| Background and ObjectiveParkinson’s disease(PD)and multiple system atrophy(MSA)are relatively common neurodegenerative diseases.There are many similarities in clinical manifestations between these two diseases,such as bradykinesia,tremor and limb rigidity.According to the clinical characteristics of MSA,they can be divided into Parkinson’s type(MSA-P)and cerebellar type(MSA-C).In clinical work,it is difficult to differentiate PD from MSA.Autopsy results showed that about 29-86%of MSA patients were misdiagnosed as PD.Moreover,the disease progression and prognosis of PD and MSA are quite different.MSA has a rapid disease progression and a poor response to levodopa drugs.Some newer surgical treatments and drug treatments are only suitable for PD patients.The main clinical treatment of MSA is symptomatic treatment.Therefore,it is of great clinical significance to find a more sensitive and specific method to distinguish PD from MSA-P.The current research shows that susceptibility weighted imaging(SWI)can evaluate the iron deposition in the deep brain nuclei by signal values,thus distinguishing PD from MSA-P;Transcranial sonography(TCS)can distinguish PD from MSA-P by detecting the echo of substantia nigra in midbrain.However,the efficacy of the two tests in the differential diagnosis of PD and MSA-P is still controversial.There were few studies on the combination of TCS and SWI,and the efficacy of the combination of both tests in the differential diagnosis of PD and MSAP is still unclear.In this study,SWI and TCS are combined to evaluate the echo intensity of substantia nigra of PD and MSA-P and the changes of SWI signal value of deep brain nuclei,so as to explore the value of combined two auxiliary examinations in the differential diagnosis of PD and MSA-P,and provide some evidence for the differential diagnosis of PD and MSA-P.MethodsIn this study,58 patients with PD and 41 patients with MSA-P from June 2020 to December 2021 were collected.The clinical data of 60 people were selected as the control group.Age and gender of control group matched to MSA-P group and PD group.TCS and SWI were performed in PD group and MSA-P group,while SWI was only performed in control group.The area of strong echo in bilateral substantia nigra was measured by TCS image.The signal values of MSA-P,PD,substantia nigra,red nucleus,caudate nucleus,putamen nucleus and globus pallidus of the control group were measured on SWI images.The signal values of SWI of substantia nigra,red nucleus,caudate nucleus,putamen nucleus and globus pallidus were measured in the PD,MSA-P and control group.We drew the receiver operating characteristic curve(ROC)for statistically significant parameters to find the best threshold of indicators and evaluate the diagnostic value of TCS and SWI for MSA-P and PD.SPSS 21.0 statistical software was used to analyze the collected data.The quantitative data according with normal distribution was expressed by X±S.The difference between the two groups was tested by independent sample T.The measurement data of non-normal distribution were expressed by median and quartile interval[M(Q)],and the difference between the two groups was tested by MannWhitney U test.Qualitative data were expressed by frequency or rate,and the difference of rate between two groups was tested by χ2 test.We drew ROC curve for statistically significant indicators,calculated the area under curve ROC curve(AUC),sensitivity and specificity,and worked out the boundary value of indicators according to Youden index.The difference was statistically significant when P<0.05.Results1 general informationGroup PD included 58 patients,including 33 males(56.9%)and 25 females(43.1%).There were 41 patients in MSA-P group,including 25 males(61.0%)and 16 females(39.0%).There were 60 cases in the control group,33 cases were male(55.0%)and 27 cases were female(45.0%),and there was no significant difference in gender among the groups(P>0.05).The average age of PD group was 59.00±10.24 years old,MSA-P group was 57.46±8.80 years old,and control group was 58.33±9.10 years old.There was no statistical difference among the groups(P>0.05).The average course of disease in PD group was 2.72±1.83 years,while that in MSA-P group was 2.17±1.72 years(P>0.05).2 TCS2.1 Abnormal echo ratio of substantia nigraThe abnormal echo rate of substantia nigra in PD group was 69.0%,and that in MSA-P group was 