Application value of amide proton transfer combined with quantitative susceptibility mapping in the diagnosis of Parkinson's disease
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摘要:
目的 探讨酰胺质子转移成像(APT)和定量磁化率成像(QSM)对帕金森病（PD）诊断的临床应用价值。 方法 纳入2022年6月~2023年6月新疆医科大学第二附属医院明确诊断为PD的患者38例作为PD组，另招募同时期相匹配的健康志愿者22例作为对照（HC）组。对所有受试者进行QSM和APT序列扫描，利用后处理软件获取所有受试者黑质区域的磁化率值（MSV）及非对称性磁化转移率（MTRasym），利用Logistic回归建模两种参数联合诊断时的预测概率，采用ROC曲线比较分析单一成像技术及两种成像技术联合的诊断效能。 结果 对比HC组，PD组双侧黑质的平均MSV值升高，平均MTRasym值减低，差异有统计学意义(P < 0.001)。运动症状受影响较重侧黑质的MSV值高于受影响较轻侧（P < 0.001），运动症状受影响较重侧黑质的MTRasym值低于受影响较轻侧(P < 0.05)。使用双侧黑质MSV和MTRasym的平均值，APT、QSM以及QSM联合APT的ROC曲线下面积分别为0.812、0.873、0.897，使用运动症状受影响较重侧黑质的MSV和MTRasym值，QSM联合APT的ROC曲线下面积为0.928。 结论 QSM和APT对PD均具有较高的诊断效能，与单独使用QSM或APT相比，QSM联合APT对PD的诊断效能更高，能够为PD的准确诊断提供影像学依据。 Abstract:Objective To explore the clinical application value of amide proton transfer (APT) and quantitative susceptibility mapping (QSM) for the diagnosis of Parkinson's disease (PD). Methods A total of 38 patients who were diagnosed with PD in the Second Affiliated Hospital of Xinjiang Medical University from June 2022 to June 2023 were included as the PD group, and 22 matched healthy control volunteers were recruited during the same period. QSM and APT images of all subjects were collected. The magnetic susceptibility value (MSV) and magnetization transfer asymmetry (MTRasym) of the substantia nigra region were obtained. The prediction probability of the combined diagnosis of two kinds of parameters was modeled by Logistics regression, and the diagnostic efficiency of the single imaging technology and the combined diagnosis of two kinds of imaging technology was compared by the ROC curve. Results Compared with the healthy control group, the average MSV value of substantia nigra in the PD group was significantly higher, while the average MTRasym value of substantia nigra in the PD group was significantly lower (P < 0.001). MSV value of substantia nigra on the more heavily affected side was higher than that on the less lightly affected side(P < 0.001), and MTRasym value of substantia nigra on the more heavily affected side was lower than that on the less lightly affected side (P < 0.05). Using the average values of bilateral substantia nigra, the area under the ROC curve of APT, QSM and QSM combined with APT were 0.812, 0.873, 0.897. While using the values of the more affected side, the area under the ROC curve of QSM combined with APT was 0.928. Conclusion Both QSM and APT have high diagnostic efficacy for PD. QSM combined with APT has higher diagnostic efficacy for PD compared with QSM or APT alone and can provide an imaging basis for accurate diagnosis of PD. -
图 1 PD与HC典型病例影像
Figure 1. PD and HC typical case images. QSM(A) image and APT (B) image of a typical normal control (female, 66 years old). QSM (C) image and APT (D) image of a PD patient (female, 69 years old, this patient was diagnosed with Parkinson's disease, right upper limb tremor with motor delay for 5 years). The MSV in regions of the right substantia nigra (white arrow) were higher in PD patients than in normal controls. The MTRasym in regions of the right substantia nigra (black arrow) were lower in PD patients than in normal controls.
图 2 QSM、APT以及联合QSM和APT的ROC曲线比较
Figure 2. ROC curve of QSM, APT and QSM combined with APT.
表 1 PD与HC组间差异分析
Table 1. Analysis of differences between PD and HC groups (Mean±SD)
Index PD group (n=38) HC group (n=20) t P MSV_Mean 0.096±0.015 0.074±0.012 5.891 < 0.001 MSV_More 0.102±0.017 - 7.485 < 0.001 MSV_Less 0.091±0.017 - 4.032 < 0.001 MTRasym_Mean 1.196±0.481 1.723±0.488 4.067 < 0.001 MTRasym_More 1.029±0.658 - 4.300 < 0.001 MTRasym_Less 1.389±0.734 - 1.897 0.063 MSV: Magnetic susceptibility value; MTRasym: Magnetization transfer asymmetry; Mean: Mean values; More: Values in the more-affected side in PD; Less: Values in the less-affected side in PD. 
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表 2 QSM、APT及两者联合在PD的诊断价值
Table 2. The diagnostic value of QSM, APT and their combination in PD
Index AUC SE P 95% CI Sensitivity(%) Specificity (%) APT 0.812 0.062 ＜0.001 0.691-0.934 81.6 77.3 QSM 0.873 0.044 ＜0.001 0.865-0.992 86.8 72.7 QSM&APT_Mean 0.897 0.044 ＜0.001 0.812-0.983 84.2 81.8 QSM&APT_More 0.928 0.032 ＜0.001 0.787-0.959 94.7 77.3 QSM&APT_Mean: Combining QSM and APT values in mean substantia nigra; QSM&APT_More: Combining QSM and APT values in the more-affected side of substantia nigra.
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