Parkinson hastalarında manyetik rezonans görüntülemesi kullanılarak beyin sapının morfometrik olarak degerlendirilmesi
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Tarih
2023
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Dicle Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Bu çalışmamızda, Parkinson hastalığında manyetik rezonans görüntülemesi kullanılarak beyin sapının morfometrik olarak değerlendirilmesi amaçlandı. Materyal-Metod: Bu çalışmaya, Dicle Üniversitesi Tıp Fakültesi Hastanesine Ocak 2018 ile Ocak 2021 tarihleri arasında başvuran ve klinik olarak Parkinson hastalığı (PD) tanısı alan, düzenli ilaç kullanım öyküsü bulunan 50 yaş üstü 100 hasta dahil edilmiştir (Grup 2= Hasta). Bu hastalar, klinik olarak Parkinson tanısı olmayan acil servise baş ağrısı şikayetiyle başvuran radyolojik görüntülemelerinde patoloji izlenmeyen 100 hasta ile karşılaştırılmıştır (Grup 1= Sağlıklı). Hastaların sosyodemografik özellikleri (yaş, cinsiyet), mezensefalon ön arka çapı-alanı, pons ön arka çapı-alanı, mezensefalonun ponsun alanına oranı, substansia nigra kalınlığı, serebral krus genişliği ve interpedinküler mesafe ölçümleri retrospektif olarak değerlendirilmiştir. Bulgular: Çalışmamıza 100 hasta ve 100 sağlıklı birey olmak üzere toplamda 200 birey dahil edildi (%57.5'i, n=115 erkek). Çalışmamızda yaş ortalaması 64.1±9.6 bulunmuştur. Grup 1'deki bireylerin mezensefalon ön-arka çapı ortalaması 0.99±0.09 cm, Grup 2'deki bireylerin ortalaması ise 1.05±0.16 cm olarak bulunmuştur. Hasta grubunda (grup 2) mezensefalon ön-arka çapı daha yüksek saptanmıştır ve bu fark istatistiksel olarak anlamlıdır (p=0.001). Grup 1'deki bireylerin pons ön-arka çapı ortalaması 2.11±0.13 cm, Grup 2'deki bireylerin ortalaması ise 2.17±0.17 cm olarak bulunmuştur. Hasta grubunda (grup 2) pons ön-arka çapı daha yüksek saptanmıştır (p=0.003). Mezensefalon alanı Grup 1'de ortalama 1.72±0.27 cm2, Grup 2'de ise ortalama 1.65±0.29 cm2 olarak bulunmuştur (p=0.058). Pons alanı Grup 1'deki bireylerde ortalama 3.57±0.44 cm2 iken, Grup 2'deki bireylerde bu değer ortalama 3.91±0.52 cm2 olarak bulunmuştur (p<0.001). Mezensefalon/pons alan oranı, Grup 1'deki bireylerde ortalama 0.48±0.07, Grup 2'deki bireylerde ise ortalama 0.42±0.09 olarak bulunmuştur (p<0.001). İnterpedinkuler mesafe, Grup 1'deki bireylerde ortalama 0.66±0.05 cm, Grup 2'deki bireylerde ise ortalama 0.73±0.12 cm olarak bulunmuştur (p<0.001). Substansia nigra kalınlığı Grup 1'deki bireylerde ortalama 2.98±0.33 cm, Grup 2'deki bireylerde ise ortalama 2.66±0.4 cm olarak bulunmuştur (p<0.001). Sağ serebral krus genişliği Grup 1'deki bireylerde ortalama 1.53±0.13 cm, Grup 2'deki bireylerde ise ortalama 1.57±0.14 cm olarak bulunmuştur (p=0.047). Sol serebral krus genişliği Grup 1'deki bireylerde ortalama 1.54±0.11 cm, Grup 2'deki bireylerde ise ortalama 1.61±0.32 cm olarak bulunmuştur (p=0.047). Sağ serebellar pedinkul genişliği Grup 1'deki bireylerde ortalama 1.62±0.13 cm, Grup 2'deki bireylerde ise ortalama 1.68±0.14 cm olarak bulunmuştur (p=0.001). Sol serebral pedinkul genişliği ise Grup 1'deki bireylerde ortalama 1.63±0.13 cm, Grup 2'deki bireylerde ise ortalama 1.69±0.13 cm olarak bulunmuştur (p=0.002). Sadece hasta grubu ele alındığında; yaş ve pons alanı arasında anlamlı negatif bir korelasyon (r=-0.284) bulunmaktadır. Benzer şekilde, yaş ve sağ serebellar pedinkul