摘要目的:探讨磁共振弥散峰度成像（DKI）对帕金森病患者早期的诊断价值。方法:选取2016年12月至2017年9月就诊于福建医科大学附属协和医院门诊或住院的早期帕金森病患者30例为病例组，同期招募健康者20名为健康对照组。应用3.0 T GE磁共振弥散峰度成像分析病例组与健康对照组嗅觉皮质相关脑区，比较两组嗅觉皮质部分各向异性分数（FA）、平均弥散系数（MD）、平均扩散峰度（MK）值之间的统计学差异，并分析病例组嗅觉皮质MK值与年龄、病程、Hoehn-Yahr（H-Y）分期、嗅觉测试、认知功能评估之间的相关性。采用受试者特征（ROC）曲线图来确定嗅皮质MK值在帕金森病中的最佳诊断界值。结果:帕金森病组与对照组左侧杏仁核MK值（分别为0.595±0.037和0.647±0.091）比较差异有统计学意义（ t=-2.183， P=0.037）；据帕金森病组左侧杏仁核MK值绘制ROC曲线示：最佳诊断界值为0.597，敏感度65.0%，特异度52.2%。帕金森病组与对照组比较，蒙特利尔认知评估量表[MoCA，分别为（21.03±3.71）分和（24.25±1.65）分， t=-3.636, P=0.001]、额叶功能评定量表（FAB）得分[分别为（13.93±1.36）分和（15.00±1.25）分， t=-2.086， P=0.042]差异有统计学意义，且MoCA、FAB得分与H-Y分期存在负相关（ r=-0.548， P=0.007； r=-0.465， P=0.025）。帕金森病组右侧直回MK值与MoCA评估结果存在正相关（ r=0.447， P=0.032）。 结论:左侧杏仁核DKI可以作为帕金森病早期的生物标志物，对帕金森病早期辅助诊断具有一定帮助。MoCA、FAB量表可用于监测帕金森病患者认知障碍进展水平的工具。帕金森病认知功能障碍可能与额叶功能损害相关。

abstractsObjective:To explore the value of magnetic resonance diffusion kurtosis imaging (DKI) in the early diagnosis of Parkinson′s disease (PD).Methods:Thirty patients with early PD who were admitted to the Fujian Medical University Union Hospital From December 2016 to September 2017 were selected as case group, and 20 healthy persons in the same period were selected as healthy control group. 3.0 T GE magnetic resonance DKI was used to analyze olfactory related brain regions of the case group and the control group, the statistical differences were compared between the two groups in fractional anisotropy (FA), mean diffusion (MD), mean kurtosis (MK) values of olfactory cortex, and the correlation between MK values of olfactory cortex of the case group and age, disease course, Hoehn-Yahr (H-Y) stage, olfactory test, cognitive function evaluation was analyzed. Receiver operating characteristic (ROC) curve was used to determine the best diagnostic cutoff value of olfactory cortical MK in PD.Results:The left amygdala MK between the PD group (0.595±0.037) and the control group (0.647±0.091) showed statistically significant difference ( t=-2.183, P=0.037). ROC curve was drawn according to the MK value of the left amygdala of the PD group: the best diagnostic cutoff value was 0.597, the sensitivity was 65.0%, and the specificity was 52.2%. There was a statistically significant difference between the PD group and the control group in Montreal Cognitive Assessment (MoCA; 21.03±3.71 vs 24.25±1.65, t=-3.636, P=0.001) and Frontal Assessment Battery (FAB) scores (13.93±1.36 vs 15.00±1.25, t=-2.086, P=0.042), and there was negative correlation between MoCA, FAB scores and H-Y stage ( r=-0.548, P=0.007; r=-0.465, P=0.025). There was a positive correlation between MK value of the right direct gyrus of the PD group and MoCA evaluation results ( r=0.447, P=0.032). Conclusions:The left amygdala DKI can be used as a biomarker of PD in the early stage, which is helpful for the early diagnosis of PD. MoCA and FAB scales can be used as tools to monitor the progress of PD cognitive impairment. PD cognitive dysfunction may be related to impairment of frontal lobe function.