Subcortical atrophy and perfusion patterns in Parkinson disease and multiple system atrophy
Subcortical atrophy and perfusion patterns in Parkinson disease and multiple system atrophy
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DOI：
10.1016/j.parkreldis.2020.02.009
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发表时间：
2020-03-01
影响因子：
4.1
通讯作者：
Pellecchia, Maria Teresa
中科院分区：
文献类型：
--
作者：
Erro, Roberto;Ponticorvo, Sara;Pellecchia, Maria Teresa
背景资料：帕金森病（Parkinson disease，PD）和多系统萎缩（multiple system atrophy，MSA）的临床鉴别是一个难点。目的：动脉自旋标记（Arterial spin labeling，ASL）是一种先进的MRI技术，它避免了使用外源性造影剂来估计脑灌注。方法：94例PD患者（PD组30例，MSA组30例，健康对照组34例）行形态测量和ASL-MRI检查，测量基底节区和小脑的体积和灌注值。感兴趣的区域进行分析，以测试结构性萎缩和区域血流量groups.Results之间的差异：MSA患者表现出较高的皮质下萎缩比PD患者和HC，而后者之间没有观察到差异。MSA和PD在几个小脑区域（脚I，脚II，右VIIb，右Villa，右VIIIb），右尾状核和两侧丘脑显示出较低的体积校正灌注值。MSA和PD患者在所有上述区域显示相似的灌注值，但右侧小脑VIIIb区（MSA较低）和右侧尾状核和双侧丘脑（PD较低）。当比较PD和MSA患者与parkinsonian variant.Conclusions时，获得了类似的结果：在MSA和PD患者中同样观察到与认知相关的小脑区域的灌注减少（即，执行功能（executive）而不是运动功能。所观察到的低灌注不能用萎缩来解释，这表明小脑参与了MSA和PD的病理生理学。
Background: The clinical differentiation between Parkinson disease (PD) and multiple system atrophy (MSA) is difficult.Objectives: Arterial spin labeling (ASL) is an advanced MRI technique that obviates the use of an exogenous contrast agent for the estimation of cerebral perfusion. We explored the value of ASL in combination with structural MRI for the differentiation between PD and MSA.Methods: Ninety-four subjects (30 PD, 30 MSA and 34 healthy controls) performed a morphometric and ASL-MRI to measure volume and perfusion values within basal ganglia and cerebellum. A region-of-interest analysis was performed to test for structural atrophy and regional blood flow differences between groups.Results: MSA patients showed higher subcortical atrophy than both PD patients and HC, while no differences were observed between the latter. MSA and PD showed lower volume-corrected perfusion values than HC in several cerebellar areas (Crus I, Crus II, right VIIb, right Villa, right VIIIb), right caudate and both thalami. MSA and PD patients displayed similar perfusion values in all aforementioned areas, but the right cerebellar area VIIIb (lower in MSA) and right caudate and both thalami (lower in PD). Similar results were obtained when comparing PD and MSA patients with the parkinsonian variant.Conclusions: A perfusion reduction was equally observed in both MSA and PD patients in cerebellar areas that are putatively linked to cognitive (i.e., executive) rather than motor functions. The observed hypo-perfusion could not be explained by atrophy, suggesting the involvement of the cerebellum in the pathophysiology of both MSA and PD.