genişliği arasında anlamlı negatif bir korelasyon (r=-0.281**) bulunmaktadır. Özellikle, interpedinkuler mesafe ölçümünün, %49'luk bir sensitivite ve %91'lik spesifisite ile 0.716'lık en yüksek Alan Altında Eğri (AUC) değerini sağladığı bulunmuştur. Bu, cut-off değeri 0.74 olarak belirlendiğinde, belirli bir hastalığın tanısında etkili bir gösterge olabilir. Ayrıca, pons alanı ölçümü de önemli bir bulgu olarak öne çıkmaktadır. Pons alanının, %77 sensitivite ve %54 spesifisite ile 0.692'lik bir AUC değeri sağladığı görülmüştür. Bu, 3.59 cut-off değeriyle hastalığın belirlenmesinde yardımcı olabilir. Hastalığın varlığıyla negatif korele olan değerler için de dönüştürülmüş ters ROC analizi yaptık. Substantia nigra kalınlığı ölçümü, %25'lik bir sensitivite ve %90'lık bir spesifisite ile en yüksek AUC değeri olan 0.744'ü sağladı. Bu, cut-off değeri 3.20 olarak belirlendiğinde, Parkinson hastalığının tanısında etkili bir gösterge olabilir. Ayrıca, mezensefalon/pons alan oranı ölçümü de önemli bir bulgu olarak öne çıkmaktadır. Bu ölçüm, %45 sensitivite ve %81 spesifisite ile 0.702'lik bir AUC değeri sağlamıştır. Bu, 0.49 cut-off değeriyle hastalığın belirlenmesinde yardımcı olabilir. Öte yandan, mezensefalon alanı ölçümünün AUC değeri daha düşük bulunmuş (%64 sensitivite ve %46 spesifisite ile 0.582). Sonuç: Bu bulgular, belirli anatomik özelliklerin ölçümlerinin Parkinson hastalığının tanısında ve belki de erken evrelerinin tespitinde önemli olabileceğini göstermektedir. Bu, bu özelliklerin daha fazla incelenmesini ve bu özelliklere dayalı tanı araçlarının geliştirilmesini gerektirir. Ancak, bu sonuçlar, bu araştırmanın daha geniş ölçekte ve farklı demografik gruplarla tekrarlanması gerektiği gerçeğini de ortaya koymaktadır.
Objective: The aim of this study was to evaluate the brain stem morphometrically in Parkinson's disease using magnetic resonance imaging. Materials and Methods: This study included 100 patients over 50 years of age who applied to Dicle University Medical Faculty Hospital between January 2018 and January 2021 and were diagnosed with Parkinson's disease (PD) clinically and had a history of regular drug use (Group 2= Patient). These patients were compared with 100 patients who were clinically not diagnosed with Parkinson's disease (Group 1= Healthy). The sociodemographic characteristics of the patients (age, gender), anteroposterior diameter-area of the mesencephalon, anteroposterior diameter-area of the pons, ratio of the area of the mesencephalon to the pons, thickness of the substantia nigra, width of the cerebral crus and interpeduncular distance measurements were retrospectively evaluated. Results: A total of 200 individuals, including 100 patients and 100 healthy individuals, were included in our study (57.5% of them, n=115, were male). The average age in our study was found to be 64.1±9.6. The average anteroposterior diameter of the mesencephalon in individuals in Group 1 was 0.99±0.09 cm, and the average in individuals in Group 2 was 1.05±0.16 cm. A higher anteroposterior diameter of the mesencephalon was found in the patient group (group 2) and this difference was statistically significant (p=0.001). The average anteroposterior diameter of the pons in individuals in Group 1 was 2.11±0.13 cm, and the average in individuals in Group 2 was 2.17±0.17 cm. A higher anteroposterior diameter of the