阿尔茨海默病、帕金森病丨影像诊断要点

2022-09-07 熊猫放射 熊猫放射

帕金森病(PD):进行性神经变性疾病,主要累及黑质致密部(SNpc)。

阿尔茨海默病

概述

  • 阿尔茨海默病(Alzheimer disease,AD):缓慢进展的神经系统变性疾病

影像

在AD诊断中,目前影像学的作用

  • 排除其他结构上的异常

  • 评价萎缩性改变的程度和部位

  • 评价代谢性的异常(疾病的早期)

  • 为可能的新发明的疗法确诊早期AD

最佳影像检查=MR体积测定、FDG-18PET

MR用来评价以下情况的存在

  • 颞叶/顶叶皮质萎缩

  • 不均匀的海马体积减少

  • 均匀的脑室扩大、脑沟增宽

  • 同时存在的微血管病变

FDG-18PET用来评价:局部的糖代谢减低

主要鉴别诊断

  • 额颞叶变性

  • 路易体痴呆

  • 正常颅压脑积水

  • 血管性痴呆

  • 正常老化

临床要点

  • 大多数痴呆发生在65岁之后

  • 年龄是最大的危险因素

  • 65岁患病率1%~2%

  • 65岁以上,患病率每10年增加15%~25%

诊断纲要

  • 无占位、出血

  • 无缺血性卒中的证据(很大可能的AD)或伴缺血性疾病(可能的AD)

一位可能的AD的70岁女性患者,立体表面投影的矢状位FDG-18PET图像。标准MR(未提供图像) 显示无明确异常。第一行=参考图像。第二行=正常老年对照组的糖代谢(n=27)。第三行=患者的糖代谢图像。注意颞叶内侧(空箭)和顶叶(箭)代谢减低, 额叶、枕叶保留。最下面一行=Z分数图

(左) 一位疑似AD的72岁患者,矢状位TIWI MR显示与其他蛛网膜下腔相比, 外侧裂(箭)显著增宽。外侧裂周边的皮质显著萎缩。

(右) 一位患AD的59岁患者,轴位NECT显示海马萎缩,其征象为颞角扩大(箭)。双侧外侧裂也显著增宽。无颅内占位或缺血/梗死的证据。

(左) 一位诊断为可能的AD的54岁女性患者,轴位FLAIR显示相对于患者的年龄,外侧裂轻微增宽,侧脑室显著扩大,海马(箭)外观正常,无脑实质缺血性病变的证据。

(右) 同一位患者,冠状位MP-RAGE成像显示颞角(箭)外观正常。海马(空箭)体积无减小的迹象。但体积分析可显示出轻微的异常,这种检查结果被称为正常。

(左) 同一位患者,FDC-18PET检查的轴位成像显示,相对于额叶和枕叶(空箭),颞叶和顶叶糖代谢轻微减少(箭)。

(右)同一位患者,立体表面投影成像显示显著异常。颞叶轻度代谢减低,特别是顶叶(箭)减低明显。Z分数图可以很好地显示代谢减低(空箭)。

帕金森病

概述

  • 帕金森病(PD):进行性神经变性疾病,主要累及黑质致密部(SNpc)

影像

MR

  • 在T2WI上可见SNpc变窄、变得不明显

  • SNpc逐渐失去正常的高信号(从外侧到内侧发展)

  • PD病人红核与SNpc边界模糊

  • 采用3T磁共振,SNpc、壳核尾部R2弛豫率增加(铁含量增加)

  • DWI可用于鉴别PD、PSP、MSA-P

  • 在尾状核、壳核均可见ADC值增高

PET/SPET有助于帕金森叠加综合征的鉴别

主要鉴别诊断

  • 多系统萎缩(MSA):MSA的帕金森变异型(MSA-P)

  • 进行性核上性眼肌麻痹(PSP)

  • 皮层基底节变性

  • 路易体痴呆

病理

  • 路易体(致密的嗜酸性的胞浆内包涵体,边缘着色浅呈光晕样,而中心致密)、神经胶质增生

临床要点

  • 静止性震颤

  • 齿轮样肌强直

  • 运动处于“关”的状态

  • 慌张步态

  • 面具脸

诊断纲要

  • 报告中,要把梗死放在重要的位置

  • 查找出血、DWI成像异常

(左)轴位中脑层面绘图显示与正常人(下图)比较,帕金森病人(上图)的黑质(箭)变窄、色素脱失。

(右)一位严重帕金森病患者的中脑层面轴位切面的大体病理改变。注意黑质网状部(直箭)变窄、色素脱失。位于黑质网状部和红核(空箭)之间的致密部(弯箭)显著变窄。

(左) 轴位T2WI MR显示一个正常人致密部的宽度(箭),与帕金森患者的异常表现形成鲜明对比。

(右) 轴位T2WI显示帕金森病患者的典型中脑表现。注意致密部(箭)边缘模糊、变窄,致密部在两个呈低信号之间,即黑质网状部和红核。结果使红核和黑质几乎靠在一起。

(左) 患帕金森病的61岁患者,轴位FLAIR MR显示大脑外侧裂增宽。

(右) 轴位FLAIR MR显示基底节后部信号减低,还可见到壳核体积轻度减小。

(左) 帕金森病患者,轴位T2WI MR显示基底节区局部信号减低(箭);

(右) 同一位患者,轴位FLAIR MR显示黑质网状部(白箭)和红核(黑箭)靠在一起,提示黑质致密带萎缩。

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    2022-10-27 ms5000001410456216

    学习了!!!

    0

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    2022-09-13 ms5000001410456216

    学习了

    0

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