CAJ | 학술논문

目的：探讨MR氨基质子转移（APT）成像技术测量帕金森病（PD）患者黑质和红核异常改变的可行性。方法27例PD患者（PD组）根据Hoehn&Yahr分期分为早期PD组（14例）和进展期PD组（13例）。23名年龄相匹配的健康志愿者作为对照组。PD患者中以右侧肢体起病者14例、以左侧肢体起病者13例。所有受试者均进行头颅APT成像，测量双侧黑质和红核氨基质子（3.5 ppm处）的不对称磁化转移率（MTRasym）。采用独立样本t检验比较PD组和对照组间红核和黑质的MTRasym（3.5 ppm），采用单因素方差分析比较正常对照者、早期和进展期PD患者间红核和黑质MTRasym（3.5 ppm）的差异。采用配对t检验比较PD患者各脑结构起病侧和对侧MTRasym（3.5 ppm）的差异。结果 PD组和对照组黑质的MTRasym（3.5 ppm）值分别为（0.96±0.35）%和（1.20±0.39）%，差异具有统计学意义（t=－2.093，P=0.039）；而PD组与对照组红核的MTRasym（3.5 ppm）值分别为（0.97±0.36）%和（1.09±0.38）%，差异无统计学意义（t=－1.148，P=0.254）。对照组、早期PD组和进展期PD组患者黑质的MTRasym（3.5 ppm）值分别为（1.20±0.30）%、（1.09±0.32）%、（0.81±0.37）%，红核的MTRasym（3.5 ppm）值分别为（1.09±0.28）%、（1.21±0.35）%和（0.71±0.33）%，3组间差异均具有统计学意义（黑质F=3.954，P=0.022；红核F=7.563，P=0.001）。PD患者起病侧和对侧黑质的MTRasym （3.5 ppm）值分别为（0.93±0.33）%和（0.99±0.30）%，红核的MTRasym（3.5 ppm）分别为（1.01±0.36）%和（0.93±0.29）%，两侧间差异均无统计学意义（t值分别为－0.660、0.545，P值分别为0.515、0.590）。结论APT成像可以显示PD患者和对照组黑质和红核MTRasym（3.5 ppm）的差异，可作为PD临床诊断和病情监测的有效工具。
목적：탐토MR안기질자전이（APT）성상기술측량파금삼병（PD）환자흑질화홍핵이상개변적가행성。방법27례PD환자（PD조）근거Hoehn&Yahr분기분위조기PD조（14례）화진전기PD조（13례）。23명년령상필배적건강지원자작위대조조。PD환자중이우측지체기병자14례、이좌측지체기병자13례。소유수시자균진행두로APT성상，측량쌍측흑질화홍핵안기질자（3.5 ppm처）적불대칭자화전이솔（MTRasym）。채용독립양본t검험비교PD조화대조조간홍핵화흑질적MTRasym（3.5 ppm），채용단인소방차분석비교정상대조자、조기화진전기PD환자간홍핵화흑질MTRasym（3.5 ppm）적차이。채용배대t검험비교PD환자각뇌결구기병측화대측MTRasym（3.5 ppm）적차이。결과 PD조화대조조흑질적MTRasym（3.5 ppm）치분별위（0.96±0.35）%화（1.20±0.39）%，차이구유통계학의의（t=－2.093，P=0.039）；이PD조여대조조홍핵적MTRasym（3.5 ppm）치분별위（0.97±0.36）%화（1.09±0.38）%，차이무통계학의의（t=－1.148，P=0.254）。대조조、조기PD조화진전기PD조환자흑질적MTRasym（3.5 ppm）치분별위（1.20±0.30）%、（1.09±0.32）%、（0.81±0.37）%，홍핵적MTRasym（3.5 ppm）치분별위（1.09±0.28）%、（1.21±0.35）%화（0.71±0.33）%，3조간차이균구유통계학의의（흑질F=3.954，P=0.022；홍핵F=7.563，P=0.001）。PD환자기병측화대측흑질적MTRasym （3.5 ppm）치분별위（0.93±0.33）%화（0.99±0.30）%，홍핵적MTRasym（3.5 ppm）분별위（1.01±0.36）%화（0.93±0.29）%，량측간차이균무통계학의의（t치분별위－0.660、0.545，P치분별위0.515、0.590）。결론APT성상가이현시PD환자화대조조흑질화홍핵MTRasym（3.5 ppm）적차이，가작위PD림상진단화병정감측적유효공구。
Objective To explore the feasibility of amide proton transfer (APT) MR imaging to detect cerebral abnormality of the substantia nigra and red nucleus in patients with Parkinson disease (PD). Methods Twenty-seven patients with PD and twenty-three age-matched healthy control subjects were recruited in this study. According to Hoehn&Yahr stages, PD group was divided into two subgroups:early-stage(n=14) and advanced-stage(n=13). PD with right limb onset were seen in 14 patients, and PD with left limb onset in 13 patients. All the PD patients and healthy controls underwent brain APT MR imaging. The magnetic resonance ratio asymmetry (MTRasym) values at 3.5 ppm of bilateral substantia nigra and red nucleus were measured on APT images. MTRasym(3.5 ppm)values of substantia nigra and red nucleus between PD patients and control subjects were compared with independent-samples t test. The difference of MTRasym(3.5 ppm)among normal controls, early-stage PD, and advanced-stage PD patients was assessed with one-way analysis of variance. Paired-samples t test was used to compare the difference of MTRasym (3.5 ppm) in substantia nigra and red nucleus between the side of onset and contralateral side in PD patients. Results Compared to normal controls, MTRasym(3.5 ppm) values of substantia nigra significantly decreased in PD patients[(0.96±0.35)%vs. (1.20±0.39)%respectively, t=-2.093 P=0.039]. No significant differences in MTRasym (3.5 ppm) values of red nucleus were observed between normal controls and PD patients[(0.97 ± 0.36)% vs. (1.09 ± 0.38)% respectively, t=-1.148, P=0.254]. Significant differences in MTRasym(3.5ppm) values of these cerebral structures were observed among normal controls, early-stage PD and advanced-stage PD [substantia nigra(1.20±0.30)%,(1.09±0.32)%and(0.81±0.37)%respectively, F=3.954, P=0.022;red nucleus(1.09±0.28)%,(1.21±0.35)%and(0.71±0.33)%respectively, F=7.563, P=0.001]. MTRasym(3.5 ppm) in substantia nigra showed a consistently decreasing tendency from normal controls to early-stage PD, to advanced-stage PD. MTRasym(3.5 ppm) values of sides of onset and contralateral sides of substantia nigra and red nucleus in PD patients had no significant statistically difference (substantia nigra(0.93 ± 0.33)% vs.(0.99 ± 0.30)%, t=-0.660, P=0.515; red nucleus(1.01 ± 0.36)% vs.(0.93 ± 0.29)%, t=0.545, P=0.590). Conclusions APT MR imaging can show sensitively the difference of MTRasym (3.5 ppm) in substantia nigra and red nucleus between early PD patients and normal controls, Thus, APT is a useful tool to diagnose PD and monitor the disease progression.