r-n-jРоссийский неврологический журналRussian neurological journal2658-79472686-7192МИА10.30629/2658-7947-2022-27-6-32-40r-n-j-369Research ArticleИССЛЕДОВАНИЯ И КЛИНИЧЕСКИЕ НАБЛЮДЕНИЯCLINICAL RESEARCHES AND CASE REPORTSКомбинированное клинико-нейровизуализационное исследование пациентов с болезнью Паркинсона с помощью транскраниальной сонографии и нейромеланин-чувствительной магнитно-резонансной томографииClinical and neuroimaging study of patients with Parkinson’s disease using transcranial sonography and neuromelanin-sensitive magnetic resonance imaginghttps://orcid.org/0000-0003-3843-6435МоскаленкоА. Н.MoskalenkoA. N.

Москаленко Анна Николаевна

Москва

Moscow

anna_nik_kern@rambler.ruhttps://orcid.org/0000-0002-8726-8928ЧечеткинА. О.ChechetkinA. O.

Москва

Moscow

andreychechetkin@gmail.comhttps://orcid.org/0000-0002-5706-6997ФилатовА. С.FilatovA. S.

Москва

Moscow

fil4tovmd@gmail.comhttps://orcid.org/0000-0001-8070-7644ФедотоваЕ. Ю.FedotovaE. Yu.

Москва

Moscow

ekfedotova@gmail.comhttps://orcid.org/0000-0001-5539-245XКоноваловР. Н.KonovalovR. N.

Москва

Moscow

krn_74@mail.ruhttps://orcid.org/0000-0002-2704-6282ИллариошкинС. Н.IllarioshkinS. N.

Москва

Moscow

snillario@gmail.comФГБНУ «Научный центр неврологии»РоссияResearch Center of NeurologyRussian Federation2022100120232763240Copyright © Москаленко А.Н., Чечеткин А.О., Филатов А.С., Федотова Е.Ю., Коновалов Р.Н., Иллариошкин С.Н., 20232023Москаленко А.Н., Чечеткин А.О., Филатов А.С., Федотова Е.Ю., Коновалов Р.Н., Иллариошкин С.Н.Moskalenko A.N., Chechetkin A.O., Filatov A.S., Fedotova E.Y., Konovalov R.N., Illarioshkin S.N.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.r-n-j.com/jour/article/view/369Введение

Введение. К ведущим патологическим признакам болезни Паркинсона (БП) относятся дегенерация содержащих нейромеланин (НМ) дофаминергических нейронов и отложение железа в черной субстанции (ЧС) среднего мозга. Показана определенная патогенетическая связь между повышенным отложением железа и снижением уровня НМ в ЧС у пациентов с БП. Логично предположить, что различные методы нейровизуализации, чувствительные к НМ и железу, могут иметь большое клиническое значение для диагностики и мониторинга прогрессирования заболевания. К таким методам нейровизуализации относятся в первую очередь транскраниальная сонография (ТКС) и нейромеланин-чувствительная магнитно-резонансная томография (НМ-МРТ).

Цель исследования

Цель исследования. Сравнение диагностической значимости и эффективности ТКС и НМ-МРТ в дифференцировании пациентов с БП от нормы, а также уточнение патофизиологии феномена гиперэхогенности ЧС (ГЧС) посредством косвенного изучения концентрации НМ при НМ-МРТ.

Материал и методы

Материал и методы. В основную группу были включены 40 пациентов с БП, в группу контроля — 20 здоровых добровольцев, сопоставимых по полу и возрасту с основной группой. В случае обнаружения ГЧС при проведении ТКС гиперэхогенную область обводили курсором вручную с последующим автоматическим расчетом площади. При НМ-МРТ полученные изображения предварительно обрабатывались с помощью общедоступной программы для обработки изображений Image-J (NIH, США) с последующим автоматическим расчетом площади ЧС. На основании полученных данных рассчитывались клинико-демографические показатели и клинико-нейровизуализационные корреляции.

Результаты

Результаты. Чувствительность и специфичность ТКС в дифференцировании БП от нормы составили 70 и 100% соответственно, чувствительность и специфичность НМ-МРТ — 90,0 и 92,5% соответственно. Анализ взаимосвязи площади ГЧС с площадью ЧС по данным НМ-МРТ на ипсилатеральной стороне показал заметную обратную корреляционную зависимость (для правой стороны: ρ = –0,606, р < 0,001; для левой стороны: ρ = –0,550; р < 0,001). Таким образом, в случае увеличения площади ГЧС ожидается уменьшение площади ЧС, измеренной с помощью НМ-МРТ.

Заключение

Заключение. ТКС и НМ-МРТ являются надежными биомаркерами, позволяющими высокоэффективно дифференцировать БП от нормы. Патофизиологические и нейровизуализационные корреляты изменений ЧС при нейродегенеративном процессе остаются не до конца ясными и требуют дальнейшего уточнения в многоцентровых проспективных исследованиях.

Background

Background. Parkinson’s disease (PD) is one of the most common neurodegenerative diseases and aff ects 1% of the population above 60 years. The leading pathological features of PD include degeneration of neuromelanin (NM) containing dopaminergic neurons and iron deposition in the substantia nigra (SN) of the midbrain. Various neuroimaging methods sensitive to NM and iron can be clinically important for diagnosing and monitoring disease progression. Examples of such neuroimaging methods include transcranial sonography (TCS) and neuromelanin-sensitive magnetic resonance imaging (NM-MRI) fi rst and foremost.

Aims

Aims. To compare the diagnostic signifi cance and eff ectiveness of TCS and NM-MRI in diff erentiating patients with PD from the norm and to elucidate the magnetic resonance- (MR-) morphological representation of the hyperechogenicity (HE) on midbrain during TCS by NM-MRI.

Material and methods

Material and methods. 40 patients with PD were included in the main group, and 20 healthy volunteers of gender and age comparable with the main group were included in the control group. In the case of HE detection during TCS, this area was manually traced and automatic calculated. NM-MRI images were pre-processed using image processing program Image-J (USA) with subsequent automatic calculation of SN area. Based on the data obtained, clinical, demographic and neuroimaging correlations were estimated.

Results

Results. The sensitivity and specifi city of TCS in diff erentiating PD from the norm were 70 and 100% respectively, the sensitivity and specifi city of NM-MRI were 90.0 and 92.5% respectively. An analysis of the relationship between the HE area and the area of the SN according to NM-MRI data on the ipsilateral side showed a noticeable inverse correlation (for the right side: ρ = –0.606, p < 0.001; for the left side: ρ = –0.550; p < 0.001). Thus, in the case of an increase in the HE area, a decrease in the area of SN measured using NM-MRI is expected.

Conclusion

Conclusion. TCS and NM-MRI are reliable biomarkers allowing highly eff ective diff erentiation of PD from normal. The pathophysiological and neuroimaging correlates of PD changes in neurodegenerative process remain not completely clear and require further clarifi cation in multicenter prospective studies.

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The authors declare that there are no conflicts of interest present.