Berding G, Odin P, Brooks D J, Nikkhah G, Matthies C, Peschel T, Shing M, Kolbe H, van Den Hoff J, Fricke H, Dengler R, Samii M, Knapp W H
Department of Nuclear Medicine, University Medical School, Hannover, Germany.
Mov Disord. 2001 Nov;16(6):1014-22. doi: 10.1002/mds.1212.
Studies of resting regional cerebral glucose consumption (rCMRGlc) in nondemented patients with Parkinson's disease (PD) have produced conflicting results, reporting both reduced and normal metabolism in advanced disease and reduced or normal metabolism after dopaminergic therapy. To investigate these issues, [(18)F]fluorodeoxyglucose (FDG) positron emission tomography (PET) was performed in 11 nondemented PD patients with advanced disease and 10 age-matched controls. PD patients were studied after withdrawal of all dopaminergic medication to produce a practically defined off condition, and a second time 1 hour after levodopa, resulting in a clinical on state. Dynamic PET scans and simultaneous arterialised venous blood samples of [(18)F] activity were obtained. A graphical approach was used to generate parametric images of rCMRGlc and statistical parametric mapping to localise significant metabolic changes in PD. Compared with controls, global rCMRGlc was reduced in the on but not in the off condition in PD. In both states, significant regional reductions of glucose uptake were found in the parietal, frontal, temporal cortex, and caudate nucleus. Reductions correlated with the severity of disability in frontal and temporal cortex. Direct comparison between on and off conditions revealed relatively greater reductions of uptake in the ventral/orbital frontal cortex and the thalamus during on. Results suggest that cortical and caudate hypometabolism are common in advanced PD and that caution is mandatory if [(18)F]FDG PET is being used to differentiate advanced PD from dementia and progressive supranuclear palsy where similar reductions are seen. Furthermore, in PD, administration of levodopa is associated with further hypometabolism in orbitofrontal cortex; an area known to be relevant for reversal learning where performance is typically impaired after dopaminergic treatment.
对非痴呆帕金森病（PD）患者静息状态下局部脑葡萄糖代谢率（rCMRGlc）的研究结果相互矛盾，有报告称在疾病晚期代谢降低和正常，以及多巴胺能治疗后代谢降低或正常。为了研究这些问题，对11例患有晚期疾病的非痴呆PD患者和10名年龄匹配的对照者进行了[（18）F]氟脱氧葡萄糖（FDG）正电子发射断层扫描（PET）。在撤掉所有多巴胺能药物以产生实际定义的关状态后对PD患者进行研究，并在左旋多巴给药1小时后再次进行研究，从而产生临床开状态。获得了动态PET扫描以及[（18）F]活性的同步动脉化静脉血样本。采用图形法生成rCMRGlc的参数图像，并使用统计参数映射来定位PD中显著的代谢变化。与对照组相比，PD患者在开状态下整体rCMRGlc降低，但在关状态下未降低。在两种状态下，均发现顶叶、额叶、颞叶皮质和尾状核的葡萄糖摄取显著区域降低。额叶和颞叶皮质的降低与残疾严重程度相关。开状态和关状态之间的直接比较显示，在开状态下腹侧/眶额皮质和丘脑的摄取降低相对更大。结果表明，皮质和尾状核代谢减退在晚期PD中很常见，如果使用[（18）F]FDG PET来区分晚期PD与痴呆和进行性核上性麻痹（在这些疾病中可见类似的代谢降低），则必须谨慎。此外，在PD中，左旋多巴的给药与眶额皮质进一步代谢减退有关；已知该区域与反转学习相关，而多巴胺能治疗后该区域的表现通常受损。
