摘要
目的 应用高角分辨率弥散成像(HARDI)生成纤维密度成像(TDI),探讨其在早期帕金森病(PD)患者脑白质纤维束微观结构变化中的应用价值.方法 2023年3月 2024年3月河南省人民医院诊治早期PD患者41例为早期PD组,健康体检者39例为对照组,2组均行HARDI全脑纤维追踪生成TDI,对其进行空间标准化以生成高分辨率TDI图像,并通过线性和非线性进行空间标准化,比较2组纤维束纤维密度值,以校正后P值(PFWE)＜0.05且团块尺寸＞50的体素为有显著差异.记录早期PD组国际运动障碍学会统一帕金森病评估量表(MDS-UPDRS)Ⅰ～Ⅲ评分、Hoehn-Yahr分期(H-Y分期)、帕金森病睡眠障碍量表(PDSS)评分、Epworth嗜睡量表(ESS)评分.采用Pearson相关法分析有显著差异的纤维束纤维密度值与MDS-UPDRS Ⅲ评分、H-Y分期、PDSS评分、ESS评分的相关性.结果 早期PD 组 MDS-UPDRS Ⅰ 评分(6.60±5.59)分,MDS-UPDRS Ⅱ 评分(8.27±7.15)分,MDS-UPDRS Ⅲ 评分(25.35±12.60)分,H-Y 分期(1.61±0.48)期,PDSS 评分(118.21±37.10)分,ESS 评分(5.59±5.05)分.早期 PD 组左、右侧丘脑前辐射(389.63±34.85、372.18±33.74),左、右侧皮质脊髓束(504.33±54.41、488.09±45.04),左、右侧下额枕束(533.04±71.74、585.50±68.22),左、右侧下纵束(478.69±47.00、575.16±52.57),左、右侧钩束(367.42±43.49、354.29±34.59)纤维密度值均低于对照组(437.61±49.67、425.92±50.91,568.19±68.12、555.33±72.40,632.05±87.58、687.49±94.63,544.47±66.00、647.87±72.91,435.66±87.78、397.19±65.15)(t=2.937～4.577,PFWE均＜0.05).右侧丘脑前辐射、左侧皮质脊髓束、左侧下额枕束、左侧下纵束纤维密度值与MDS-UPDRSⅢ评分均呈负相关(r=-0.346,P=0.029;r=-0.331,P=0.037;r=-0.362,P=0.022;r=-0.359,P=0.023);左侧丘脑前辐射、右侧皮质脊髓束、右侧下额枕束、右侧下纵束纤维密度值与PDSS评分均呈正相关(r=0.343,P=0.032;r=0.371,P=0.020;r=0.383,P=0.016;r=0.362,P=0.023).结论 TDI可广泛、精准地检测早期PD患者脑白质纤维束的微观结构变化,丘脑前辐射、皮质脊髓束、下纵束和下额枕束的纤维密度变化与运动及非运动症状密切相关.
Abstract
Objective To apply high angular resolution diffusion imaging(HARDI)to generate track density imaging(TDI),and to explore its value in the microstructural changes in white matter fiber bundles in patients with early Parkinson's disease(PD).Methods From March 2023 to March 2024,41 early PD patients(PD group)were diagnosed and treated in Henan Provincial People's Hospital,and another 39 healthy subjects(control group)received physical examination.Both groups underwent whole-brain tractography using HARDI to generate TDI.Spatial normalization was performed to obtain high-resolution TDI images,using both linear and nonlinear methods.Fiber density values were compared between two groups,with voxels of corrected P values(PFWE)＜0.05 and cluster sizes＞50 as significant differences.The Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale(MDS-UPDRS)Ⅰ-Ⅲ scores,Hoehn-Yahr stage(H-Y stage),Parkinson's Disease Sleep Scale(PDSS),and Epworth Sleepiness Score(ESS)were recorded in the PD group.Pearson correlation analysis was conducted to evaluate the relationships of significantly different fiber density values with MDS-UPDRS Ⅲ score,H-Y stages,PDSS and ESS.Results In the PD group,the MDS-UPDRS Ⅰ,Ⅱ and Ⅲ scores were 6.60±5.59,8.27±7.15 and 25.35±12.60,the H-Y stage was 1.61±0.48,the PDSS was 118.21±37.10,and the ESS was 5.59±5.05.The fiber density values of the left and right anterior thalamic radiation(389.63±34.85,372.18±33.74),corticospinal tract(504.33±54.41,488.09±45.04),inferior fronto-occipital fasciculus(533.04±71.74,585.50±68.22),inferior longitudinal fasciculus(478.69±47.00,575.16±52.57),and uncinate fasciculus(367.42±43.49,354.29±34.59)in the PD group were lower than those in the control group(437.61±49.67,425.92±50.91;568.19±68.12,555.33±72.40;632.05±87.58,687.49±94.63;544.47±66.00,647.87±72.91;435.66±87.78,397.19±65.15)(t=2.937-4.577,all PFWE values＜0.05).The fiber density values of the right anterior thalamic radiation,left corticospinal tract,left inferior fronto-occipital fasciculus,and left inferior longitudinal fasciculus were negatively correlated with MDS-UPDRS Ⅲ score(r=-0.346,P=0.029;r=-0.331,P=0.037;r=-0.362,P=0.022;r=-0.359,P=0.023),and the fiber density values of the contralateral ones were positively correlated with PDSS(r=0.343,P=0.032;r=0.371,P=0.020;r=0.383,P=0.016;r=0.362,P=0.023).Conclusion TDI can comprehensively and precisely detect the microstructural changes in the white matter fiber bundles of early PD patients,and the changes in fiber density in anterior thalamic radiation,corticospinal tract,inferior longitudinal fasciculus,and inferior fronto-occipital fasciculus are closely associated with both motor and non-motor symptoms.
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