pons was found in the patient group (group 2) (p=0.003). The average area of the mesencephalon in Group 1 was 1.72±0.27 cm2, while in Group 2 it was 1.65±0.29 cm2 (p=0.058). The average area of the pons in individuals in Group 1 was 3.57±0.44 cm2, while in individuals in Group 2 it was 3.91±0.52 cm2 (p<0.001). The ratio of the mesencephalon/pons area in individuals in Group 1 was 0.48±0.07, while in individuals in Group 2 it was 0.42±0.09 (p<0.001). The interpeduncular distance in individuals in Group 1 was 0.66±0.05 cm, while in individuals in Group 2 it was 0.73±0.12 cm (p<0.001). The thickness of the substantia nigra in individuals in Group 1 was 2.98±0.33 cm, while in individuals in Group 2 it was 2.66±0.4 cm (p<0.001). The width of the right cerebral crus in individuals in Group 1 was 1.53±0.13 cm, while in individuals in Group 2 it was 1.57±0.14 cm (p=0.047). The width of the left cerebral crus in individuals in Group 1 was 1.54±0.11 cm, while in individuals in Group 2 it was 1.61±0.32 cm (p=0.047). The width of the right cerebellar peduncle in individuals in Group 1 was 1.62±0.13 cm, while in individuals in Group 2 it was 1.68±0.14 cm (p=0.001). The width of the left cerebral peduncle in individuals in Group 1 was 1.63±0.13 cm, while in individuals in Group 2 it was 1.69±0.13 cm (p=0.002). When only the patient group was considered, a significant negative correlation (r=-0.284) was found between age and pons area. Similarly, a significant negative correlation (r=-0.281**) was found between age and the width of the right cerebellar peduncle. Particularly, it was found that the measurement of interpeduncular distance provided the highest Area Under the Curve (AUC) value of 0.716 with a sensitivity of 49% and a specificity of 91%. This could be an effective indicator in the diagnosis of a particular disease when the cut-off value is set at 0.74. Also, the measurement of the pons area emerged as a significant finding. It was found that the area of the pons provided an AUC value of 0.692 with a sensitivity of 77% and a specificity of 54%. This could help identify the disease with a cut-off value of 3.59. We also did a reverse ROC analysis for values that negatively correlate with the presence of the disease. The measurement of substantia nigra thickness provided the highest AUC value of 0.744 with a sensitivity of 25% and a specificity of 90%. This could be an effective indicator in the diagnosis of Parkinson's disease when the cut-off value is set at 3.20. Also, the measurement of the mesencephalon/pons area ratio emerged as a significant finding. This measurement provided an AUC value of 0.702 with a sensitivity of 45% and a specificity of 81%. This could help identify the disease with a cut-off value of 0.49. On the other hand, the AUC value of the measurement of the mesencephalon area was found to be lower (with a sensitivity of 64% and a specificity of 46% with 0.582). Conclusion: These findings suggest that measurements of certain anatomical features may be important in the diagnosis of Parkinson's disease and perhaps in the detection of its early stages. This requires further investigation of these features and the development of diagnostic tools based on these features. However, these results also reveal the need for this research to be repeated on a larger scale and with different demographic groups.
