Parkinson's disease: diagnosis.
Parkinson's disease: diagnosis.
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DOI：
10.1016/s1353-8020(11)70012-8
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发表时间：
2012-01-01
影响因子：
4.1
通讯作者：
Brooks, David J
中科院分区：
文献类型：
--
作者：
Brooks, David J
在已建立的PD中，由专家应用的Queen Square Brain Bank标准显示中脑路易体存在的敏感性和特异性为90%。然而，在早期疾病中，临床诊断并不那么简单。在社区中由非专家做出的PD诊断与25%的错误率相关。黑质异常现在可以在体内检测7特斯拉MRI和扩散张量MRI。磁化转移可以证明黑质中的黑色素损失。经颅超声（TCS）检测散发性和遗传性PD中脑高回声。PET和SPECT配体可以证明在早期和临床前疾病中存在多巴胺末端功能障碍，以及皮质和皮质下区域中静息脑血流代谢水平之间的异常协方差模式。在非典型帕金森综合征中，多系统萎缩（MSA）T2加权MRI可以显示特征性变化，包括由于铁沉积引起的putmen信号减少和脑桥“热十字面包”征，因为横纤维变得可见。进行性核上性麻痹（PSP）与中脑萎缩和第三脑室增宽有关。在这两种情况下，弥散加权MRI显示纹状体水扩散率增加，但MSA靶向小脑中脚，PSP靶向上级脚。在这篇综述中，将讨论结构和功能成像在支持各种退行性帕金森综合征鉴别诊断中的作用。
In established PD the Queen Square Brain Bank criteria applied by experts show 90% sensitivity and specificity for the presence of midbrain Lewy bodies. However, in early disease clinical diagnosis is less straightforward. PD diagnosis made in the community by non-experts is associated with a 25% error rate. Nigral abnormalities can now be detected in vivo with 7 tesla MRI and diffusion tensor MRI. Magnetisation transfer can demonstrate melanin loss in the substantia nigra. Transcranial sonography (TCS) detects midbrain hyperechogenicity in both sporadic and genetic PD. PET and SPECT ligands can demonstrate the presence of dopamine terminal dysfunction in early and preclinical disease and an abnormal covariance pattern between levels of resting brain blood flow metabolism in cortical and subcortical regions. In the atypical parkinsonian syndrome multiple system atrophy (MSA) T2-weighted MRI can reveal characteristic changes including reduced putmen signal due to iron deposition and the pontine 'hot cross bun' sign as transverse fibres become visible. Progressive supranuclear palsy (PSP) is associated with midbrain atrophy and 3(rd) ventricular widening. In both these conditions diffusion weighted MRI shows increased striatal water diffusivity but the middle cerebellar peduncle is targeted in MSA and the superior peduncle in PSP. In this review the role of structural and functional imaging for supporting the differential diagnosis of the various degenerative parkinsonian syndromes will be discussed.