| Objective:To explore the value of quantitative susceptibility mapping(QSM)histogram analysis for differential diagnosis of Parkinson's disease and healthy controls and the correlation between histogram parameters and to further explore its clinical symptoms relevance.Materials and Methods:35 PD patients diagnosed by the neurology specialists of****Hospital from August 2019 to January 2020 were enrolled.The diagnosis criteria were based on the latest diagnostic criteria for PD(2015)by the Movement Disorder Society(MDS).At the same time,23 age-and gender-matched healthy controls(HC)were recruited in this study.The Mini-mental State Examination(MMSE)scale was performed on the HC group.All PD patients were assessed using:disease duration(years);Hoehn and Yahr stage(H&Y stage),The third part of Unified Parkinson's Disease Rating Scale(UPDRS-?),MMSE,Hamilton Anxiety Scale(HAMA)score,Hamilton Depression Scale(HAMD).All subjects were scanned with the same MRI device and the original images were reconstructed for QSM.The QSM and ROI of subjects were imported into A.K software for histogram analysis,and 15 histogram parameters(mean,maximum,median,root mean square,variance,entropy,kurtosis,skewness,standard deviation,10th,25th,45th,50th,75th,90th)of MS value of deep brain nuclei were extracted.The histogram parameters in PD group and HC group.were compared.Multivariate logistic regression analysis was used to determine the best combined model for two histogram parameters.The Spearman test was used to evaluate the correlation of histogram parameters in the deep brain nuclei with clinical date in PD group.Results:1.Comparison of histogram parameters of MS value in deep brain nuclei between PD group and HC group(1)SN:PD patients have increased the mean,maximum,median,root mean square,variance,standard deviation,10th,25th,45th,50th,75th and 90th of MS values compared with healthy controls.(2)RN:PD patients have increased the mean,maximum,median,root mean square,variance,standard deviation,10th,25th,45th,50th,75th and 90th of MS value compared with healthy controls.(3)PUT:PD patients have increased the mean,median,root mean square,variance,entropy,standard deviation,10th,25th,45th,50th,75th and 90th of MS value compared with healthy controls.(4)GP:PD patients have increased the deviation and lower the entropy of MS value compared with healthy controls.(5)DN:PD patients have increased the mean,median,root mean square,10th,25th,45th,50th and 75th of MS value compared with healthy controls.(6)CN:PD patients have increased the maximum value,mean value,root mean square,variance,standard deviation,75th and 90th of MS value compared with healthy controls.2.Diagnostic performance of histogram parameters of MS value in deep brain nuclei(1)53 histogram parameters which have significant difference between PD group and HC group have good diagnostic performance(AUC>0.5).Among them,the standard deviation of the MS value in the PUT and the 45th of the MS value in the SN showed the best diagnostic performance,and the diagnostic performance of the two is similar(P=0.17).The 45 th of the MS value in the SN has the best diagnostic performance and the highest specificity(AUC=0.95;sensitivity=89th,specificity=93th),and the best threshold is 135.04ppb;the standard deviation of the MS value in the PUT has the best diagnostic efficacy and the highest sensitivity(AUC=0.93;sensitivity=100th,specificity=84th),and the best threshold is 23.82ppb.(2)The histogram parameters that have best diagnostic performance in every deep brain nuclei are:the 45th of MS value in the SN(AUC=0.95,sensitivity=100th,specificity=84th),the standard deviation of MS value in the PUT(AUC=0.93,sensitivity=89th,specificity=93th),the 75th of MS value in the RN(AUC=0.75,sensitivity=79th,specificity=76th),the 90th of MS value in the CN(AUC=0.74,sensitivity=79th,specificity=77th),the 75th of MS value of in the DN(AUC=0.72,sensitivity=85th,specificity=63th),and the skewness of MS value of in the GP(AUC=0.69,sensitivity=88th,specificity=52th).Among them,The 45th of the MS value in the SN and the standard deviation of MS value in the PUT have similar diagnostic performance.Compared with the 75 th of MS value in the RN,the 90th of MS value in the CN,the 75th of MS value of in the DN,the skewness of MS value of in the GP,The 45th of the MS value in the SN and the standard deviation of MS value in the PUT have better diagnostic performance.