19.5%.The abnormal echo ratio of substantia nigra in PD patients was higher than that in MSA-P patients(P<0.001).The distribution of substantia nigra echo levels in PD patients and MSA-P patients was different(P<0.001).2.2 Hyperechoic area of substantia nigraIn PD group,the median of area of hyperechoic in substantia nigra was 0.26 cm2,and the interquartile spacing was 0.26 cm2.In MSA-P group,the median of area of hyperechoic in substantia nigra was 0.14 cm2,and the interquartile spacing was 0.21cm2.The hyperechoic area of substantia nigra in PD patients was larger than that in MSA-P patients(P<0.001).3 SWI3.1 Substantia nigraSWI signal value of substantia nigra:203.02±52.73 in PD group,209.96±50.98 in MSA-P group and 230.50±63.87 in control group.The difference of signal value of substantia nigra between PD group and control group was statistically significant(t=2.552,P=0.012),and the signal value of PD group was lower than that of control group.There was no statistically significant difference between MSA-P group and control group in substantia nigra signal value(t=-1.792,P=0.076).There was no statistically significant difference in substantia nigra signal value between MSA-P group and PD group(t=-0.654,P=0.515).3.2 Red nucleusSWI signal value of red nucleus:227.22±55.63 in PD group,218.69±41.81 in MSA-P group and 236.93±59.52 in control group.There was no statistically significant difference in red nucleus signal value between PD group and control group(t=-0.915,P=0.362).There was no statistically significant difference in signal value of red nucleus between MSA-P group and control group(t=-1.809,P=0.073).There was no statistically significant difference in red nucleus signal value between MSA-P group and PD group(t=0.223,P=0.409).3.3 Globus pallidusSWI signal value of globus pallidus:203.49±42.75 in PD group,195.75±38.61 in MSA-P group and 208.14±50.01 in control group.There was no statistically significant difference in the signal value of globus pallidus between PD group and control group(t=-0.543,P=0.588).The signal value of globus pallidus in MSA-P group and control group had no statistically significant difference(t=-1.402,P=0.164).The signal value of globus pallidus in MSA-P group and PD group had no statistically significant difference(t=0.940,P=0.350).3.4 Putamen nucleusSWI signal value of putamen nucleus:226.62±41.08 in PD group,197.23±37.07 in MSA-P group and 233.00±55.10 in control group.There was no statistically significant difference in putamen signal value between PD group and control group(t=-0.714,P=0.477).The difference of signal value of putamen nucleus in MSA group and control group was statistically significant(t=-3.899,P<0.001),and the signal value of putamen nucleus in MSA-P group was lower than that in control group.The difference of signal value of putamen nucleus in MSA-P group and PD group was statistically significant(t=3.648,P<0.001),and the signal value of putamen nucleus in MSA-P group was lower than that in PD group.3.5 Caudate nucleusSWI signal value of caudate nucleus:237.13±38.93 in PD group,231.50±43.90 in MSA-P group and 240.50±55.54 in control group.There was no statistically significant difference in signal value of caudate nucleus between PD group and control group(t=-0.383,P=0.703).There was no statistically significant difference in signal value of caudate nucleus between MSA-P group and control group(t=-0.907,P=0.367).There was no statistically significant difference in signal value of caudate nucleus between MSA-P group and PD group(r=0.672,P=0.503).4 ROC curve analysisWhen the hyperechoic area of substantia nigra in TCS was≥0.19cm2,the sensitivity,specificity and area under the curve were 75.9%,70.7%and 0.775,respectively.When the signal intensity of putamen nucleus in SWI was≥212.91,the sensitivity,specificity and area under the curve were 72.4%,73.2%and 0.723,respectively.When SWI and TCS were combined in the differential diagnosis of PD and MSA-P,the sensitivity was 75.9%,the specificity was 80.5%and the area under the curve was 0.816.ConclusionTCS and SWI were valuable in differentiating MSA-P from PD,and PD was more likely to be diagnosed when the substantia nigra area was ≥0.19cm2 or the SWI signal value of putamen nucleus was≥212.91.When the two tests were combined to differentiate PD from MSA,the specificity was increased. |
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