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目的研究磁共振脑径线测量对于多系统萎缩(MSA)的诊断价值。方法 11例 MSA患者,可能 MSA 2例,拟诊 MSA 9例。其中以帕金森综合征为主要表现(MSA-P)5例,以小脑性共济失调为主要表现(MSA-C)6例。健康对照组6名,病例对照组9例(帕金森病1例、其他类型的帕金森综合征8例)。选取反映脑干、小脑和基底节形态学的径线进行测量,计算全脑三维体积,比较各项参数的组间差异。结果 MSA 组的脑桥横径(mm,下同)明显短于健康对照组和病例对照组(27.6±2.0、30.5±0.6、29.9±1.1),MSA 患者的四脑室前后径(11.9±2.8)明显长于健康对照(9.0±2.1)。MSA-C 组的脑桥横径明显短于健康对照组和病例对照组(27.2±2.1、30.5±0.6、29.9±1.1)。MSA-C 患者的四脑室前后径和横径(12.8±2.6和9.0±2.1)明显长于健康对照(17.3±2.1和13.8±1.7)。MSA-P 患者的脑桥横径较健康对照组短(28.2±1.8、30.5±0.6)。MSA-P 患者的苍白球最长径(23.7±5.0)和红核直径(6.6±0.8)明显较 MSA-C 患者(29.7±2.4和8.2±0.4)短。MSA-C 患者的第四脑室横径较 MSA-P 患者宽(17.3±2.1、12.6±2.7),小脑中脚宽度较 MSA-P 患者缩短(13.3±1.9、15.8±1.2)。结论磁共振脑体积径线测量对于 MSA 患者脑组织局部萎缩的程度提供了量化的手段。脑桥的横径缩短可以客观地反映 MSA 患者脑桥的萎缩,但不能用于区分 MSA-P 和 MSA-C。MSA-C 患者更易出现第四脑室的扩大和 MCP 的萎缩,MSA-P 患者更易出现红核萎缩。
Objective To study the diagnostic value of magnetic resonance imaging (MRA) for multiple system atrophy (MSA). Methods 11 cases of MSA patients, 2 cases may MSA, 9 cases of MSA to be diagnosed. Among them, 5 were diagnosed as Parkinson’s syndrome (MSA-P) and 6 were MSA-C (mainly cerebellar ataxia). 6 healthy controls, 9 case-control subjects (1 Parkinson’s disease and 8 other Parkinson’s syndromes). The diameters of the brainstem, cerebellum and basal ganglia were selected to measure the three-dimensional volume of the whole brain and the differences between the groups were compared. Results The transverse diameter of trabecular meshwork (mm, the same below) in MSA group was significantly shorter than that in healthy control group and case control group (27.6 ± 2.0,30.5 ± 0.6,29.9 ± 1.1), and the anterior and posterior dimensions (11.9 ± 2.8) in MSA group were significantly Longer than healthy controls (9.0 ± 2.1). The transverse diameter of the pons in MSA-C group was significantly shorter than that in healthy controls and the case-control group (27.2 ± 2.1, 30.5 ± 0.6, 29.9 ± 1.1). The anteroposterior diameter and transverse diameter (12.8 ± 2.6 and 9.0 ± 2.1) in MSA-C patients were significantly longer than those in healthy controls (17.3 ± 2.1 and 13.8 ± 1.7). Pituitary diameters in MSA-P patients were shorter (28.2 ± 1.8, 30.5 ± 0.6) than those in healthy controls. The longest globus pallidus (23.7 ± 5.0) and nucleus accumbens (6.6 ± 0.8) in patients with MSA-P were significantly shorter than those with MSA-C (29.7 ± 2.4 and 8.2 ± 0.4). The fourth ventricle size of MSA-C patients was wider than that of MSA-P patients (17.3 ± 2.1, 12.6 ± 2.7) and shorter than that of MSA-P patients (13.3 ± 1.9, 15.8 ± 1.2). Conclusion Magnetic resonance brain volume-diameter measurements provide a quantitative measure of the extent of local atrophy of brain tissue in MSA patients. The shortening of pontine diameter can objectively reflect the atrophy of pons in patients with MSA, but can not be used to distinguish between MSA-P and MSA-C. MSA-C patients are more likely to expand in the fourth ventricle and MCP atrophy, MSA-P patients are more prone to red nucleus atrophy.