Objective: The aim of this study was to evaluate the brain stem morphometrically in Parkinson's disease using magnetic resonance imaging. Materials and Methods: This study included 100 patients over 50 years of age who applied to Dicle University Medical Faculty Hospital between January 2018 and January 2021 and were diagnosed with Parkinson's disease (PD) clinically and had a history of regular drug use (Group 2= Patient). These patients were compared with 100 patients who were clinically not diagnosed with Parkinson's disease (Group 1= Healthy). The sociodemographic characteristics of the patients (age, gender), anteroposterior diameter-area of the mesencephalon, anteroposterior diameter-area of the pons, ratio of the area of the mesencephalon to the pons, thickness of the substantia nigra, width of the cerebral crus and interpeduncular distance measurements were retrospectively evaluated. Results: A total of 200 individuals, including 100 patients and 100 healthy individuals, were included in our study (57.5% of them, n=115, were male). The average age in our study was found to be 64.1±9.6. The average anteroposterior diameter of the mesencephalon in individuals in Group 1 was 0.99±0.09 cm, and the average in individuals in Group 2 was 1.05±0.16 cm. A higher anteroposterior diameter of the mesencephalon was found in the patient group (group 2) and this difference was statistically significant (p=0.001). The average anteroposterior diameter of the pons in individuals in Group 1 was 2.11±0.13 cm, and the average in individuals in Group 2 was 2.17±0.17 cm. A higher anteroposterior diameter of the pons was found in the patient group (group 2) (p=0.003). The average area of the mesencephalon in Group 1 was 1.72±0.27 cm2, while in Group 2 it was 1.65±0.29 cm2 (p=0.058). The average area of the pons in individuals in Group 1 was 3.57±0.44 cm2, while in individuals in Group 2 it was 3.91±0.52 cm2 (p<0.001). The ratio of the mesencephalon/pons area in individuals in Group 1 was 0.48±0.07, while in individuals in Group 2 it was 0.42±0.09 (p<0.001). The interpeduncular distance in individuals in Group 1 was 0.66±0.05 cm, while in individuals in Group 2 it was 0.73±0.12 cm (p<0.001). The thickness of the substantia nigra in individuals in Group 1 was 2.98±0.33 cm, while in individuals in Group 2 it was 2.66±0.4 cm (p<0.001). The width of the right cerebral crus in individuals in Group 1 was 1.53±0.13 cm, while in individuals in Group 2 it was 1.57±0.14 cm (p=0.047). The width of the left cerebral crus in individuals in Group 1 was 1.54±0.11 cm, while in individuals in Group 2 it was 1.61±0.32 cm (p=0.047). The width of the right cerebellar peduncle in individuals in Group 1 was 1.62±0.13 cm, while in individuals in Group 2 it was 1.68±0.14 cm (p=0.001). The width of the left cerebral peduncle in individuals in Group 1 was 1.63±0.13 cm, while in individuals in Group 2 it was 1.69±0.13 cm (p=0.002). When only the patient group was considered, a significant negative correlation (r=-0.284) was found between age and pons area. Similarly, a significant negative correlation (r=-0.281**) was found between age and the width of the right cerebellar peduncle. Particularly, it was found that the measurement of interpeduncular distance provided the highest Area Under the Curve (AUC) value of 0.716 with a sensitivity of 49% and a specificity of 91%. This could be an effective indicator in the diagnosis of a particular disease when the cut-off value is set at 0.74. Also, the measurement of the pons area emerged as a significant finding. It was found that the area of the pons provided an AUC value of 0.692 with a sensitivity of 77% and a specificity of 54%. This could help identify the disease with a cut-off value of 3.59. We also did a reverse ROC analysis for values that negatively correlate with the presence of the disease. The measurement of substantia nigra thickness provided the highest AUC value of 0.744 with a sensitivity of 25% and a specificity of 90%. This could be an effective indicator in the diagnosis of Parkinson's disease when the cut-off value is set at 3.20. Also, the measurement of the mesencephalon/pons area ratio emerged as a significant finding. This measurement provided an AUC value of 0.702 with a sensitivity of 45% and a specificity of 81%. This could help identify the disease with a cut-off value of 0.49. On the other hand, the AUC value of the measurement of the mesencephalon area was found to be lower (with a sensitivity of 64% and a specificity of 46% with 0.582). Conclusion: These findings suggest that measurements of certain anatomical features may be important in the diagnosis of Parkinson's disease and perhaps in the detection of its early stages. This requires further investigation of these features and the development of diagnostic tools based on these features. However, these results also reveal the need for this research to be repeated on a larger scale and with different demographic groups.
Açıklama
Anahtar Kelimeler
Parkinson, Manyetik rezonans, Morfometrik
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Oğuz, A. (2023). Parkinson hastalarında manyetik rezonans görüntülemesi kullanılarak beyin sapının morfometrik olarak degerlendirilmesi. Yayımlanmamış uzmanlık tezi, Dicle Üniversitesi, Diyarbakır.
