Soriani-Lefèvre Marie-Hélène, Hannequin Didier, Bakchine Serge, Ménard Jean-François, Manrique Alain, Hitzel Anne, Kotzki Pierre-Olivier, Boudousq Vincent, Vera Pierre
Department of Nuclear Medicine, Rouen University Hospital, Henri Becquerel Center, Laboratoire Universitaire Quantification en Imagerie Fonctionnelle, Rouen, France.
J Nucl Med. 2003 Jul;44(7):1013-22.
Primary progressive aphasia (PPA) is rare. Only limited series have been reported with SPECT or PET. Moreover, in the majority of studies, the left-to-right asymmetry ratio was used, leading to difficulties in right hemisphere analyzes.
Twenty-nine patients with clinical criteria of PPA (Mesulam and Weintraub) were included and compared with 12 control subjects. Complete language examination was performed in all patients. SPECT was performed on a double-head gamma camera after intravenous injection of hexamethylpropyleneamine oxime (22 patients and 12 control subjects) or ethylcysteinate dimer (7 patients). Nineteen regions of interest (ROIs) were drawn on each hemisphere in all patients using the Talairach atlas. The perfusion index (PI = cortex-to-cerebellum ratio) was calculated for each ROI. Atrophy was quantified on MRI by consensus of 3 observers in 16 cortical ROIs. ANOVAs were used to compare the PI between (a). patients and control subjects, (b). patients with (n = 15) or without (n = 14) lexicosemantic abnormalities (LS+ vs. LS-) and patients with (n = 19) or without (n = 10) arthric disorders (A+ vs. A-), and (c). patients with or without atrophy.
In the 29 patients, the PI was significantly lower in the left temporopolar, left lateral temporal, left Wernicke, left parietal, and right lateral temporal cortex when compared with control subjects (P < 0.001). In LS+ patients versus control subjects, the PI significantly decreased in the left temporal cortex (lateral temporal; medial temporal; temporopolar; Wernicke), left Broca, left parietal, and right lateral temporal cortex (P < 0.001). In addition, LS+ versus LS- comparison showed a significant decrease in the left lateral, left medial temporal, and left Broca cortex (P < 0.001). In comparison with control subjects, the PI was not significantly different in A+ patients, whereas in A- patients the PI was significantly decreased in the left and right lateral temporal cortex, left Wernicke, and left parietal cortex. Moreover, the PI significantly decreased in the left lateral temporal region in A+ patients compared with A- patients. Finally, in patients without atrophy, the PI significantly decreased in the right and left lateral temporal cortex and the left parietal cortex (P < 0.01).
Our study demonstrates that right-handed patients with PPA present a decreased perfusion in the bilateral temporal cortex. Moreover, in these regions, morphologic abnormalities are preceded by perfusion abnormalities. Finally, our results show that large left temporal dysfunction occurs in patients with LS disorders.
原发性进行性失语（PPA）较为罕见。仅有有限的系列研究采用单光子发射计算机断层扫描（SPECT）或正电子发射断层扫描（PET）进行过报道。此外，在大多数研究中，使用的是左右不对称比率，这给右半球分析带来了困难。
纳入29例符合PPA临床标准（梅苏拉姆和温特劳布标准）的患者，并与12名对照受试者进行比较。对所有患者进行了全面的语言检查。在静脉注射六甲基丙烯胺肟（22例患者和12名对照受试者）或半胱氨酸乙酯二聚体（7例患者）后，使用双头伽马相机进行SPECT检查。在所有患者的每个半球上，使用Talairach图谱绘制19个感兴趣区域（ROI）。计算每个ROI的灌注指数（PI = 皮质与小脑比率）。通过3名观察者对16个皮质ROI的共识，在磁共振成像（MRI）上对萎缩进行量化。采用方差分析比较（a）患者与对照受试者之间、（b）有（n = 15）或无（n = 14）词汇语义异常（LS+与LS-）的患者以及有（n = 19）或无（n = 10）关节炎疾病（A+与A-）的患者之间、（c）有或无萎缩的患者之间的PI。
在29例患者中，与对照受试者相比，左侧颞极、左侧颞叶外侧、左侧韦尼克区、左侧顶叶和右侧颞叶外侧皮质的PI显著降低（P < 0.001）。与对照受试者相比，LS+患者的左侧颞叶皮质（颞叶外侧；颞叶内侧；颞极；韦尼克区）、左侧布洛卡区、左侧顶叶和右侧颞叶外侧皮质的PI显著降低（P < 0.001）。此外，LS+与LS-比较显示左侧外侧、左侧内侧颞叶和左侧布洛卡皮质显著降低（P < 0.001）。与对照受试者相比，A+患者的PI无显著差异，而在A-患者中，左侧和右侧颞叶外侧皮质、左侧韦尼克区和左侧顶叶皮质的PI显著降低。此外，与A-患者相比，A+患者左侧颞叶外侧区域的PI显著降低。最后，在无萎缩的患者中，右侧和左侧颞叶外侧皮质以及左侧顶叶皮质的PI显著降低（P < 0.01）。
我们的研究表明，右利手PPA患者双侧颞叶皮质灌注减少。此外，在这些区域，形态学异常之前存在灌注异常。最后，我们的结果表明，LS疾病患者存在左侧颞叶功能障碍。
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