(SN vs RN,P<0.01;SN vs CN,P<0.01;SN vs GP,P<0.01;SN vs DN,P<0.01;PUT vs RN,P<0.01;PUT vs RN,P<0.01;PUT vs DN,P<0.01 CN,P<0.01;PUT vs GP,P=0.02;PUT vs DN,P=0.04).The 75th of MS value in the RN,the 90th of MS value in the CN,the 75th of MS value of in the DN,the skewness of MS value of in the GP have the similar diagnostic performance.(CN vs RN,P=0.38;CN vs GP,P=0.90;CN vs DN,P=0.93;RN vs GP,P=0.92;RN vs DN,P=0.36;GPvs DN,P=0.72)?Multivariate logistic regression analysis showed the 45th of MS value in the SN combined with the standard deviation of MS value in the PUT was best combined model for two histogram parameters.The results of paired ROC showed that the diagnostic performance of the 45th of MS value in the SN combined with the standard deviation of MS value in the PUT was higher than that of the standard deviation of MS value in the PUT(P=0.04).(3)The comparison between the histogram parameters that have best diagnostic performance in every deep brain nuclei and the mean of MS value.The mean of MS values of SN,PUT,CN,RN and DN nuclei have good diagnostic performance.(AUC=0.76,sensitivity=94%,specificity=73%;AUC=0.76,sensitivity=74%,specificity=73%;AUC=0.70,sensitivity=94%,specificity=52%;AUC=0.73,sensitivity=68%,specificity=73%;AUC=0.68,sensitivity=68%,specificity=69%).There was no significant difference between PD group and HC group in the mean of MS values in the GP and TH nuclei.Compared with the mean of MS values of SN,PUT and GP,the 45th of the MS value in the SN,the standard deviation of MS value in the PUT and the skewness of MS value of in the GP have better diagnostic performance.(P=0.01;P=0.04;P=0.03;P=0.02).There was no significant difference in diagnostic performance between the 75th of MS value in the RN,the 90th of MS value in the CN,the 75th of MS value of in the DN and the mean value of MS value in the RN,CN,DN.3.The correlation of the histogram parameters and clinical symptoms.(1)The strongest correlation histogram parameters with disease duration and H&Y stage was the 25th of MS value in the PUT(rho=0.72,P<0.01;rho=0.37,P=0.03).(2)The the strongest correlation histogram parameters with UPDRS-? was the standard deviation of MS value in the SN(rho=0.55,P<0.01).(3)The the strongest correlation histogram parameters with HAMD was the 25th of MS value in the RN(rho=-0.36,P=0.33).(4)The the strongest correlation histogram parameters with HAMA was the 90th of MS value in the PUT(rho=0.37,P=0.03).(5)The correlation of the mean and clinical symptoms:the mean in the SN was positively correlated with UPDRS-?(rho=0.42,P=0.07),but not with disease duration,H&Y stage,HAMA and HAMD(rho=0.16,P=0.35;rho=0.07,P=0.69;rho=-0.09,P 0.60;rho=-0.01,P=0.97).The mean values in the RN,PUT,DN,CN nuclei had no correlation with disease duration,UPDRS-?,H&Y stage,HAMA and HA:MD.(RN:rho=0.08,P=0.63:rho=-0.17,P=0.32;rho=-0.18,P=0.30;rho=-0.31,P=0.07;rho=-0.30,P=0.08)(PUT:rho=0.30,P=0.01;rho=0.1,P=0.27;rho=0.31,P=0.07;rho=0.31,P=0.07;rho=0.18,P=0.31)(DN:rho=-0.02,P=0.90;rho=-0.14,P=0.43;rho=-0.20,P=0.25;rho=0.03,P=0.89;rho=0.01,P=1.00)(CN:rho=0.21,P=0.22;rho=0.02,P=0.92;rho=-0.19,P=0.27;rho=0.07,P=0.68;rho=0.07,P=0.69)Conclusions:1.QSM histogram analysis can distinguish PD group and HC group better than the conventional mean in most studies,and can reflect the uneven distribution information of iron deposition in deep brain nuclei.Among these histogram parameters,the most reliable parameters for PD diagnosis are 45th of MS value in the SN and standard deviation of MS value in the PUT.2.The study shows that 25th of the MS value in the PUT is most closely related to the disease duration,disease stages and Degree of depression;the standard deviation of the MS value in the SN is most closely related to motor symptoms;90th of the MS value in the PUT is most closely related to Degree of anxiety.The correlation between the above parameters and diseases is stronger than the mean.The histogram analysis of QSM is an imaging index to monitor the disease progression of PD patients. |
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