目的：探究帕金森病（Parkinson’s disease, PD）、进行性核上性麻痹(progressive supranuclear palsy, PSP)、震颤麻痹型多系统萎缩（Parkinsonian variant of multiple system atrophy, MSA-P）及小脑共济失调型多系统萎缩(Cerebeller variant of multiple system atrophy, MSA-C) 病人的全脑血流灌注及灰质体积、微结构及铁沉积等方面的特征性改变模式，并探索以上改变模式是否可作为组间鉴别诊断的影像指标。

材料和方法：本回顾性研究已通过本医院伦理审查委员会的评审。117例PD，27例PSP，10例MSA-P，17例MSA-C及51例正常对照人群（文章三部分样本略有差异）进行3.0 T ASL及3D T1WI-MRI扫描，提取计算皮层90 ROI、深部核团16 ROI、脑干（中脑、桥脑及延髓）及小脑34 ROI的CBF、GM体积、AD、RD、MD、FA、QSM、T1、T2*、PD值。 Kruskal-Wallis 检验分析以上各参数的组间差异。用Bonferroni 校正的Mann-Whitney U检验进行两两组间差异分析。通过以上有差异参数建立Logistic回归模型，绘制受试者工作特征 (ROC) 曲线分析模型在PD、PSP及MSA鉴别诊断中的效能。

结果：PD、PSP、MSA-C及MSA-P在血流灌注、灰质体积、微结构及铁沉积等方面各表现出了不同的改变模式，且CBF、DTI、STAGE及多模态MRI用于MSA-C、MSA-P、PD及PSP的组间鉴别诊断，效能良好。

结论：多模态MRI有望相对早期对PD及PPS鉴别诊断，建立的相关鉴别诊断模型有望在临床上进一步推广。

Objective: To investigate the characteristic change patterns of cerebral blood perfusion, gray matter volume, microstructure and iron deposition of the whole brain in patients with  Parkinson's disease (PD), progressive supranuclear palsy (PSP), Parkinsonian variant of multiple system atrophy (MSA-P) and  Cerebeller variant of multiple system atrophy (MSA-C), and to explore whether the above change patterns can be used as  Imaging indicators for differential diagnosis among groups.

Materials and Methods: This retrospective study has been reviewed by the ethics review committee of our hospital. 117 cases of PD, 27 cases of PSP, 10 cases of MSA-P, 17 cases of MSA-C and 51 cases of normal controls (there are slight differences in the sample size in the three parts of the article) underwent 3.0 T ASL and 3D T1WI-MRI scans, we extracted and calculated the CBF, GM volume, AD, RD, MD, FA, QSM, T1, T2*, PD values ​​of  90 ROI of the cortex ,16 ROIs of deep nucleus, brainstem (midbrain, pons and medulla) and 34 ROIs of cerebellum. The Kruskal-Wallis test was used to analyze the group differences of the above parameters. Differences between two groups were analyzed using the Bonferroni-corrected Mann-Whitney U test. Logistic regression model was established by the above-mentioned difference parameters, and receiver operating characteristic (ROC) curve was drawn to analyze the efficacy of the model in the differential diagnosis of PD, PSP ,MSA-C and MSA-P.

Results: PD, PSP, MSA-C and MSA-P showed different changes in blood perfusion, gray matter volume, microstructure and iron deposition, and CBF, DTI, STAGE and multimodal MRI could be used for the differential diagnosis between groups of MSA-C, MSA-P, PD and PSP with good efficacy.

Conclusion: Multimodal MRI can be used  in the differential diagnosis of PD and PPS in relatively early phase of disease duration, and the established differential diagnosis models are expected to be further promoted in clinical practice.