教育講演12
脳MRIから変性疾患の診断に迫る‐病理，臨床の対比から-
渡辺 宏久1）, 吉田 眞理2）, 長縄 慎二3）, 祖父江 元1）
1）名古屋大学医学部神経内科〔〒466―8550 名古屋市昭和区鶴舞町65〕
2）愛知医科大学加齢医科学研究所
3）名古屋大学医学部放射線科
Diffusion tensor imaging and voxel based morphometry are efficient in the diagnosis of neurodegenerative disorders, however, these technologies are available at a limited number of facilities. Thus, conventional MRI remains important in the diagnosis of neurodegenerative disorders. Dorsolateral putaminal hyperintensity (DPH) and hot cross bun sign discriminate Parkinson's disease from multiple system atrophy (MSA). However, differences in magnetic field strength and sequence affect the sensitivity of DPH, and mild DPH may be observed in normal elderly subjects. Patients with progressive supranuclear palsy (PSP) presenting Richardson's syndrome show midbrain tegmentum atrophy, but Parkinsonian PSP (PSP-P) and pure akinesia with gait freezing, which are other phenotypes of PSP, may not show especially during early course of illness. In patients with corticobasal degeneration (CBD), asymmetrical cerebral atrophy corresponding with corticobasal syndrome (CBS) may be a characteristic finding. However, at autopsy, CBS patients presenting asymmetrical cerebral atrophy have CBD as the underlying pathology in approximately 50% of PSP patients. The sensitivity and specificity of MRI for the diagnosis of MSA, PSP, and CBD is based generally on clinical diagnostic criteria. Diagnosis based on MRI has limitations, and, therefore, we should reconsider our diagnoses, particularly during the early course of illness.
Full Text of this Article in Japanese PDF (144K)
(臨床神経, 51：863−864, 2011)
key words：MRI，多系統萎縮症，進行性核上性麻痺，大脳皮質基底核変性症
（受付日：2011年5月20日）
