. 2012. The lower limb motor function of those patients was assessed using measurement scales. All patients received magnetic resonance image(MRI)and diffusion tensor image(DTI). Results Patients in VP group showed more seri⁃ous movement disorders such as freezing of gait(gait ignition failure)than these in PD group,and the movement disorders of their lower limbs prog⁃ress more rapidly in VP group than the PD group. Movement disorders of their lower limbs in VP group were related to fibers in bilateral frontal lobes (P=0.008). Movement disorder of their lower limbs in PD group were related to fibers in substantia nigra(P=0.030). There are statistically signifi⁃cant differences in both the FA values of substantia nigra,bilateral frontal lobes and the ADC values of frontal lobes,and the pars compacta and pars reticulata of substantia nigra between these two groups(all P<0.05). Conclusion Movement disorders of bilateral lower limbs are more seriously manifested in VP patients than in PD patients. The onset movement dysfunction of bilateral lower limbs is closely related to fibers in the frontal lobe.%目的：探讨弥散张量成像（DTI）在血管性帕金森综合征（VP）诊断中的应用及VP患者下肢运动障碍的致病机制。方法选取2011年12月至2012年12月就诊于中国医科大学附属第一医院神经内科16例VP患者（VP组）及32例帕金森病患者（PD组），应用量表及DTI检查评价患者的双下肢运动功能。结果 VP组与PD组比较存在严重的双下肢运动障碍（冻结步态、起步困难等）。VP组患者双下肢运动障碍与双侧额叶纤维束相关（P=0.008）。PD组双下肢运动障碍与黑质纤维束相关（P=0.030）。2组在黑质、双侧额叶各项异性值，额叶、黑质致密部及网状部表观弥散系数存在统计学差异（均P<0.05）。结论 VP患者较PD患者存在更为严重的下肢运动障碍；DTI为鉴别VP与PD提供了新的方法；VP患者双下肢运动障碍形成可能与额叶纤维束密切相关。