静息态功能磁共振功能连接在帕金森病与 多系统萎缩帕金森型鉴别诊断中的临床价值

Clinical Value of Functional Connectivity of Resting-State Functional Magnetic Resonance Imaging in the Differential Diagnosis of Parkinson’s Disease and Multiple System Atrophy-Parkinsonian Type

摘要: 目的：以静息态功能磁共振成像(resting-state functional MRI, rs-fMRI)比较帕金森病(Parkinson’s disease, PD)与多系统萎缩帕金森型(Multiple system atrophy-Parkinson, MSA-P)之间的功能连接(functional connectivity, FC)差异，并探索区分这两种疾病的潜在无创神经影像学标志物。方法：本研究纳入25例PD患者、15例MSA-P患者及20例健康对照，基于种子点后扣带回开展全脑功能连接分析，采用单因素方差分析及事后检验比较三组间差异脑区，并通过受试者工作特征曲线评估FC的诊断效能。结果：与HC组相比，PD组右侧枕下回、左侧楔叶FC显著降低；与PD组相比，MSA-P组右侧枕叶、左侧枕上回FC值升高；ROC曲线分析显示，右侧枕叶FC鉴别PD与MSA-P的曲线下面积(AUC)为0.760 (敏感性66.7%，特异性80.0%)，左侧枕上回AUC为0.787 (敏感性86.7%，特异性68.0%)。结论：PD组在后扣带回–视觉网络相关脑区的FC显著下降，MSA-P组则通过后扣带回–视觉网络FC部分恢复形成代偿。右侧枕叶和左侧枕上回的后扣带回–视觉网络组合指标可作为鉴别PD与MSA-P的无创影像标志物。

Abstract: Objective: To compare the functional connectivity (FC) differences between Parkinson’s disease (PD) and multiple system atrophy-parkinsonism (MSA-P) subtype using resting-state functional magnetic resonance imaging (rs-fMRI), and to explore potential non-invasive neuroimaging biomarkers for distinguishing between the two diseases. Methods: A total of 25 PD patients, 15 MSA-P patients, and 20 healthy controls (HC) were enrolled. FC analysis was performed based on the posterior cingulate cortex (PCC) as the seed region. One-way analysis of variance (ANOVA) and post-hoc tests were used to compare the FC differences across the three groups, and receiver operating characteristic (ROC) curve analysis was employed to evaluate the diagnostic efficacy of FC. Results: Compared with the HC group, PD patients showed significantly decreased FC in the right precuneus and left cuneus. In contrast, MSA-P patients demonstrated increased FC in the right precuneus and left cuneus compared to PD. ROC analysis showed that the area under the curve (AUC) for distinguishing PD from MSA-P based on the FC of the right precuneus was 0.760 (sensitivity = 66.7%, specificity = 80.0%), while the AUC for the left cuneus was 0.787 (sensitivity = 86.7%, specificity = 68.0%). Conclusion: PD is characterized by a significant reduction in FC within the posterior cingulate-visual network, whereas MSA-P shows partial compensation with FC in this network. The combination of the posterior cingulate-visual network in the right precuneus and left cuneus could serve as a non-invasive imaging biomarker for differentiating PD from MSA-P.