Kim Yun J, Ichise Masanori, Ballinger James R, Vines Douglas, Erami Sean S, Tatschida Tatsuro, Lang Anthony E
Morton & Gloria Shulman Movement Disorders Center and the Division of Neurology (Department of Medicine), The Toronto Western Hospital, Toronto, Ontario, Canada.
Mov Disord. 2002 Mar;17(2):303-12. doi: 10.1002/mds.10042.
It is often difficult to differentiate clinically between Parkinson's disease (PD), multiple system atrophy (MSA), and progressive supranuclear palsy (PSP). The objective of this work was to investigate whether combined pre- and postsynaptic dopaminergic single photon emission computed tomography (SPECT) scanning can reliably demonstrate changes in the nigrostriatal dopaminergic system and help differentiate between normal controls, PD, MSA, and PSP patients. We performed SPECT evaluation of the dopamine transporter (DAT) and dopamine D2 receptors (D2). SPECT scans using [123I]beta-CIT (for DAT) and [123I]IBF (for D2) were performed in 18 patients with PD (12 dopa-naïve and 6 on levodopa and/or dopamine agonists), 7 with MSA of the striatonigral degeneration type, 6 with PSP, and 29 normal controls. Antiparkinsonian drugs were withheld for at least 12 hours before the scans. DAT and D2 binding potentials (Rv = V3/V2) were measured for caudate, anterior, and posterior putamen on the sides ipsilateral and contralateral to the worst motor symptoms. DAT binding in the posterior putamen was markedly reduced in all patients. However, D2 binding in posterior putamen was significantly increased in dopa-untreated PD, being greater than the normal range in 4 of 12 (33%), and it was significantly reduced in MSA, being below the normal range in 5 of 7 (71%). None of the patients with PD showed reduced D2 binding below the normal range in posterior putamen. The degree of DAT binding could not discriminate between the patient groups. The ratio of posterior putamen to caudate percentage D2 Rv compared with the controls showed an opposite pattern between PD or PSP and MSA; the caudate was greater in 16 of 18 with PD and 6 of 6 with PSP, whereas caudate was less in 5 of 7 with MSA. These findings suggest that DAT SPECT may be useful in differentiating parkinsonism from controls and D2 SPECT in further differentiating MSA from Parkinson's disease and possibly PSP.
临床上往往难以区分帕金森病（PD）、多系统萎缩（MSA）和进行性核上性麻痹（PSP）。本研究的目的是调查突触前和突触后多巴胺能单光子发射计算机断层扫描（SPECT）联合扫描是否能可靠地显示黑质纹状体多巴胺能系统的变化，并有助于区分正常对照、PD、MSA和PSP患者。我们对多巴胺转运体（DAT）和多巴胺D2受体（D2）进行了SPECT评估。使用[123I]β-CIT（用于DAT）和[123I]IBF（用于D2）对18例PD患者（12例未服用多巴，6例服用左旋多巴和/或多巴胺激动剂）、7例纹状体黑质变性型MSA患者、6例PSP患者和29例正常对照进行了SPECT扫描。扫描前至少停用抗帕金森病药物12小时。在运动症状最严重一侧的同侧和对侧的尾状核、前壳核和后壳核测量DAT和D2结合电位（Rv = V3/V2）。所有患者后壳核的DAT结合均显著降低。然而，未服用多巴的PD患者后壳核的D2结合显著增加，12例中有4例（33%）高于正常范围，而MSA患者后壳核的D2结合显著降低，7例中有5例（71%）低于正常范围。没有PD患者后壳核的D2结合低于正常范围。DAT结合程度无法区分患者组。与对照组相比，后壳核与尾状核D2 Rv百分比的比值在PD或PSP与MSA之间呈现相反的模式；18例PD患者中有16例、6例PSP患者中有6例尾状核较大，而7例MSA患者中有5例尾状核较小。这些发现表明，DAT SPECT可能有助于将帕金森综合征与对照区分开来，而D2 SPECT有助于进一步将MSA与帕金森病以及可能的PSP区分开来。
